Pharmocology Flashcards
what neurotransmitter does Anti anxiety medications work on?
Gamma aminobutyric acid (GABA
what is a benzodiazepine?
anxiolytic
what is the action of benzodiazepines?
promote activity of GABA by binding to GABA receptor complexes, therefore increases GABA
examples of Benzodiazepines?
diazepam (valium)
Lorazepam (Ativan)
what can Benzodiazepines do for alcohol withdrawl?
they calm over excited neurons
what can you not have with benzos
Alcohol or other CNS depressants
opiates
TCAs
side effects of Benzos
- decrease in judgement, attention and motor activity (dont drive with them)
- Ataxia
- sedation
- Potential dependence (use only for short term)
what part of the brain do Benzos work on?
Cerebellum
when do you use Benzos?
- acute mania
- helps with psychomotor agitation in mania
- anxiety
what is the alternative drug to Benzos?
Bustab (buspirone hydrochloride)
what is the action of Bustab?
maybe increases serotonin and decreases dopamine 2
what are the types of antidepressants?
- TCAs
- SSRIs
- SNRIs
- SNDIs
- MAOIs
what is the therapeutic response of antidepressants?
2-4 weeks
what is the action of Tricyclic antidepressants
act by blocking reuptake of norepinephrine and serotonin, and may block muscarinic receptors (acetylcholine)
Adverse affects of TCAs
- Anticholinergic effects
- esophogeal reflux
- weight gain
- Orthostatic hypertension
- may increase serum bilirubin
- sedation (histamine blockage)
how do anticholinergic effects present
- blurred vision
- dry eyes
- dry mouth
- urinary retention
- constipation
- tachycardia
- weight gain
what herbal drug can you not take with TCAs?
st johns wart
if toxic from TCAs what do you give?
Charcoal
what are the toxic effects of TCAs?
- dyrhythmias
- tachycardia
- myocardial infarction
- heart block
what is the drug name under TCAs
- amitriptyline (Elavil)
what is the first line drug for depression?
SSRIs
what are examples of SSRIs?
- fluoxetine hydrochloride (Prozac)
- citalopram hydrobromide (celexa)
- Zoloft
- Paxil
what is the action of SSRIs?
- inhibit the re-uptake of serotonin, better than TCAs because they dont have anticholinergic effects
when are SSRIs used?
Depression with anxiety Depression with psychomotor agitation OCD Panic Bulimia
what are adverse effects of SSRIs
- aggitation, irritability
- insomnia
- tension head ache
- nausea and vomiting
- sexual dysfunction
- hyponatremia
what tests should you perform with SSRIS
check renal and liver function tests and blood counts
what is the toxic effect of SSRIs?
SEROTONIN SYNDROME
- too much serotonin in CNS, from OD or from mixing with other antidepressants or MAOIs**
- normal range of serotonin is 101-283 mg/L
what are symptoms of serotonin syndrome?
- ab pain
- diarrhea
- sweating and fever
- tachycardia and increased BP
- altered mental status (delirium)
- myoclonus (muscle spasms)
- Increased motor activity
- irritability, hostility and mood changes
- extreme = death
what are the nursing interventions for Serotonin Syndrome?
- stop drug for 2-5 weeks
- give serotonin- receptor blockers with propranolol
- cooling blankets
- chlorpromazine for hyperthermia
- anticonvulsants and diazepam for muscle rigidity
- artificial ventilation
what is the action of serotonin norepinephrine re uptake inhibitors (SNRIs) ?
increases serotonin and norepinephrine
can aid in neuropathic pain like in diabetes
types of SNRIs?
Effexor XR- venlafaxine
example of serotonin and norepinephrine disinhibitors (SNDIs)
mirtazapin (remeron)
action of SNDIs
increases NE, dopamine, and serotonin
action of Monoamine Oxidase Inhibitors (MAOIs)
blocks monoamine oxidase which normal causes the reuptake of serotonin, NE, dopamine and tyramine
adverse effects of MAOIs
increase tyramine… which leads to hypertensive crisis and eventually cardiovascular accident
so dont eat foods with tyramine in them when taking this drug
what foods have tyramine in them?
- avocados
- chocolate
- red wine
- dairy
- bananas
- cheese
- some meats
- some beers
when can you give MAOIs?
- atypical depression
- panic disorders
- social phobias
- generalized anxiety disorder
- OCD
- PTSD
- bulimia
Adverse drug reactions of MAOIs
Orthostatic hypotension weight gain edema change in cardiac rate and rhythm insomnia weakness and fatigue constipation urinary hesitancy sexual dysfunction overactivity and muscle twitch hypo/er manic behaviours
Toxic effects of MAOIs?
- increase BP
- hypertensive crisis**
- intracranial hemorrhage
- convulsions
- coma
- death
check BP for first 6 weeks
what can you give for hypertensive crisis?
calcium channel blockers
