Psych Drugs

Question 1

Side effects of Benzodiazepines

Answer 1

Drowsiness, impaired intellect, reduced motor coordination, anterograde amnesia, withdrawal can be life threatening and cause seizures, respiratory depression in overdose, esp when combined with alcohol.

Question 2

Diazepam

Answer 2

AKA Valium. Long-acting benzodiazepine; half-life >20 hrs. Rapid onset, used during detoxification from alcohol or sedative-hypnotic anxiolytics and for seizures; less commonly prescribed to treat anxiety than previously.

Question 3

Clonazepam

Answer 3

AKA Klonopin. Long-acting benzodiazepine; half-life >20 hrs. Treatment of anxiety, including panic attacks; avoid with renal dysfunction, longer half-life allows for once daily dosing. This drug is effective in 90% of pts with REM sleep behavior disorder, and a lot of other sleep issues.

Question 4

Alprazolam

Answer 4

AKA Xanax. Intermidate-acting benzodiazepine; half-life 6-20 hrs. Used in treatment of anxiety, including panic attacks. Short onset of action –> euphoria, high abuse potential.

Question 5

Lorazepam

Answer 5

AKA Ativan. Intermiadate-acting benzodiazepine; half-life 6-20 hrs. Treatment of panic attacks, alcohol and sedative-hypnotic anxiolytic detoxification and agitation, not mettabolized by liver so good for treatment of alcoholics!

Question 6

Oxazepam

Answer 6

AKA Serax. Intermediate-acting benzodiazepine; half-life 6-20 hrs. Alcohol and sedative-hypnotic anxiolytic detoxification; not metabolized by the liver so good for treatment of alcoholics!

Question 7

Temazepam

Answer 7

AKA Restoril. Intermediate-acting benzodiazepine; half-life 6-20 hrs. Decreasingly used for treatment of insomnia due to dependence, not metabolized by the liver so good for treatment of alcoholics!

Question 8

Triazolam

Answer 8

AKA Halcion. Short-acting benzodiazepine. Half-life <6 hours. Treatment of insomnia, primarily used in medical and surgical settings

Question 9

Midazolam

Answer 9

AKA Versed. Short-acting benzodiazepine. Primarily used in medical and surgical settings

Question 10

Zolpidem

Answer 10

AKA Ambien. A non-benzodiazepine hypnotic. Works by selective receptor binding to benzodiazepine receptor 1, responsible for sedation, used for short-term insomnia treatment, less tolerance/dependence occurs with prolonged use (but still can occur), Zaleplon has a shorter half-life than zolpidem. Anterograde amnesia, hallucinations, sleepwalking, GI side effects may limit tolerability.

Question 11

Zaleplon

Answer 11

AKA Sonata. A non-benzodiazepine hypnotic. Works by selective receptor binding to benzodiazepine receptor 1, responsible for sedation, used for short-term insomnia treatment, less tolerance/dependence occurs with prolonged use (but still can occur), Zaleplon has a shorter half-life than zolpidem. Anterograde amnesia, hallucinations, sleepwalking, GI side effects may limit tolerability.

Question 12

Eszopiclone

Answer 12

AKA Lunesta. A non-benzodiazepine hypnotic. Works by selective receptor binding to benzodiazepine receptor 1, responsible for sedation, used for short-term insomnia treatment, less tolerance/dependence occurs with prolonged use (but still can occur), Zaleplon has a shorter half-life than zolpidem. Anterograde amnesia, hallucinations, sleepwalking, GI side effects may limit tolerability.

Question 13

Diphenhydramine

Answer 13

AKA Benedryl. A non-benzodiazepine hypnotic. An antihistamine; side effects include sedation, dry mouth, constipation, urinary retention, blurry vision.

Question 14

Chloral hydrate

Answer 14

AKA Noctec or Somnote. A non-benzodiazepine hypnotic. Not commonly prescribed due to tolerance and dependence; lethal in overdose, causing hepatic and liver failure.

Question 15

Ramelteon

Answer 15

AKA Rozerem. A non-benzodiazepine hypnotic. Selective melatonin MT1 and MT2 agonist; no tolerance or dependence.

Question 16

Buspirone

Answer 16

AKA Buspar. An anxiolytic. 5HT-1A receptor partial agonist. Slower onset of action than benzodiazepine - 1-2 weeks for effect. Not as effective as other options, so often used in combination. Does not potentiate CNS depression of alcohol so useful in alcoholics. Low potential for a

Question 17

Hydroxyzine

Answer 17

AKA Atarax. An anxiolytic. Antihistamine; side effects are sedation, dry mouth, constipation, urinary retention, blurry vision; useful for pts who want quick-acting short-term medication but who cannot take benzos.

Question 18

Barbiturates

Answer 18

Anxiolytics. Still used in general anesthesia, for epilepsy, and assisted suicide. Positive allosteric modulation of GABA-A receptor. Bind to the GABA-A receptor at the beta subunit. Rarely used because of lethality of overdose and side effect profile. Barbiturates produce effects similar to ethanol during intoxication.

Question 19

Propanolol

Answer 19

Beta blocker, useful in treating the autonomic effects of panic attacks or performance anxiety, such as palpitations, sweating, and tachycardia. It can also be used to treat akathisia (side effect of typical antipsychotics).

Question 20

Dextroamphetamine and amphetamines

Answer 20

AKA Dexadrine and Adderall. Stimulant. Dextroamphetamine is the D-isomer of amphetamine; Adderall is Schedule II, RX in triplicate and high potential for abuse; monitor BP and watch for wt loss, insomnia. Treats excessive daytime sleepiness in narcolepsy.

Question 21

Methylphenidate

Answer 21

AKA Ritalin, Concerta. CNS stimulant, similar to amphetamine, schedule II, Rx in triplicate and high potential for abuse; watch for leukopenia, anemia, increased LFTs - monitor labs - monitor BP and watch for wt loss, insomnia. Treats excessive daytime sleepiness in narcolepsy.

Question 22

Atomoxetine

Answer 22

AKA Strattera. Presynaptic norepinephrine transporter inhibitor; less appetite suppression and insomnia than psychostimulants; rare liver toxicity; possible increased SI in children/adolescents.

Question 23

Modafanil

Answer 23

AKA Provigil. Listed under psychostimulants. Used in Narcolepsy

Question 24

Donepezil

Answer 24

AKA Aricept – an acetylcholinesterase inhibitor. Once daily dosing, some GI effects, mild to moderate dementia

Question 25

Galantamine

Answer 25

AKA Reminyl – an acetylcholinesterase inhibitor.

Question 26

Rivastigmine

Answer 26

AKA Excelon – an acetylcholinesterase inhibitor. Has a patch, less side effects

Question 27

Tacrine

Answer 27

AKA Cognex – an acetylcholinesterase inhibitor

Question 28

Memantine

Answer 28

AKA Namenda – an acetylcholinesterase inhibitor. Moderate to severe dementia, better together with Acetylcholinesterase inhibitor.

Question 29

Benzodiazepines not metabolized by the liver

Answer 29

Lorazepam, Oxazepam, Temazepam (LOT)

Question 30

Flumazenil

Answer 30

Used to reverse the effects of benzodiazepine receptor agonists during benzodiazepine overdose.

Question 31

What effect do SSRIs have on warfarin?

Answer 31

They increase levels of warfarin! …. Like basically every other drug known to man…

Question 32

Butalbitol

Answer 32

A barbiturate

Question 33

Phenobarbitol

Answer 33

A barbituate

Question 34

Amobarbitol

Answer 34

A barbituate

Question 35

Pentobarbitol

Answer 35

A barbituate

Question 36

Benztropine

Answer 36

Anticholinergic. Trade name Cogentin. Can be used to treat anti-psychotic induced extrapyramidal symptoms, but not in the management of NMS. Cogentin which is used in the treatment of Parkinson’s disease, Parkinsonism, and dystonia. It improves tremor, but not rigidity and bradykinesia.

Question 37

Clonidine

Answer 37

Catapres, Kapvay, Nexicl. Alpha-2 agonist. First line treatment for tics associated with Tourette Syndrome. Also used to treat high blood pressure, ADHD, anxiety/panic disorder, and certain pain conditions

Question 38

Guanfacine

Answer 38

Tenex, Intuniv. Alpha-2A agonist. Treats Tourette’s syndrome.

Question 39

Dantrolene sodium

Answer 39

Dantrium. A direct muscle relaxant - therapy for neuroleptic malignant syndrome, which involves rhabdomyolysis. Useful in malignant hyperthermia. There is a risk of hepatotoxicity, and dantrolene should probably be avoided if liver function tests are very abnormal.

Question 40

Amantadine

Answer 40

Has dopaminergic and anticholinergic effects and is used as an alternative to bromocriptine in treating neuroleptic malignant syndrome

Question 41

Bromocriptine

Answer 41

A dopamine agonist, is prescribed to restore lost dopaminergic tone for neuroleptic malignant syndrome