Psych pharm Flashcards
(98 cards)
Lorazepam
Clonazepam - *most common treatment of REM behavior disorder
Oxazepam
Diazepam
Acute Anxiety Benzos
• GABAergic in that they potentiate the actions of the inhibitory neurotransmitter GABA • Bind to GABAA receptors in CNS neuronal synapses, thereby facilitating GABA-mediated Cl- ion channel opening and enhancing membrane hyperpolarization.
• Anxiolytic doses result in CNS depression that is manifested by a calming effect with concomitant reduction of anxiety.• 1st-line agents for rapid relief of acute anxiety states in generalized anxiety disorder (GAD) or panic disorder.• Should be used for short periods, no longer than 2-4 weeks.
Midazolam
acute anxiolytic benzo
• Midazolam is labeled for sedation prior to medical or surgical procedures.
Benzo: refer to other slides
Adverse effects of Benzos
- Risk of dependence (schedule IV controlled substances).• Taper slowly (over weeks) to avoid precipitation of withdrawal symptoms.• Additive effects with ethanol, anticholinergics, and antihistamines.
- abrupt cessation can lead to withdrawal states
ManifestationsofCNS
-depressant effects: Drowsiness - Impaired judgement - Diminished motor skills - Anterograde amnesia - Lethargy - Confusional states in the elderly (slower metabolism)
Clorazepate
Benzo acute anxiolytic
- GABAergic in that they potentiate the actions of the inhibitory neurotransmitter GABA • Bind to GABAA receptors in CNS neuronal synapses, thereby facilitating GABA-mediated Cl- ion channel opening and enhancing membrane hyperpolarization.
- Anxiolytic doses result in CNS depression that is manifested by a calming effect with concomitant reduction of anxiety.• 1st-line agents for rapid relief of acute anxiety states in generalized anxiety disorder (GAD) or panic disorder.• Should be used for short periods, no longer than 2-4 weeks.
Alprazolam
aka Xanax - acute anxiety benzo
- GABAergic in that they potentiate the actions of the inhibitory neurotransmitter GABA • Bind to GABAA receptors in CNS neuronal synapses, thereby facilitating GABA-mediated Cl- ion channel opening and enhancing membrane hyperpolarization.
- Anxiolytic doses result in CNS depression that is manifested by a calming effect with concomitant reduction of anxiety.• 1st-line agents for rapid relief of acute anxiety states in generalized anxiety disorder (GAD) or panic disorder.• Should be used for short periods, no longer than 2-4 weeks.
Escitalopram
Seriously Escaping From Very Dull Pakistan
Lexapro
SSRI
Clinical uses: major depression, anxiety disorder, OCD, PTSD, PMDD, bulimia
Mechanism of action for anti-anxiety is unclear.• Implicated in the modulation of receptor activation of neuronal signal transduction pathways connected to serotonin, dopamine, and norepinephrine.• Theorized to activate stress-adapting pathways.
- Reduce somatic anxiety symptoms and the general distress associated with those symptoms.
- 1st-line agents for the chronic management of GAD, particularly with comorbid depression.• Anti-anxiety response requires 2 to 4 weeks or longer.• Assessment of initial response should be after 4 to 6 weeks of therapy at adequate doses.
Adverse effects of SSRIs and SNRIs
First Aid:
SNRI: increase BP, stimulant effects, sedation, nausea
SSRI: fewer than TCA’s. GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido)
Most common adverse effects include: Diarrhea Nausea and vomiting Sexual dysfunction Insomnia Weight gain Headache Diaphoresis
seizures with gross overdose
Thediaphoresis are often transient, whereas weight gain and sexual dysfunction may continue in long-term treatment.• Discontinuation rates secondary to side effects tend to be higher with the SNRIs than the SSRIs.
Paroxetine
SSRI
Clinical uses: major depression, anxiety disorder, OCD, PTSD, PMDD, bulimia
*potent inhibitor of CYP2D6
Mechanism of action for anti-anxiety is unclear.• Implicated in the modulation of receptor activation of neuronal signal transduction pathways connected to serotonin, dopamine, and norepinephrine.• Theorized to activate stress-adapting pathways.
- Reduce somatic anxiety symptoms and the general distress associated with those symptoms.
- 1st-line agents for the chronic management of GAD, particularly with comorbid depression.• Anti-anxiety response requires 2 to 4 weeks or longer.• Assessment of initial response should be after 4 to 6 weeks of therapy at adequate doses.
Sertraline
aka Zoloft
SSRI
Clinical uses: major depression, anxiety disorder, OCD, PTSD, PMDD, bulimia
Mechanism of action for anti-anxiety is unclear.• Implicated in the modulation of receptor activation of neuronal signal transduction pathways connected to serotonin, dopamine, and norepinephrine.• Theorized to activate stress-adapting pathways.
- Reduce somatic anxiety symptoms and the general distress associated with those symptoms.
- 1st-line agents for the chronic management of GAD, particularly with comorbid depression.• Anti-anxiety response requires 2 to 4 weeks or longer.• Assessment of initial response should be after 4 to 6 weeks of therapy at adequate doses.
Duloxetine
aka Cymbalta
SNRI Uses: major depression chronic pain fibromyalgia menopausal symptoms
Mechanism of action for anti-anxiety is unclear.• Implicated in the modulation of receptor activation of neuronal signal transduction pathways connected to serotonin, dopamine, and norepinephrine.• Theorized to activate stress-adapting pathways.
- Reduce somatic anxiety symptoms and the general distress associated with those symptoms.
- 1st-line agents for the chronic management of GAD, particularly with comorbid depression.• Anti-anxiety response requires 2 to 4 weeks or longer.• Assessment of initial response should be after 4 to 6 weeks of therapy at adequate doses.
Venlafaxine XR
SNRI
*metabolized extensively via CYP2D6 - so inhibitors or inducers need to be considered
major depression
chronic pain
fibromyalgia
menopausal symptoms
Mechanism of action for anti-anxiety is unclear.• Implicated in the modulation of receptor activation of neuronal signal transduction pathways connected to serotonin, dopamine, and norepinephrine.• Theorized to activate stress-adapting pathways.
- Reduce somatic anxiety symptoms and the general distress associated with those symptoms.
- 1st-line agents for the chronic management of GAD, particularly with comorbid depression.• Anti-anxiety response requires 2 to 4 weeks or longer.• Assessment of initial response should be after 4 to 6 weeks of therapy at adequate doses.
Buspirone
First AID: GAD, does not cause sedation, addiction or tolerance. Does not interact with alcohol as opposed to barbituates and benzodiazepines.
It does not interact with GABAergic systems.• Mechanism uncertain. Partial agonist at 5- HT1A receptors Also has affinity for dopamine D2receptors.
Selective anxiolytic without causing marked sedative, hypnotic, or euphoric effects.
2nd-line agent for the chronic management of GAD.• Classified as 2nd-line due to inconsistent reports of long-term efficacy and lack of suitability for comorbid disorders (e.g., panic disorder or depression).• Anxiolytic effects take 2 weeks or longer to become established.
Adverse effects Buspirone
Most common adverse effects are typically transient, and include:
Nausea
Abdominal pain
Drowsiness
Dizziness
• Interacts with inducers and inhibitors of CYP3A4 as well as monoamine oxidase (MAO) inhibitors.
Pregabalin
aka Lyrica
GABAergic agent that does not interact with the GABAA receptor.• Thought to potentiate GABA activity in two ways:1. Increasing presynaptic GABA release by binding to the alpha2delta subunit of voltage- gated calcium channels and altering calcium influx.2. Increasing GABA biosynthesis by modulating the actions glutamate decarboxylase and branched chain aminotransferase.
Produces anxiolytic effects similar to the benzodiazepines and antidepressants.
2nd-line agent for the chronic management of GAD.• Not currently approved as a 1st-line agent for GAD in the US, due to a lack of sufficient clinical experience.
Adverse effects Pregabalin
Most common adverse effects include: -Dizziness -Somnolence - Incoordination - Dry mouth -Blurred vision - Weight gain • More idiosyncratic adverse effects include: Peripheral edema Thrombocytopenia• Lower risk of dependence than the benzodiazepines (schedule V controlled substance) but you can still get withdrawal symptoms with abrupt discontinuation
Imipramine
TCA (acts like an SNRI) Uses: major depression, chronic pain, OCD
inhibit NE and 5 HT reuptake, more selective for 5HT!
Produces anxiolytic effects similar to the newer antidepressants.
2nd-line agent for the chronic management of GAD.• Classified as 2nd-line due to higher toxicity and adverse effect rates than the newer antidepressants.
Adverse effects imipramine
Adverse effects are related to blockade of histamine, muscarinic/cholinergic, and alpha -adrenergic receptors.
• Antihistamine effects include:
Sedation Somnolence
• Anticholinergic (muscarinic block) effectsinclude: Dry mouth, Constipation, Blurred/double vision, Tachycardia
• Antiadrenergic effects include: Orthostatic hypotension
• Risk of serious toxicity (including seizures, tachycardia, and cardiac arrest) with high doses.
First AID: TriC’s: Convulsions, Coma, Cardiotoxicity (arrhytmia)
Hydroxyzine
potent H1 antihistamine that also acts as a strong antagonist at 5-HT2a receptors.• Antiserotonergic activity is thought to underlie its anxiolytic properties.
Produces anxiolytic effects similar to buspirone and the benzodiazepines.
Alternative agent for the treatment of GAD.• Although commonly used in the primary care setting, it is considered an alternative agent due to adverse effects and lack of efficacy for comorbid disorders.• Used as a sedative prior to dental procedures.
Adverse effects Hydroxyzine
Adverse effects are related to blockade of histamine, muscarinic/cholinergic, and dopamine receptors.
• Antihistamine effects include:
Sedation Somnolence
- Anticholinergic effectsinclude: Dry mouth Constipation Blurred/double vision
- Antidopaminergic effects include: Extrapyramidal symptoms (dyskinesias and tremors)
- Overdose can result in hallucinations and cardiac effects (QT prolongation and Torsades des Pointes).
Quetiapine XR
Atypical antipsychotic
Antagonist activity at 5-HT2a receptors is thought to underlie its anxiolytic properties.
• Produces anxiolytic effects similar to the newer antidepressants, but with an earlier onset of action.• Alternative agent for the treatment of GAD.• It is considered an alternative agent due to adverse effects and insufficient clinical experience with regard to long-term risks and benefits.
Quetiapine XR adverse effects
Adverse effects are related to blockade of alpha-adrenergic, muscarinic/cholinergic, and dopamine receptors.
• Antiadrenergic effects include: Orthostatic hypotension
- Anticholinergic effectsinclude: Dry mouth Constipation Tachycardia
- Antidopaminergic effects include: Extrapyramidal symptoms (tardive dyskinesia and akathisia)
Estazolam
Sleep Benzo
Decrease sleep latency (time to fall asleep) and the number of awakenings.• Increase total sleep time.
Sleep disorders characterized by difficulty in falling asleep.• Hypnotic doses are higher than those used for anxiolytic applications.• Should be used at the lowest possible dose for the shortest possible time period.• Typically maintain hypnotic efficacy for 1 month, but tolerance can develop with time.
Flurazepam
Sleep Benzo
Decrease sleep latency (time to fall asleep) and the number of awakenings.• Increase total sleep time.
Sleep disorders characterized by difficulty in falling asleep.• Hypnotic doses are higher than those used for anxiolytic applications.• Should be used at the lowest possible dose for the shortest possible time period.• Typically maintain hypnotic efficacy for 1 month, but tolerance can develop with time.
Quazepam
Sleep Benzo
Decrease sleep latency (time to fall asleep) and the number of awakenings.• Increase total sleep time.
Sleep disorders characterized by difficulty in falling asleep.• Hypnotic doses are higher than those used for anxiolytic applications.• Should be used at the lowest possible dose for the shortest possible time period.• Typically maintain hypnotic efficacy for 1 month, but tolerance can develop with time.
