Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology (Dale Turley) > Psychiatric Disorders Medications - SSRIs > Flashcards

Psychiatric Disorders Medications - SSRIs Flashcards

1
Q

Which Benzo is only available in injectable?

A

Midazolam

it is the only one that is water soluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SSRIs clinical uses?

A

Major depression

Depression in patients with concurrent illnesses, such as coronary artery disease, glaucoma, hypertension

Panic disorder

Used in the treatment of stroke patients, including those with and without symptoms of depression

chronic pain syndrome - more pain = more depressed etc..

stroke and limbic system = more sensitive - tend to use these for treatment of acute depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Benzodiazepines Prescribing considerations?

A

DEA schedule IV controlled substance

Beers Criteria in elderly

Addictive property

Not a primary therapy

Not effective comorbid depression

Lethal when used with alcohol or other CNS depressants

Impaired driving / cognitive skills 1mg alprazolam = BAC 0.15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSRI increase the extracellular level of the neurotransmitter _________ limiting its reabsorption into the ____________ cell, thus increasing the level of _________

A

serotonin

presynaptic

serotonin

**higher therapeutic concentration inside the cleft **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why are SSRIs better than other antidepressants?

A

Act more reliably, act more quickly, and have fewer side effects than other antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Benzodiazepines are useful in the management of _____ situational anxiety disorder and ___________ disorder

A

acute

adjustment

people that have panic attacks for lying or driving long distances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SNRIs: Agents with dual serotonin and norepinephrine re-uptake inhibition (SNRIs) are sometimes called ?

A

non-tricyclic serotonin and norepinephrine reuptake inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Benzodiazepines has ____________ of panic attacks

A

rapid control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nonbenzodiazepine Benzodiazepine Receptor Agonist?

A

Currently 3 on the market

Zolpidem (Ambien)

Zaleplon (Sonata)

Eszopicclone (Lunesta)

Sleep driving discussed in Neurology

sub cat for benzos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SSRI: Symptoms of serotonin syndrome?

A

Myoclonus (intermittent jerking or twitching)

Hyperreflexia (greater in upper limbs)

Increased heart rate
Shivering
Sweating
Dilated pupils / slow to react

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SNRIs most common adverse effects?

A

The most common include loss of appetite, weight, and sleep.

There may also be drowsiness, dizziness, fatigue, headache, increase in suicidal thoughts, nausea/vomiting, sexual dysfunction, and urinary retention.

because of nor-epi = watch for urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Benzodiazepines Prescribing considerations: Possible fetal abnormalities
?

A

Can affect chromosomes in both sperm and ovum

Can cause birth defects caused by use by mother or father during conception period with active metabolite longer half-life periods

**chromosome disorders prior to inception **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Benzodiazepines
 Pharmacokinetics: Liver?

A

Metabolized by liver and active metabolite can be higher in elderly and liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Venlafaxine is?

A

Effexor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NET ?

A

norepinephrine transporter (NET)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Midazolam is ___ used as anxiolytic, it is used more as a ________ (nasal) - does not suppress respiratory drive so it is good

A

NOT

sedative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Duloxetine is?

A

Cymbalta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Citalopram is?

A

Celexa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SNRIs sexual side-effects?

A

Two common sexual side-effects: diminished libido and difficulty reaching climax (anorgasmia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Benzodiazepines BBW?

A

watch for seizures with chronic use and withdrawal, prepare seizure management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Prozac HF?

A

4-6 days,

effects up to 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SSRIs have interactions with other psych meds, including?

A

MAOI’s

buspirone

diazapam

lithium

TCA’s

**SSRI’s do interact quite a bit with other medications **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What benzos are not metabolized by the liver so they are useful in liver disease?

A

Oxazepan (Serax)

lorazepam (Ativan)

temazepam (Restoril)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Desvenlafaxine is?

A

Pristiq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

lorazepam is?

A

Ativan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SNRIs: __________ and ___ monitor blood pressure

A

Hypertension

CAD

**watch if they have underlying CAD or cardiovascular problems **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

SSRI examples?

A

fluoxetine (Prozac)
more side effects than others

paroxetine (Paxil)

sertraline (Zoloft)

citalopram (Celexa)

escitalopram (Lexapro)

venlafaxine (Effexor) SNRI - bad one?

**everyone will have different reactions when they take them , a lot of people do not tolerate these very well, watch out for in kids and young adults it can enlarge the suicide ideology **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

SNRI aka?

A

Serotonin Norephinephrine reuptake inhibitors

serotonin–noradrenaline reuptake inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

________ poorly absorbed via IM injection

A

Diazepam

Oral better than injection

Popular PO anxiolytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Benzodiazepines adverse effects?

A

Orthostatic hypotension

Constipation, nausea, vomiting, diarrhea

CNS effects of ataxia, drowsiness, dizziness, slurred speech, confusion, somnolence

Respiratory depression

Retrograde amnesia (why midazolam used preoperatively) - Versed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

_________ is an efficient property in mediating antidepressant activity

A

Synergism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Benzos have active ?

A

metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Benzos have peak blood flow _ to _ hours

A

1-3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

SNRIs: Elevation of norepinephrine levels can sometimes cause ?

A

anxiety

mildly elevated pulse

elevated blood pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the date rape drug and is now banned in the US?

A

flunitrazepam (Rohypnol)

36
Q

SSRI adverse reactions?

A

Serotonin syndrome ( if they are not closely watched)

Aggitation, insomnia, headache, nervousness, sedation, tremor

Nausea / Vomiting

Anorgasmia in both men and women

Ejaculatory disturbances in men

37
Q

Paroxetine is?

A

Paxil

38
Q

The duration of pharmacotherapy of Benzo’s is anticipated to be ________ or less - because of its dependance effect

A

6 weeks

39
Q

Benzodiazepines class?

A

Anxiolytic Class

40
Q

Benzodiazepines contraindications?

A

trilazolam (Halcion) and aprazolam (Xanax) reacts with ketoconazole (hepatic)

Concern with history of depression / suicidal ideation

41
Q

SNRIs: Usually somewhat _____ with the SNRIs in comparison to the SSRIs.

A

milder

42
Q

____________________ have improved potency and onset action

A

Non-tricyclic antidepressants

**do not take 6 weeks for theraputic effect, this one is way shorter **

43
Q

Due to the active metabolites, Benzos can be placed into one of three groups based on its ?

A

HF

44
Q

Benzos active metabolites might causes daytime withdrawal sxs. such as?

A

next dayrebound anxiety with prolonged usage

** watch for rebound- if they are stopped abruptly they may have more anxiety and more of a panic attack **

45
Q

SSRI MOA?

A

Selectively inhibit 5-HT neuronal reuptake at selected nerve terminals in the CNS and inhibit cytochrome P-450

block reuptake into the pre synaptic cleft

46
Q

SSRIs have a weak or no effect on ______________ reuptake and ________

A

norepinephrine

dopamine

47
Q

Benzos HL?

A

Half-life varies among the 12 US available drugs

Review page 288 half-life chart

Some half-life as much as 100 hours

older people and people with liver disease they may not be able to metabolize it off, maybe alcoholism patients the meds will last a lot longer in

48
Q

Serotonin syndrome PE?

A

Mental changes include hypervigilance or insomnia and agitation

include metabolic acidosis, rhabdomyolysis- break down of muscle , seizures and renal failure

abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia (HHH)

temperature as high as 40°C (104°F)

Seen in OD and MDMA’s (Ecstasy)

49
Q

How long can it take for SSRIs to relieve depression?6

A

can take up to 6 weeks

** more than likely they have side effects and have to get off of it before the 6 weeks **

** this medicine has to be tapered off, high lack of compliance , once they are a therpautic levels they feel fine - if they want to stop to has to be slow and tapered **

50
Q

SNRI examples?

A

venlafaxine (Effexor)

duloxetine (Cymbalta)

desvenlafaxine (Pristiq)

51
Q

Benzodiazepines Prescribing considerations: Benzo overdose TX?

A

Flumazeril (Romazicon)

0.2 mg IV q min x 1 to 5 doses

  • *this is the antidote to benzos
  • *
52
Q

flunitrazepam is?

A

Rohypnol

53
Q

because of the ___________ availability of __________ at the receptors… it results in mood _________ and reduced _______

A

Increased availability of Serotonin at the receptors results in mood elevation and reduced anxiety

54
Q

What Benzo is water soluble ?

A

Midazolam

55
Q

Benzodiazepines
 Pharmacokinetics: Kidney?

A

excretion

56
Q

Active metabolites increase the effective _______?

A

half-life

57
Q

Benzos active metabolites have few residual effects if taken before ______, and rebound _________ may occur upon discontinuation

A

bedtime

insomnia

58
Q

Benzodiazepines clinical uses?

A

Adjuvant for anesthesia
fentanyl and versad?

Anxiety disorders

Anticonvulsant

Muscle relaxant for spasticity disorders

Treatment of alcohol addiction and drug withdrawal

Sedative-Hypnotic, Insomnia

59
Q

Sertraline is?

A

Zoloft

60
Q

Escitalopram is?

A

Lexapro

61
Q

Agents Used in the Treatment of Anxiety Disorder?

A

Benzodiazepines

62
Q

Benzodiazepines
 Pharmacokinetics: mostly _____ _______ and thus it is taken orally

A

lipid soluble

63
Q

SSRI HF?

A

Half-life 24 hours average

64
Q

SSRI Pharmacokinetics: Kidney?

A

excretion

65
Q

Xanax and Ativan crushed and snorted has no effect since they are __________.

A

not water soluble

66
Q

Midazolam is injectable but it can also be given?

A

intranasal

**Versed is the only water soluble and we give it nasally and it is rapidly absorbed in the nasal mucosa **

67
Q

Benzodiazepines
: Long-acting compounds have a half-life of ___

A

40–250 hours

**longer acting more for muscle spasms

68
Q

diazepam is?

A

Valium

69
Q

SERT ?

A

human serotonin transporter (SERT)

70
Q

Benzodiazepines adverse effects? cont

A

Rapid withdrawal may cause tremor, cramping, diaphoresis, seizures

Additive effect with other CNS depressants like opioids, alcohol or TCA’s

**if they are on high dosage and they abruptly stop it they can get tremors and seizures so listen to their history **

71
Q

Benzodiazepines MOA?

A

Depress all levels of the CNS by enhancing the action of gamma-butyric acid (GABA)

**
increase chloride flow throw the GABA protein and there is more concentration inside the membrane

shuts down stimulation to the brain and limbic areas that does cause the anxiety **

72
Q

Benzodiazepines
: Intermediate-acting compounds have a median half-life of ___.

A

12–40 hours

73
Q

What are SERT and NET?

A

membrane proteins that are responsible for the reuptake of serotonin and norepinephrine

74
Q

SSRI Pharmacokinetics: Liver?

A

Significant first pass metabolism by liver

75
Q

midazolam is?

A

Versed

76
Q

Venlafaxine is?

A

Effexor

77
Q

What are injectable Benzodiazepines
?

A

midazolam (Versed)

diazepam (Valium)

lorazepam (Ativan)

78
Q

_____ are more common the TCAs in the tx of MDD and anxiety disorders

A

SSRIs

**mainstream tx for depression - a lot safe, easier to dose, more common, less side effects **

79
Q

Benzodiazepines
 pharmacokinetics: Absorption?

A

Well absorbed orally

diazepam onset 30-60 min

Peak effects usually occur in 1 to 2 hours

Duration last 2 to 3 hours

Given IM midazolam and lorazepam onset 1 to 5 min

80
Q

Benzodiazepines
: Short-acting compounds have a median half-life of ___.

A

1–12 hours

81
Q

SNRIs ________ the concentration in the synaptic cleft of both _________ and __________ are more successful than single acting agents in the treatment of depression

A

increase

norepinephrine

serotonin

combination of both seem to be better than just the SSRI

82
Q

Benzos MOA: ___________ ______ comes from increased action of ____, thereby decreases the effect of any neuronal excitation

A

Anxiolytic effect

GABA

**Primal emotions fear and anxiety frontal cortex Amygdala = excitation

Passion flower reuptake inhibitor**

83
Q

What is the single most commonly prescribed psychotropic drug for anxiety

A

Benzodiazepines

84
Q

Depression Drugs?

A

SSRIs

SNRIs

85
Q

SSRI black box warning?

A

Increased suicide risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders

**while they are on it they can get these and if you abruptly stop it it can cause these exacerbations **

Pharmacology (Dale Turley) (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions