Psychotherapeutics Flashcards
________ are a class of drugs that cause a dose-dependent depression of the Central Nervous System function, inducing sedation,
sleep, and unconsciousness with increasing dose.
Sedative-hypnotics
_______ depress the sensory cortex, decrease motor activity, alter cerebellar function, and produce drowsiness, sedation, and hypnosis.
Barbiturates
Sedatives and Hypnotics
Using to treat insomnia is NOT recommended for long-term use due to….
risk of dependence
Adverse Effects of what class?
(a) Dependence with long term use
(b) CNS: Somnolence
(c) Respiratory: Hypoventilation
(d) GI: Nausea
(e) CV: Bradycardia
(f) Other: Agitation, confusion, nightmares, lethargy, vomiting, diarrhea, and
hypotension
Sedatives and Hypnotics
What Class are these drugs in?
-barbiturates
-benzodiazepine
-melatonin agonists.
Sedatives and Hypnotics
What would you want to educate your patient about when giving Sedatives and Hypnotics?
Abuse potential
Antianxiety drugs can be subdivided into
_________
_________
Benzodiazepines
Non- Benzodiazepines
Which one is for short term use only?
Benzodiazepines
Non- Benzodiazepines
Benzodiazepines
________ may produce tolerance with long-term use and have potential for psychological or physical dependence. These agents have NO analgesic properties.
- Benzo diazepines
- Non-Benzodiazepines
Benzo diazepines
Benzodiazepines: Bind to specific benzodiazepine receptors in the GABA receptor complex, which enhances ___________
the binding of this inhibitory
neurotransmitter
_____ acts on brain’s dopamine and serotonin receptors
- Benzo
- Non-benzo
Non-Benzo
Long term use of benzodiazepines: Withdrawal syndrome after as little as ______ weeks of therapy. Never discontinue abruptly decrease over _____ weeks
4-6 weeks
Fatigue, metallic taste, HA, numbness in extremities, sweating, and dry mouth are symptoms of withdrawal from _____
- Benzos
- Non- Benzos
- Sedative Hypnotics
Benzos
Contraindication/Warning/Caution for what Drug class?
(a) Should not be used in comatose patients or in those with pre- existing CNS depression. Should not be used in patients with uncontrolled severe pain. Avoid use during pregnancy or lactation.
(b) Acute narrow-angle glaucoma
(c) Pregnancy class: D; Not recommended for use during pregnancy.
(d) Caution with impaired liver or kidney function.
(e) BuSpar and Zolpidem are Pregnancy Class: B
(f) Not to be taken with Alcohol, tricyclic antidepressants, and other antipsychotics.
Antianxiety Drugs
Benzo or Non-Benzo
1) Alprazolam: Xanax
2) Diazepam: Valium
3) Lorazepam: Ativan
Benzodiazepines
Benzo or Non-Benzo
1) Buspirone hydrochloride: Bu Spar
2) Hydroxyzine: Atarax
3) Sertraline (SSRI): May be used long term.
Non-benzos
Patient Management for what class of drug?
(a) Use caution in older patient due to slow excretion.
(b) Benzodiazepines are used primarily in acute situations.
(c) Patient should lie down at least 30 minutes after taking benzodiazepines.
(d) May be taken with or without food or meals.
Antianxiety Drugs
Use of this class of drug
-Sedation
-Seizures: Management of generalized tonic-clonic, status epilepticus and partial
Seizures.
Not recommended to treat insomnia
Sedative and Hypnotics
What Class of drug
Used in the management of various forms of anxiety,
including generalized anxiety disorder.
Antianxiety agents
These fall under what class?
(a) Tricyclic antidepressants (TCAs)
(b) Monoamine Oxidase Inhibitors (MAOI)
(c) Selective Serotonin Reuptake Inhibitors (SSRI)
(d) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
(e) Serotonin Reuptake inhibitor/Antagonist
Antidepressants
______ increase levels of norepinephrine and serotonin by inhibiting their reuptake and blocking the action of acetylcholine.
- SNRI
- SSRI
- MAOI
- TCA
TCA
_____ inhibits the activity of Monoamine oxidase resulting in increased endogenous neuro-hormones.
- SNRI
- SSRI
- MAOI
- TCA
MAOI
_______ increase serotonin by inhibiting neuronal uptake to CNS.
- SNRI
- SSRI
- MAOI
- TCA
SSRI
What Class of drug for these uses?
Depressive symptoms, Anxiety (class dependent), Obsessive Compulsion Disorder, Smoking cessation:
Anti Depressants
Adverse effects of what subclass?
blurred vision, Dry mouth, postural hypotension, urinary retention, constipation, and orthostatic hypotension
- SNRI
- SSRI
- MAOI
- TCA
TCA
Memory Aid: “Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone and the heart runs alone”.
Adverse effects of what subclass?
Food interactions, medication interactions, vertigo, nausea, constipation, dry mouth, headache, and over-activity.
- SNRI
- SSRI
- MAOI
- TCA
MAOI:
Adverse effects of what subclass?
Nausea, vomiting (transient), sexual dysfunction, insomnia, and weight gain.
- SNRI
- SSRI
- MAOI
- TCA
SSRI
Contraindication to what?
Hypersensitivity to TCAs or any component of the formulation; coadministration with or within 14 days of MAOIs; acute recovery phase following myocardial infarction.
- TCA
- MAOI
- Wellbutrin
- SSRI
TCA
Contraindication to what?
Current use of SSRI/SNRI/DNRI/Meperidine (can cause Serotonin Syndrome), diet high in red wine or smoked meats/cheeses,CVA disease, hypertension, CHF, and elderly. MANY MEDICATION INTERACTIONS
- TCA
- MAOI
- Wellbutrin
- SSRI
MAOI
Contraindication to what?
Contraindicated in patients with a seizure
disorder or a predisposition to seizures, as it reduces the seizure threshold.
- TCA
- MAOI
- Wellbutrin
- SSR
Wellbutrin
SSRI: ______ is less effective in patients who smoke
Fluoxetine
_______ used with MAOI may result in a fatal reaction (serotonin syndrome)
Sertraline
What is the first line medication for depression
SSRI
What Sub class of anti depressants?
1) Citalopram: Celexa
2) Fluoxetine: Prozac
3) Sertraline: Zoloft
4) Paroxetine: Paxil
SSRI
What Class
Block dopamine receptors in the brain; also alter dopamine release and turnover. Peripheral effects include anticholinergic properties and alpha-adrenergic blockade.
Antipsychotics
Should you use Antipsychotics for a patient that is severely depressed or hypotensive?
Contraindicated
What Adverse effect? Multiple choice
Mainly seen in Haloperidol (Haldol), hyperthermia, rare but may progress rapidly over 24-72 hours. Immediately stop medication, requires intensive symptomatic treatment.
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Extrapyramidal
- Anticholinergic
Neuroleptic malignant syndrome
What Adverse effect? Multiple choice
Dry mouth, hypotension, sedation, photophobia,
photosensitivity, and headache.
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Extrapyramidal
- Anticholinergic
Anticholinergic
What Adverse effect? Multiple choice
Irreversible, involuntary dyskinetic movements, rhythmic, movements of the tongue face mouth or jaw. Tongue may protrude.
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Extrapyramidal
- Anticholinergic
Tardive dyskinesia
Adverse Effects what class?
Parkinson like symptoms, Akathisia (extreme restlessness), and Dystonia (Facial grimacing and twisting of the neck)
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Extrapyramidal
- Anticholinergic
Extrapyramidal
1st Generation or 2nd Generation
(a) Haloperidol: Haldol
(b) Prochlorperazine: Compazine
1st Generation
1st Generation or 2nd Generation
(c) Quetiapine: Seroquel
(d) Olanzapine: Zyprexa
2nd Generation
This use is for what subclass of drugs?
The treatment of narcolepsy and as adjunctive treatment in the management of attention deficit hyperactivity disorder (ADHD).
Amphetamines and Anorexiants
What produces CNS stimulation by increasing levels of neurotransmitters in the CNS.
CNS Stimulants
Amphetamines and Anorexiants
Amphetamines and Anorexiants:
You would tell the patient to Take the drug in the morning _______ before breakfast and before lunch?
30-45 minutes
When taking Amphetamines the patient should decrease intake of _____
coffee or caffeine.
Phentermine: Ionamin
is an example of what type of CNS stimulant
Anorexiant
What type of drugs?
1) Methylphenidate HCL: Concerta
2) Dextroamphetamine: Adderall
Amphetamines
CNS Stimulants
Insomnia and anorexia usually disappear _________
during continued therapy
