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Pharm > Sedatives.Anticonvulsants.Antidepressants > Flashcards

Sedatives.Anticonvulsants.Antidepressants Flashcards

1
Q

DOC for acute anxiety

A

benzodiazepines

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2
Q

DOC for GAD

A

benzodiazepines

buspirone

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3
Q

drugs used for panic disorder

A

SSRIs

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4
Q

drugs used for phobias

A

SSRIs

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5
Q

drugs used for OCD

A

SSRIs

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6
Q

drugs used for PTSD

A

antidepressants

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7
Q

drugs used for short term insomnia

A

sedative hypnotics

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8
Q

DOC for enuresis

A

TCA

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9
Q

major inhibitory neurotransmitter

A

GABA

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10
Q

what kind of channels associated with GABA receptors?

A

Cl-

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11
Q

hydroxyzine

A

antihistamine used as anti-anxiety med

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12
Q

drug that produces inhibition independent of GABA

A

barbituates

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13
Q

marked CNS depressant
causes euphoria
controlled drug

A

barbituate

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14
Q

drug used for induction of anesthesia

A

short-acting barbituate

thiopental

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15
Q

long-acting barbituates used for?

A

phenobarbital

anticonvulsants

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16
Q

kinetics of barbituates

A

induce CYP450s

liver metabolism

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17
Q

SEs of barbituates

A

CNS depression
paradoxical excitement
severe physio/psych dependence

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18
Q

CIs of barbituates

A

enhance porphyrin synthesis
pulmonary insufficiency
supra-additive effects (w/ other depressants)
pregnancy

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19
Q

withdrawal with barbituates?

A

yes

can be severe

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20
Q

toxicity of barbituates

A

low margin of safety with no ceiling effect

supra additive w/ other depressants

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21
Q

do we give stimulates with barbituate overdose?

A

no

increases mortality rate

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22
Q

how do we treat barbituate overdose?

A

diuresis and alkalization of the urine

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23
Q

benzos with no intermediate metabolites

A

lorazepam

oxazepam

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24
Q

metabolism of benzos

A

liver

CYP3A4

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25
Q

benzos with long duration

A

diazepam

flurazepam

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26
Q

benzos with intermediate duration of action

A

alprazolam

oxazepam/lorazepam

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27
Q

benzos with very short duration of action

A

midazolam

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28
Q

benzos: dependent or independent on GABA?

A

dependent

binds to receptors–increase affinity–prolonged action

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29
Q

benzos: ceiling effect?

A

yes

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30
Q

anxiety DOC

A

benzodiazepines

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31
Q

sedatives used for insomnia

A

flurazepam

temazepam

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32
Q

“hangover” effect

A

flurazepam

temazepam

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33
Q

sedatives/anxiolytics for status epilepticus

A

diazepam

lorazepam

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34
Q

what benzo can cause anterograde amnesia?

A

midazolam

used in prep for anesthesia

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35
Q

benzo used for mm relaxation

A

diazepam

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36
Q

what benzos are used to taper withdrawal?

A

chlordiazepoxide
diazepam
lorazepam

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37
Q

SE of benzos

A

CNS depression
paradoxical excitement
supra-additive
sleep related behaviors

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38
Q

disinhibition of suppressed behavior

A

benzos

especially in elderly

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39
Q

dependence with benzos?

A

yes but pts don’t usually increase dose

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40
Q

CIs for benzodiazepines

A

pregnancy
sleep apnea
elderly

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41
Q

withdrawal of benzos

A

abrupt discontinuation= rebound insomnia/anxiety= taper slowly

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42
Q

benzos ooverdose

A

generally safe= long deep sleep

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43
Q

benzodiazepine antagonist

A

flumazenil

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44
Q

reverses effects of benzos?

A

flumazenil

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45
Q

flumazenil SE

A

triggers withdrawal and seizures in patients who are physically dependent on benzos

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46
Q

CIs of flumazenil

A

hx of seizures

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47
Q

“Z”drugs

A

zolpidem
zaleplon
eszopiclone

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48
Q

effects of z drugs

A

sedative

no anxiolytic, convulsant, mm relaxant

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49
Q

MOA of Z drugs

A

bind to subtype of GABA receptor to increase GABA-medated inhibiton

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50
Q

use of z drugs?

A

insomnia

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51
Q

unique aspect of eszopiclone

A

long half-life=long-term treatment

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52
Q

what may increase half life of z drugs?

A

severe hepatic dz

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53
Q

SE of z drugs

A 
GI
CNS
sleep-related behaviors
rebound insomnia (after discontinuation)
withdrawal sxs
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54
Q

suvorexant MOA

A

antagonist at orexin receptors

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55
Q

SE of suvorexant

A

HA

abnormal dreams

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56
Q

CI in pts with narcolepsy

A

suvorexant

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57
Q

melatonin analogue

A

ramelteon

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58
Q

how does ramelteon work?

A

promotes sleepiness w/o GABA effect

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59
Q

kinetics of ramelteon

A

addative sedation with other depressants

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60
Q

SE of ramelteon

A

drowsiness
dizziness
nausea

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61
Q

MOA of chloral hydrate

A

acts similarly to barbituates on GABA receptor

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62
Q

safety of chloral hydrate

A

low margin: high doses induce respiratory and vasomotor depression

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63
Q

long term SE of chloral hydrate

A

liver damage

fatal intoxication

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64
Q

benefit of chloral hydrate

A

cheap but not used often

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65
Q

buspirone MOA

A

partial agonist postsynaptic
full agonist at presynaptic
decreased 5-HT cell signaling/release

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66
Q

how long does it take to see buspirone effects?

A

2 weeks

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67
Q

additive effects with buspirone?

A

no

no mm relaxant, sedative, anticonvulsant properties

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68
Q

anxiolytic with low addiction potential

A

buspirone

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69
Q

jerking x60 sec

no LOC

A

simple partial seizure

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70
Q

impairment of consciousness <2 min

automatic mvmt-lip smacking, hand wringing

A

complex partial

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71
Q

loss of consciousness

originated from partial seizure

A

partial with secondary generalized tonic-clonic

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72
Q

loss of consciousness

tonic rigidity followed by tremor followed by clonic violent jerking

A

tonic clonic

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73
Q

staring

generally <30 sec

A

absence seizure

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74
Q

brief shock-like muscle contraction

A

myoclonic seizure

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75
Q

absence seizures associated with what channels?

A

voltage gated Ca channels

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76
Q

anticonvulsants that increase GABA transmission

A

phenobarbital

benzos

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77
Q

anticonvulsants that inhibit sodium channels

A

phenytoin
carbamazepine
lamotrigine
valporate

78
Q

anticonvulsants that inhibit thalamic calcium channels

A

ethosuximide

valproic acid

79
Q

which anticonvulsants induce CYP450s?

A

phenytoin
carbamaxepine
phenobarbital

80
Q

phenytoin MOA

A

prolonging inactivation of Na channel

81
Q

why is fosphenytoin IM injection?

A

water soluble

82
Q

phenytoin elimination

A

first order at low levels then zero order at max capacity

83
Q

drug interactions with phenytoin

A

warfarin

OCP

84
Q

what increases metabolism of phenytoin?

A

carbamazapine

85
Q

SE of phenytoin

A

gingival hyperplasia
hirstuism
teratogenic

86
Q

DOC for partial seizures

A

carbamazepine

87
Q

carbamazepine MOA

A

inhibits sodium channels– decreases transmitter release

88
Q

other uses for carbamazepine

A

trigeminal neuralgia

bipolar d/o

89
Q

pharmacokinetics of carbamazepine

A

induces liver enzymes–drug interactions

induces its own metabolism

90
Q

drug interactions with carbamazapine

A

phenytoin
ethosuximide
valproic acid

91
Q

what drugs inhibit carbamazaepine metabolism?

A

cimetidine
fluoxetine
isoniazid
erythromycin

92
Q

SE of carabamazapine

A 
GI
double vision, ataxia
blood dyscrasias
teratogenic 
SJS
93
Q

test for SJS

94
Q

phenobarbital MOA

A

prolongs opening of GABAa receptor chloride channel

95
Q

phenobarbital anticonvulsant uses

A

partial and generalized tonic-clonic

96
Q

phenobarbital CI

97
Q

lamotrigine MOA

A

inactivates voltage dependent Na channels

98
Q

lamotrigine uses

A

partial seizures add on

absence seizures in children

99
Q

SE of lamotrigine

A

dizzy, HA
teratogenic
hypersensitiivity

100
Q

gabapentin MOA

A

GABA analogue

may increase GABA release

101
Q

gabapentin use

A

adjunct for partial and generalized tonic-clonic

neuropathic pain

102
Q

gabapentin SE

A 
dizzy, drowsy
ataxia, HA
tremor
weight gain
teratogenic
103
Q

pregabalin MOA

A

GABA analogue

binds to voltage-gated sodium channel-inhibt excitatory NT

104
Q

pregabalin uses

A 
anticonvulsant w/ sedative properties
neuropathic pain
fibromyalgia
post-op pain
pruritus
restless leg syndrome
105
Q

SE of pregabalin

A 
peripheral edema
dizzy
fatigue
weight gin
xerostomia
ataxia
blurred vision
GI
Cat C
106
Q

topiramate MOA

A

inhibits voltage-dependent Na channels– enhance GABA currents

107
Q

topiramate use

A

broad spectrum

inhibit spread of seizures

108
Q

SE of topiramate

A 
dizziness
sedaion
nervous
confusion
Cat C
decreased OCP
109
Q

levetiraceam MOA

A

reduces glutamate release while increasing GABA release

110
Q

levetiraceam use

A

partial, myoclonic, generalized tonic-clonic

111
Q

SE of levetiraceam

A

dizziness
somnolence
ataxia
asthenia

112
Q

tiagabine MOA

A

inhibits uptake of GABA

113
Q

tiagabine use

A

adjunct for partial sizures

114
Q

SE of tiagabine

A

nervousness
dizziness, tremor
Cat C

115
Q

vigabatrin MOA

A

irreverisble inhibitor of GABA rransaminase which breaks down GABA

116
Q

vigabatrin use

A

refrctory adult complex partial seizures

infantile spasm

117
Q

SE of vigabatrin

A

constriction of visual field, retinal damage
drowsy
dizzy
weight gain

118
Q

CI of vigabatrin

A

pre-existing mental illness

119
Q

DOC for absence seizures

A

ethosuximide

120
Q

ethosuximide MOA

A

reduces low threshold Ca2+ current in thalamus

121
Q

SE of ethosuximide

A

GI
SJS
Cat C

122
Q

valproic acid MOA

A

inhibits Na channels=increased GABA

123
Q

valproic acid use

A

absence seizures

124
Q

DOc for combo of absence and generalized tonic-clonic seizures

A

valproic acid

125
Q

other uses for valproic acid

A

bipolar

migrain prophylaxis

126
Q

SE of valproic acid

A

GI
hepatotoxicity
SJS
Cat D

127
Q

CI of valproic acid

128
Q

drug interactions of valproic acid

A

inhibits own metabolism at low doses

inhibits metabolism of phenytoin, carbamazepine

129
Q

clonazepam use

A

benzo

absence seizures

130
Q

clonazepam SE

A

sedation

tolerance to antiseizure effect

131
Q

drugs used for status epilepticus

A

diazepam

lorazepam

132
Q

DOC for status epilepticus

133
Q

monoamine hypothesis of depression

A

enhancement of monoamine neurotransmission

134
Q

neurotrophic hypothesis of depression

A

los of neutrophic agents contribute

BDNF

135
Q

neuroendocrine hypothesis of depresion

A

dysregulation of the HPA axis

increased glucocorticoid release and decrease in brain glucocorticoid receptor activity

136
Q

TCA MOA

A

inhibit uptake of Ne and 5HT

block muscarinic, alpha adrenergic and histamine receptors

137
Q

tertiary amine TCA OMA

A

inhibit 5HT and Ne reuptake

138
Q

secondary amine TCA MOA

A

more effect on NE reuptake

fewer CV effects, sedation

139
Q

drug interactions with TCAs

A

common

metabolized by CYPs in liver

140
Q

CNS SE of TCAs

A

drowsy, sedating
memory, cognition-anticholinergic effect
decreased seizure threshold

141
Q

peripheral SE of TCAs

A 
cardiac arrhythmias-TdP
postural hypotension
weight gain
anticholinergic effects
SIADH-hyponatremia
sexual dysfunction
142
Q

why is there postural hypotension with TCAs?

A

alpha1 blockade

143
Q

uses of TCA

A 
depression
panic d/o
chronic pain
fibromyalgia
enuresis
144
Q

what can we use for enuresis?

A

imipramine

145
Q

anticholinergic SE are more common with what TCAs?

146
Q

can TCAs be used in pregnancy?

147
Q

TCA overdose

A

very dangerous

TdP

148
Q

severe hypotension
agitation
neuromuscular excitability
seizuresq

A

TdP

TCA Od

149
Q

TCA drug interactions

A

serotonin syndrome w/ MOAI

fluoxetine (+other SSRIs) compete for metabolism=toxic levels

150
Q

issues with TCA and SSRI together

A

compete for metabolism=toxic levels of TCA

151
Q

TCA +sympathomimetic drugs

A

hypertension

152
Q

TCAs and CNS depressants

A

potentiate sedation

153
Q 
restlessness
mm twitching
hyperreflexia
sweating
proceeds to hyperpyrexia, convulsions
A

serotonin syndrome

154
Q

DOC for depression

A

SSRI–citalopram

155
Q

SSRIs that inhibit CYP2D6

A

*fluoxetine

paroxetine

156
Q

uses of SSRIs

A 
depression
panic d/o
OCD
social anxiety
bulimia
EtOHism
157
Q

preferred SSRI in elderly

A

sertraline

158
Q

issues with fluoxetine

A

inhibits CYP2D6

impairs BG in DM

159
Q

agoraphobia DOC

160
Q

OCD DOC

A

paroxetine

161
Q

social anxiety DOC

A

paroxetine

162
Q

SE of SSRIs

A

Gi
CNS stimulation
sexual dysfunction/libido
photosensitivity

163
Q

SSRIs with higher occurence of anxiety/insomnia

A

fluoxetine

sertaline

164
Q

SSRI that may cuase sedation

A

paroxetine

165
Q

drug interactions with SSRIs

A 
serotonin syndrome- MAOI, St. johns Wort
TCAs
Warfarin
phenytoin, carbamazapine
beta blockers
opioids
166
Q

venlafaxine MOA

A

5HT and NE reuptake inhibitors

167
Q

uses of venlafaxine

A

depression
neuropathic pain
post-menopausal hot flashes

168
Q

duloxetine MOA

A

5HT and NE reuptake inhibitors

169
Q

SE of duloxetine

A

hepatotoxicity

acute angle closure glaucoma

170
Q

MAO A

A

metabolizes NE, 5HT and DA in CNS AND GI tract

171
Q

MAO B

A

metabolizes DA in the CNS ONLY

172
Q

GI effects: MAOA or MAOB?

173
Q

phenelzine MOA

A

inhibits both MAOA and MAOB

174
Q

drug of last choice for depression

A

phenelzine

175
Q

selegiline MOA

A

irreversibly inhibits only MAOB

176
Q

use for selegiline

A

Parkinson’s

177
Q

how long do MAOI effects last?

A

1-3 weeks after d/c because long half life and irreversible inhibition

178
Q

SE of MAOI

A

HTN crisis
orthostatic hypotension
weight gain
anticholinergic effects

179
Q

HTN crisis with MAOI

A

inhibition in GI tract=accumulation of tyramine–> release catecholamines–> crisis

180
Q

how do we treat HTN crisis caused by MOAI?

A

alpha blocker

181
Q

MAOI drug interactions

A

sympathomimetic–HTN

mepiridine, dextromethorphan, TCA, SSRI=serotonin syndrome

182
Q

buproprion MOA

A

inhibits reuptake of DA

183
Q

Zyban

A

extended release buproprion used for smoking cessation

184
Q

SE of buproprion

185
Q

mirtazapine

A

blocks presynaptic alpha2 receptors= increased release of NE and 5HT

186
Q

mirtazapine SE

A

drowsiness-histamine blocker

187
Q

atomoxetine MOA

188
Q

non-stimulant treatment for ADHD

A

atomoxetine

189
Q

SE of atomoxetine

A

GI

insomnia

190
Q

trazadone MOA

A

5 HT2a receptor antagonist

191
Q

use of trazadone

A

often sleep aid or pain mgmt

Pharm (10 decks)

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