Week 6 Mental health part 3

Question 1

Alprazolam

Answer 1

Xanax

ODT ( Panic disorder
Acute episodes of anxiety), ER

SHORT DURATION OF ACTION

Central Nervous System

Anti-anxiety (Anxiolytic)

Benzodiazepine

Anxiety/Panic disorder; seizures; insomnia (due to anxiety or stress)

drowsiness/sedation/somnolence; memory impairment; respiratory depression; physical/psychological dependence; dizziness/coordination problems; hypotension

additive CNS and Respiratory Depression (Alchohol, Barbiturates, Opioids); ethinyl estradiol and estroen-based contraceptives

Boxed Warning: Use with Opioids;
Precautions: tolerance/dependence/misuse possible; withdrawal and abrupt discontinuation; debilitated/elderly patients; respiratory disease; caution in patients with history of drug abuse; anterograde amnesia

• Clinical Pearls
o Duration of Use:
 For sleep and anxiety
 Recommended to use medications for SHORT term treatment
• 2-4 weeks
• Ideal to use lowest dose possible
o Frequently abused due to habit forming effect
 Physically and psychologically addictive
o Pregnancy category D or X
 Evidence of fetal harm
 D benefits may still outweigh the risks, X risks definitively outweigh the benefits

• Patient Education/Counseling
o Should be limited to 2-4 weeks of therapy
 Warning: May be habit forming

o Avoid activities that need mental alertness
 Driving; Operating machinery
o Do not suddenly stop medication if have been taking regularly without consulting physician
o Avoid alcohol and other CNS depressants

• Withdrawal
o Any abrupt or overly rapid reduction in benzodiazepine dose can produce withdrawal in chronic use
o May appear as early as 24 to 48 hours
o Symptoms may be delayed up to three weeks
o Dose should be tapered down slowly

Question 2

Clonazepam

Answer 2

Klonopin

ODT ( Panic disorder
Acute episodes of anxiety)
, ER

LONG DURATION OF ACTION

Central Nervous System

Anti-anxiety (Anxiolytic)

Benzodiazepine

Anxiety/Panic disorder; seizures; insomnia (due to anxiety or stress)

drowsiness/sedation/somnolence; memory impairment; respiratory depression; physical/psychological dependence; dizziness/coordination problems; hypotension

Additive CNS and Respiratory Depression (Alchohol, Barbiturates, Opioids); ethinyl estradiol and estroen-based contraceptives

Boxed Warning: Use with Opioids; Precautions: tolerance/dependence/misuse possible; withdrawal and abrupt discontinuation; debilitated/elderly patients; respiratory disease; caution in patients with history of drug abuse; anterograde amnesia

• Clinical Pearls
o Duration of Use:
 For sleep and anxiety
 Recommended to use medications for SHORT term treatment
• 2-4 weeks
• Ideal to use lowest dose possible
o Frequently abused due to habit forming effect
 Physically and psychologically addictive
o Pregnancy category D or X
 Evidence of fetal harm
 D benefits may still outweigh the risks, X risks definitively outweigh the benefits

• Patient Education/Counseling
o Should be limited to 2-4 weeks of therapy
 Warning: May be habit forming

o Avoid activities that need mental alertness
 Driving; Operating machinery
o Do not suddenly stop medication if have been taking regularly without consulting physician
o Avoid alcohol and other CNS depressants

• Withdrawal
o Any abrupt or overly rapid reduction in benzodiazepine dose can produce withdrawal in chronic use
o May appear as early as 24 to 48 hours
o Symptoms may be delayed up to three weeks
o Dose should be tapered down slowly

Question 3

Diazepam

Answer 3

Valium

Diastat AcuDial (Rectal Gel)- USE FOR SEIZURE

LONG DURATION OF ACTION

PO, IM, Rectal

Central Nervous System

Anti-anxeity (Anxiolytic)

Benzodiazepine

Anxiety/Panic disorder; seizures; insomnia (due to anxiety or stress); alcohol withdrawal syndrome/delirium

drowsiness/sedation/somnolence; memory impairment; respiratory depression; physical/psychological dependence; dizziness/coordination problems; hypotension

Additive CNS and Respiratory Depression (Alchohol, Barbiturates, Opioids); ethinyl estradiol and estroen-based contraceptives

Boxed Warning: Use with Opioids; Precautions: tolerance/dependence/misuse possible; withdrawal and abrupt discontinuation; debilitated/elderly patients; respiratory disease; caution in patients with history of drug abuse; anterograde amnesia

• Clinical Pearls
o Duration of Use:
 For sleep and anxiety
 Recommended to use medications for SHORT term treatment
• 2-4 weeks
• Ideal to use lowest dose possible
o Frequently abused due to habit forming effect
 Physically and psychologically addictive
o Pregnancy category D or X
 Evidence of fetal harm
 D benefits may still outweigh the risks, X risks definitively outweigh the benefits

• Patient Education/Counseling
o Should be limited to 2-4 weeks of therapy
 Warning: May be habit forming

o Avoid activities that need mental alertness
 Driving; Operating machinery
o Do not suddenly stop medication if have been taking regularly without consulting physician
o Avoid alcohol and other CNS depressants

• Withdrawal
o Any abrupt or overly rapid reduction in benzodiazepine dose can produce withdrawal in chronic use
o May appear as early as 24 to 48 hours
o Symptoms may be delayed up to three weeks
o Dose should be tapered down slowly

Question 4

Eszopiclone

Answer 4

Lunesta

Schedule: C4

PO

Central Nervous System

Sedative

Nonbenzodiazepine Receptor Agonist (NBRA)

Insomnia

Drowsiness/Sedation/Confusion/Somnolence; Dizziness; Headache; Abnormal Thinkin/Behaviors/Dreams; Complex behavior (“sleep driving”); taste disturbances

CNS depressants (Benzodiazepines, Opioids) – respiratory depression risk

Precautions: Risk Vs. Benefit; Abnormal Thinking and Behavior Changes; Sleep-Related Activities; Depression; Pulmonary disease or Sleep Apnea; Elderly; CI-Pregnancy-May increase the risk of fetal malformations if used in first trimester

• Patient Counseling
o Sleep hygiene is the preferred first-line treatment
 Not for long-term use, ideal is 7-10 days
• Warning: May be habit forming
 “Reset”

o Be prepared for bed prior to taking medication to avoid “behaviors”
 Sleep: walking, eating, driving, phone calls, sexual activity
o Be able to devote 7-8 hours to sleep
o Possible next day impairment
 Try to start medication when this won’t cause a work-related issue)
 Avoid activities that need mental alertness (i.e. driving; operating machinery)
o Withdrawal effects possible: fatigue, nausea, flushing, crying, vomiting, stomach pain, nervousness
o Do not suddenly stop medication if have been taking regularly

Question 5

Lorazepam

Answer 5

Ativan

PO, IM

SHORT DURATION OF ACTION

Central Nervous System

Anti-anxeity (Anxiolytic)

Benzodiazepine

Anxiety/Panic disorder; seizures; insomnia (due to anxiety or stress)

Drowsiness/sedation/somnolence; memory impairment; respiratory depression; physical/psychological dependence; dizziness/coordination problems; hypotension

Additive CNS and Respiratory Depression (Alchohol, Barbiturates, Opioids); ethinyl estradiol and estroen-based contraceptives

Boxed Warning: Use with Opioids; Precautions: tolerance/dependence/misuse possible; withdrawal and abrupt discontinuation; debilitated/elderly patients; respiratory disease; caution in patients with history of drug abuse; anterograde amnesia

• Clinical Pearls
o Duration of Use:
 For sleep and anxiety
 Recommended to use medications for SHORT term treatment
• 2-4 weeks
• Ideal to use lowest dose possible
o Frequently abused due to habit forming effect
 Physically and psychologically addictive
o Pregnancy category D or X
 Evidence of fetal harm
 D benefits may still outweigh the risks, X risks definitively outweigh the benefits

• Patient Education/Counseling
o Should be limited to 2-4 weeks of therapy
 Warning: May be habit forming

o Avoid activities that need mental alertness
 Driving; Operating machinery
o Do not suddenly stop medication if have been taking regularly without consulting physician
o Avoid alcohol and other CNS depressants

• Withdrawal
o Any abrupt or overly rapid reduction in benzodiazepine dose can produce withdrawal in chronic use
o May appear as early as 24 to 48 hours
o Symptoms may be delayed up to three weeks
o Dose should be tapered down slowly

Question 6

Temazepam

Answer 6

Restoril

Central Nervous System

LONG DURATION OF ACTION

Anti-anxiety (Anxiolytic)

Benzodiazepine

Anxiety/Panic disorder; seizures; insomnia (due to anxiety or stress)

Drowsiness/sedation/somnolence; memory impairment; respiratory depression; physical/psychological dependence; dizziness/coordination problems; hypotension

Additive CNS and Respiratory Depression (Alchohol, Barbiturates, Opioids); ethinyl estradiol and estroen-based contraceptives

Boxed Warning: Use with Opioids; Precautions: tolerance/dependence/misuse possible; withdrawal and abrupt discontinuation; debilitated/elderly patients; respiratory disease; caution in patients with history of drug abuse; anterograde amnesia

• Clinical Pearls
o Duration of Use:
 For sleep and anxiety
 Recommended to use medications for SHORT term treatment
• 2-4 weeks
• Ideal to use lowest dose possible
o Frequently abused due to habit forming effect
 Physically and psychologically addictive
o Pregnancy category D or X
 Evidence of fetal harm
 D benefits may still outweigh the risks, X risks definitively outweigh the benefits

• Patient Education/Counseling
o Should be limited to 2-4 weeks of therapy
 Warning: May be habit forming

o Avoid activities that need mental alertness
 Driving; Operating machinery
o Do not suddenly stop medication if have been taking regularly without consulting physician
o Avoid alcohol and other CNS depressants

• Withdrawal
o Any abrupt or overly rapid reduction in benzodiazepine dose can produce withdrawal in chronic use
o May appear as early as 24 to 48 hours
o Symptoms may be delayed up to three weeks
o Dose should be tapered down slowly

Question 7

Zolpidem

Answer 7

Ambien

Ambien CR; Intermezzo (SL–FYI)

Schedule: C4

Central Nervous System

Sedative

Nonbenzodiazepine Receptor Agonist (NBRA)

Insomnia

Drowsiness/Sedation/Confusion/Somnolence; Dizziness; Headache; Abnormal Thinkin/Behaviors/Dreams; Complex behavior (“sleep driving”)

CNS depressants (Benzodiazepines, Opioids) – respiratory depression risk; bupropion/sertraline/venlafaxine – increased risk of hallucination

Precautions: Risk Vs. Benefit; Abnormal Thinking and Behavior Changes; Sleep-Related Activities; Depression; Pulmonary disease or Sleep Apnea; Elderly; CI-Pregnancy-May increase the risk of fetal malformations if used in first trimester

• Patient Counseling
o Sleep hygiene is the preferred first-line treatment
 Not for long-term use, ideal is 7-10 days
• Warning: May be habit forming
 “Reset”

o Be prepared for bed prior to taking medication to avoid “behaviors”
 Sleep: walking, eating, driving, phone calls, sexual activity
o Be able to devote 7-8 hours to sleep
o Possible next day impairment
 Try to start medication when this won’t cause a work-related issue)
 Avoid activities that need mental alertness (i.e. driving; operating machinery)
o Withdrawal effects possible: fatigue, nausea, flushing, crying, vomiting, stomach pain, nervousness
o Do not suddenly stop medication if have been taking regularly

Question 8

Buspirone

Answer 8

BuSpar

Central Nervous System

Anti-anxeity (Anxiolytic)

Anxiolytic

Anxiety; Depression (off-label)

Dizziness/drowsiness; hostile behavior; confusion/fatigue; excitement/feeling nervous

linezolid (MAOI structure antibiotic; isocarbuxacid, phenelzine); SSRIs; St. John’s Wart

Use with MAO-Is — hypertensive crisis

Question 9

Which of	the following	answer choices is	the	
correct brand	name for	Lorazepam?
A. Restoril®
B. Lunesta®
C. Ativan®
D. Ambien®

Answer 9

C. Ativan®

Question 10

Which benzodiazepine	is	available	in a rectal	
gel formulation?
A. Alprazolam
B. Clonazepam
C. Diazepam
D. Lorazepam
E. Temazepam

Answer 10

C. Diazepam

Question 11

Which agent could	be	utilized for the acute treatment of anxiety, and	given “as	needed”	or	
prn?
A. Zolpidem
B. Buspirone
C. Clonazepam
D. Eszopiclone

Answer 11

B. Buspirone

Question 12

Which of the following is an INCORRECT or WRONG
counseling point for a patient prescribed a NBRA medication?
A. Take while in bed just prior to falling asleep
B. Be able to devote 7-8 hours to sleep
C. Next day impairment is
possible
D. Withdrawal effects do not
occur with these medication

Answer 12

D. Withdrawal effects do not

occur with these medication

Question 13

Taste disturbances	isNa	common	adverse	
effect of which medication?
A. Zolpidem
B. Eszopiclone
C. Clonazepam
D. Temazepam
E. No answer choice is	correct

Answer 13

B. Eszopiclone

Question 14

• Treatment of Insomnia

Answer 14

o Treat the underlying cause
o Behavioral interventions
o Pharmacologic interventions
 If underlying cause persists or remains problematic
 If insomnia remains despite adequate treatment of underlying cause/disorder
 If insomnia is problematic and/or patient requests pharmacologic therapy