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Kinds of anxiety disorders (5)
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Social anxiety disorder (social phobia)
Benzodiazapines act as... (4)
- muscle relaxants
What does GABA do?
- body's natural valium
- inhibitory neurotransmitter
- -induces skeletal muscle relaxation
- -causes sedation
- -depresses CNS function
What causes a benzodiazapine to cause anti-anxiety effects rather than hypnotic?
Benzodiazapine protoptypes (3)?
Valium (not used as much anymore)--diazapam
- Ativan (lorazepam)
- Xanax (alprazolam)
Benefits of benzodiazapines?
- safer than general CNS depressants
- less potential for abuse
- -less tolerance and physical dependence
- fewer drug interactions
what drug-drug interaction is most important to watch for with benzodiazepines?
other CNS depressants
Why don't you give the antidote to benzodiazapines (Romazicon) to a patient with a history of seizures?
it can induce seizures
which route of benzodiazapines requires the closest monitoring of vital signs? Which should you watch most particularly?
- watch for cardiac issues (bradycardia, cardiac arrest)
what should you watch for when combining benzodiazapines and opiates?
AE's of benzodiazapines
anterograde amnesia (not always considered adverse when used for surgery)
effects opposite to what it's supposed to do (increased anxiety, etc)
benzodiazapines have greater effect on cardiac and blood pressure when given by which route?
IV (rather than PO)
when are benzodiazapines used?
- General anxiety disorder
- Panic disorder
- -short-term management of anxiety
- -stabilize sever anxiety
- Social anxiety disorder
What is the typical long-term management strategy for GAD?
buspirone and antidepressants
What are the advantages of buspirone?
- less sedation
- doesn't increase effects of CNS depressants
- lower potential for abuse
disadvantages of buspirone
what do you do to manage them?
- takes longer to achieve peak and steady state
- initial response: 1 week
- Peak: several weeks
benzodiazapines can be used to stabilize anxiety initially until buspirone kicks in
what can buspirone be used to treat?
General anxiety disorder
common AE's of buspirone
- rapid heart rate/chest pains/heart palpitations
patient education for buspirone during intial phase of treatment
wait to operate machinery and activities requiring alertness and psychomotor coordination until CNS effects are known
What outcome goals should you have for treatment with buspirone?
- increased sense of well-being
- reduction in feelings of anxiety
how do MAO Inhibitors work?
inhibit monoamine oxidase, an enzyme that metabolizes neurotransmitters like NE, seratonin and dopamine. When those are more available to receptors, it alleviates depression.
What can MAOI's be used to treat?
- atypical depression
- depression (not first choice)
- bulimia nervosa
- panic attacks
why are MAOI's so troublesome?
They interact with pretty much everything!
Many drugs and foods
what are some AE's of MOAI's?
- Hypertensive crisis
- orthostatic hypotension
- CNS stimulation
what foods should be avoided when on MAOI's?
- foods high in tyramine:
- aged cheese
- soy sauce
- aged meats
- pickled fish
- tofu (soy curd)
- tap beer
- red wine
What drugs can be used to treat depression?
- MAO Inhibitors
- Wellbutrin (Bupropion)
- St. John's Wort
What does SSRI stand for? How's it work?
Selective Serotonin Reuptake Inhibitors
stop serotonin reuptake so it's more available in the brain
What's the prototype SSRI?
medical term for antianxiety
- can't form new memories after event that caused amnesia
- long-term memories are intact
good for surgery
which drug class can cause anterograde amnesia?
how is a drug selected for depression?
by safety, side effects, drug interactions, tolerability, preference and cost
all are equally effective
how soon do antidepressants work?
- initial response: 1-3 weeks
- max response: 12 weeks
what's the major consideration when treating with antidepressants?
what should you monitor?
- suicide risk
- Black Box warning
Monitor for thoughts of suicide, worsening mood, changes in behavior (esp in people less than 25)
What syndrome is a potential AE of SSRIs?
S/S of seratonin syndrome?
- mental and musculoskeletal
- agitation, confusion, anxiety
Tricyclic antidepressants MOA
- block reuptake of norepinephrine
- (similar to antipsychotics)
also block acetylcholine and histamine
Effects of tricyclic antidepressants due to inhibition of reuptake of seratonin and NE
- cardiac dysrhythmias
- sedative: confusion, agitation
- anticholinergic: dry mouth, urine retention
- vasodilation: flushing, hyperthermia
MOA of Monoamine Neurotransmitters and Tyramine (MOA's)
- convert monamine neurotransmitters and foods with tyramine into inactive substances so they can't break down norepinephrine and seratonin
If MOA's aren't working, how should you go about switching to another drug?
discontinue 2 weeks before starting on another antidepressant
what AE may occur if a patient is taking an MOA and eats foods rich in tyramine?