Pharm 2 week 2

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  1. Kinds of anxiety disorders (5)
    • Generalized Anxiety Disorder (GAD)
    • Panic Disorder
    • OCD
    • Social anxiety disorder (social phobia)
    • PTSD
  2. Benzodiazapines act as... (4)
    • anticonvulsant
    • antianxiety
    • sedative-hypnotics
    • muscle relaxants
  3. What does GABA do?
    • body's natural valium
    • inhibitory neurotransmitter
    • -induces skeletal muscle relaxation
    • -causes sedation
    • -depresses CNS function
  4. What causes a benzodiazapine to cause anti-anxiety effects rather than hypnotic?
  5. Benzodiazapine protoptypes (3)?
    Valium (not used as much anymore)--diazapam

    • Ativan (lorazepam)
    • Xanax (alprazolam)
  6. Benefits of benzodiazapines?
    • safer than general CNS depressants
    • less potential for abuse
    • -less tolerance and physical dependence
    • fewer drug interactions
  7. what drug-drug interaction is most important to watch for with benzodiazepines?
    other CNS depressants
  8. Why don't you give the antidote to benzodiazapines (Romazicon) to a patient with a history of seizures?
    it can induce seizures
  9. which route of benzodiazapines requires the closest monitoring of vital signs?  Which should you watch most particularly?
    • IV
    • watch for cardiac issues (bradycardia, cardiac arrest)
    • hypotension
  10. what should you watch for when combining benzodiazapines and opiates?
    respiratory depression
  11. AE's of benzodiazapines
    anterograde amnesia (not always considered adverse when used for surgery)

    CNS depression

    sleep driving

    effects opposite to what it's supposed to do (increased anxiety, etc)
  12. benzodiazapines have greater effect on cardiac and blood pressure when given by which route?
    IV (rather than PO)
  13. when are benzodiazapines used?
    • General anxiety disorder
    • Panic disorder
    •      -short-term management of anxiety
    •        -stabilize sever anxiety
    • Social anxiety disorder
  14. What is the typical long-term management strategy for GAD?
    buspirone and antidepressants
  15. What are the advantages of buspirone?
    • less sedation
    • doesn't increase effects of CNS depressants
    • lower potential for abuse
  16. 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
  17. what can buspirone be used to treat?
    General anxiety disorder
  18. common AE's of buspirone
    • dizziness
    • insomnia
    • fatigue
    • rapid heart rate/chest pains/heart palpitations
    • hyperventilation
    • headache
  19. 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
  20. What outcome goals should you have for treatment with buspirone?
    • increased sense of well-being
    • reduction in feelings of anxiety
  21. 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.
  22. What can MAOI's be used to treat?
    • atypical depression
    • depression (not first choice)

    • OCD
    • bulimia nervosa
    • panic attacks
  23. why are MAOI's so troublesome?
    They interact with pretty much everything!

    Many drugs and foods
  24. what are some AE's of MOAI's?
    • Hypertensive crisis
    • orthostatic hypotension
    • CNS stimulation
  25. what foods should be avoided when on MAOI's?
    • foods high in tyramine:
    • aged cheese
    • soy sauce
    • aged meats
    • pickled fish
    • tofu (soy curd)
    • sauerkraut
    • tap beer
    • red wine
  26. What drugs can be used to treat depression?
    • SSRIs
    • SNRIs
    • MAO Inhibitors
    • TCAs
    • Wellbutrin (Bupropion)
    • St. John's Wort
  27. What does SSRI stand for?  How's it work?
    Selective Serotonin Reuptake Inhibitors

    stop serotonin reuptake so it's more available in the brain

    CNS excitation
  28. What's the prototype SSRI?
  29. medical term for antianxiety
  30. anterograde amnesia
    • can't form new memories after event that caused amnesia
    • long-term memories are intact

    good for surgery
  31. which drug class can cause anterograde amnesia?
  32. how is a drug selected for depression?
    by safety, side effects, drug interactions, tolerability, preference and cost

    all are equally effective
  33. how soon do antidepressants work?
    • initial response: 1-3 weeks
    • max response: 12 weeks
  34. 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)
  35. What syndrome is a potential AE of SSRIs?
    Serotonin Syndrome
  36. S/S of seratonin syndrome?
    • mental and musculoskeletal
    • agitation, confusion, anxiety
    • hallucinations
    • seizures
    • incoordination
    • hyperreflexia
    • fever
  37. Tricyclic antidepressants MOA
    • block reuptake of norepinephrine
    • (similar to antipsychotics)

    also block acetylcholine and histamine
  38. Effects of tricyclic antidepressants due to inhibition of reuptake of seratonin and NE
    • cardiac dysrhythmias 
    • antihistaminic
    • sedative: confusion, agitation
    • anticholinergic: dry mouth, urine retention
    • vasodilation: flushing, hyperthermia
  39. 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 
    • -NE
    • -dopamine
  40. If MOA's aren't working, how should you go about switching to another drug?
    discontinue 2 weeks before starting on another antidepressant
  41. what AE may occur if a patient is taking an MOA and eats foods rich in tyramine?
    hypertensive crisis
Card Set:
Pharm 2 week 2
2014-01-27 02:56:36

Drugs for Anxiety Disorders ADHD Bipolar Depression Drugs to manage psychosis Insulin
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