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What are the commonly used brand names for the following?
Alprazolam (al PRAY zoe lam)
Clonazepam (kloe NAZE e pam)
Diazepam (dye-AZE-uh-pam)
Lorazepam
Oxazepam (ox-AZE-uh-pam)
What is the drug category?
- Alprazolam (Xanax)
- Clonazepam (Klonipin)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam (Serax)
Benzodiazpines
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Name 5 things benzodiazepines treat / are used for
- Anxiety & anxiety symptoms
- Acute alcohol withdrawal
- Skeletal muscle spasms
- Convulsions, status epilepticus
- Sedation during pre-op
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What is the general action of benzodiazepines?
Depress subcortical levels CNS (limbic system & reticular formation)
Increases effects of GABA (calming effect)
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What is buspirone? How is it different from CNS depressants?
Brand Name: BuSpar
An anti-anxiety medication that does not depress the CNS (compared to benzos)
Produces effects by interacting with serotonin, dopamine, & other neurotransmitters
Physical & psychological tolerance is not an issue (compared to benzos)
Onset is delayed (takes 10-14 days between onset of therapy & symptom relief
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Contraindications for anti-anxiety agents
- Pregnancy, lactating
- Narrow angle glaucoma
- Shock
- Coma
- Taking another CNS depressant
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Why should caution be taken when giving anti-anxiety medications to anyone with…
A history of drug abuse or addiction?
A history of depression or suicide?
Benzos are habit forming, cause dependence
CNS depressants exacerbate symptoms of depression
Depression is a symptom during withdrawal
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Side effects of benzos are...
- Drowsiness, lethargy
- Confusion, impaired memory
- Poor coordination
- Exaggeration of depression symptoms
- Orthostatic hypotension
- Dry mouth
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Symptoms of benzodiazepine withdrawal are…
- Increased anxiety
- Depression
- Insomnia
- Abdominal & muscle cramps
- Vomiting
- Sweating
- Seizures
Remember that abrupt withdrawal can be life threatening!
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What are the generic names of the following?
What category are these medications?
Abilify
Clozaril
Seroquel
Invega
Zyprexa
Risperdal
Latuda
Geodan
- Abilify (aripiprazole)
- Clozaril (clozapine)
- Seroquel (quetiapine)
- Invega (paliperidone)
- Zyprexa (olanzapine)
- Risperdal (risperidone)
- Latuda (lurasidone)
- Geodan (ziprasidone)
These are Atyptical Anti-psychotics
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What are the generic names of the following?
What category are these medications?
Thorazine
Prolixin
Mellaril
Stelazine
- Thorazine (chlorpromazine)
- Prolixin (fluphenazine)
- Mellaril (thioridazine)
- Stelazine (trifluoperazine)
A class of typical anti-psychotics called Phenothiazines
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What is the generic name for Haldol?
What category is it in?
How long does it take this medication to take effect?
- Generic name is haloperidol
- Typical Anti-psychotic, in the Butyrophenone family
- 4 weeks
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Which medications treat positive symptoms and which negative of schizophrenia?
Typical Anti-Psychotics treat Positive
Atypical Anti-Psychotics treat Both
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Which anti-psychotic has a high risk of agranulocytosis?
What % of those who take it get it?
What precautions are put in place?
- Clozapine (Clozaril)
- 2%
- Patient must be put on the national registry
- Patient must have CBCs weekly for the 1st six months
- Afterwards, CBCs are done every other week
- Medication is filled to last until next blood test
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Side effects for anti-psychotics are…
- Orthostatic Hypotension
- Patient may feel dizzy when changing
- positions
- Anti-Cholinergic side effects
- Dry mouth, constipation
- Urinary retention
- Blurred vision
- Extra pyramidal side effects (EPS)
- Pseudo Parkinsonian Side Effects
- Dystonic Side Effects
- Tardive Dyskinesia
- Neuroleptic Malignant Syndrome (NMS)
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Pseudo Parkinsonian Side Effects are…
A type of EPS (Extra pyramidal Side Effect)
- Difficulty speaking, swallowing
- Loss of balance
- Mask-like face
- Shuffling gait
- Tremors (more common in elderly)
- Cogwheel rigidity (ratchet-like movement of joints)
- Drooling
- Coarse pill-rolling movements of fingers at rest
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Dystonic Side Effects are…
A type of EPS (Extra pyramidal Side Effect)
- Sustained muscle contractions / spasms
- Twisting & repetitive movements, abnormal postures
- Inability to move eyes
- Weakness of arms & legs (more common in younger patients)
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what is Tardive Dyskinesia (TD)?
An adverse effect of anti-psychotic drugs
- Uncontrolled rhythmic movements of mouth, face, & extremities
- Lip smacking or puckering
- Puffing of cheeks
- Uncontrolled chewing
- Rapid movement of the tongue
If noted, call provider ASAP as irreversible damage may occur
If EPS (extra pyramidal side effects) is managed, patients will not get TD
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What is Neuroleptic Malignant Syndrome?
List the symptoms & management of it.
A rare but life threatening adverse effect of anti-psychotic drugs
- Symptoms
- Fever
- Respiratory distress
- Cardiac problems
- Patient’s BP is all over the place (hypo or hyper)
- Tachycardia
- Diaphoresis
- Rigidity
- Convulsions & delirium
- Elevated CPK levels
It can happen any time while on medication (patient could be on it for a long time and then just get it)
Get patient to ICU STAT & manage symptoms until the medication is out of the system as there is no antidote
After recovery, patient will need to go on a different medication that is chemically different
CPK is an enzyme found mainly in the heart, brain, and skeletal muscle
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What does decanoate mean?
What anti-psychotics are available in decanoate form?
How often should the medication be given?
- Decanoate Form
- Sustained release given IM
- Given every 2-4 weeks
- HALDO Decanoate (haloperidol)
- HALDO Decanoate 100 (haloperidol)
- Fluphenazine decanoate (formerly Prolixin)
- Given every 2-3 weeks
- Risperidone Injct (Risperdal Consta)
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To treat acute symptoms of EPS, such as acute dystonic reactions, administer ______ as a one-time deal.
Name the drug & route.
Why is it a one-time deal?
Then, administer a(n) ______
(name the drug category & example)
Diphenhydramine (Benadryl) 25-50 mg IM or IV
This is a one-time deal because this medication makes the patient sleepy
Administer an anticholinergic such as Benztropine (Cogentin) 1-2 mg IM or IV
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