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36 Cards in this Set

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antianxiety agents
prescribed more frequently than any other class of therapeutic agent.

Most effective on a short term basis.

Ineffective if used for months.
antianxiety agents
What drug is used to treat anxiety?
1. sedative-hyponotics
2. Beta blockers
3. Buspirone
What are the different kinds of antianxiety agents?
sedative-hyponotics
may be used as antianxiety agents already talked about.

Caution: Insomnia may accompany either anxiety or depression. Insomnia accompanying anxiety may be treated with this medication. However, if insomnia is accompanying depression, this drug should NOT be used.
Beta blockers
help individuals through temporary stress.

WIll alleviate "pounding" heart and may also lessen muscular "tremor" or shaking hands. Advantage: no sedation and no addiction potential.
Buspirone
a new chemical entity not related to benzodiazepines and not a controlled substance. No euphoria or addictive CNS depression. In contrast, nervousness may be a problem. Not as effective as benzodiazepines. May take 1-2 weeks for effect. OK for short term use. Long term safety needs to be established but may offer substantial advantages.
Antipsychotic agents
agents used to treat psychoses

also called Neuroleptics

difficut to diagnose and to even define

-psychotic individual
- often distortion of reality (hallucinations or delusions)
-may be diagnosed as schizophrenic
psychotic individual
has mental function sufficiently impaired to inferferes with capacity to meet demands of life.
i.e. personality disintegration, antisocial behavior.
True
ALL antipsychotic agents BLOCK the effects of DOPAMINE. Potency correlates with this pharmacological activity.

True or false?
DOPAMINE
ALL antipsychotic agents BLOCK the effects of __________. Potency correlates with this pharmacological activity.
may be the result of excessive dopaminergic activity. (probably more complicated than this theory indicates.)
What is the hypothesis for Psychoses?
Evidence for psychoses
Amphetamines make schizophrenia worse and cause psychoses in "normal" individuals. Psychoses produced by amphetamine can be blocked by antidopamine agents. Autopsy results on patients verify much higher than normal dopamine levels.
Therapeutic expectations
1. reduce bizarreness of behavior - alleviate anxiety and reduce hallucinations delusions, and feelings of paranoia.

2. cannot CURE, but make patient less disabled - reduce hospitalization. Antipsychotic drugs are NOT general depressants. Many areas of brain appear to be stimulated - may produce seizures. Does seem to depress lower brain centers, autonomic centers, vomiting center, body temperature.
1. schizophrenia
2. manic phase of manic depressive until Lithium takes effect
3. Antiemetic and hiccups
What are the therapeutic uses for antipsychotic agents?
therapeutic uses for antipsychotic agents
1. schizophrenia
2. manic phase of manic depressive until Lithium takes effect
3. Antiemetic and hiccups
Side effects for antipsychotic agents
for all three groups

1. sedation
2. anticholinergic effects - dry mouth, blurred vision, constipation, urinary retention
3. antiadrenergic effects- orthostatic hypotension, reflex tachycardia
4. extrapyramidal effects
5. endocrine imbalance
sedation
indifference or apathy with a drowsy feeling; not pleasant feeling;different from sedative hypnotic effect (does not progress to anesthesia). Taking these drugs is not a subjectively pleasant experience due to fatigue and indifference. May depress the patient.
anticholinergic effects
dry mouth, blurred vision, constipation, urinary retention
antiadrenergic effects
orthostatic hypotension, reflex tachycardia
extrapyramidal effects
Locomotor effects.

Especially note Tardive dyskinesia (may be permanent). May occur after single dose or after prolonged therapy.
endocrine imbalance
due to depression of hypothalamus

delayed ovulation and menstruation, weight gain, impotency in men, may see some feminization.
1. phenothiazines
2. Thioxanthenes
3. Butyrophenones
4. "atypical" antipsychotics
What are the 4 different kinds of Antipsychotic agents?
phenothiazines
more sedation, less extrapyramidal

useful in noncompliant patient

injection may last 2 weeks

also an antiemetic
Thioxanthenes
less sedation but MORE extrapyramidal
Butyrophenones
little sedation, more extrapyramidal; FEWER AUTONOMIC SIDE EFFECTS
"atypical" antipsychotics
Newer

inhibit serotonin receptors even more than dopamine

available through special patient managment system.

given one week supply

weekly blood tests

severe bone marrow depression possible

given to severely ill schizophrenic diabetes, high cholesterol and , as a result, perhaps heart disease.
depressants
brain
Cautions for antipsychotics. All CNS __________ (including alcohol, barbiturates). Causes additive depression in some areas of _______.
Lithium
Antipsychotic agents
Antidepressants
Anticonvulsants
What drug treats bipolar disorder, mania, or manic depressive episodes?
Lithium
The only drug SPECIFICALLY for bipolar disease.

Therapeutic use: antimanic (both acute and recurrent attacks)

-takes 7-10 days to act
-initially used in conjunction with phenothiazines (antipsychotic agents)
Mechanism of action for Lithium
decreases release NE and increases reuptake

very specific in relieving manic symptoms without sedation or tranquilization
Side effects for Lithium
a. NOT a sedative - no CNS effect in normal individuals - MAY complain of fatigue and muscle weakness.
b. blurred speech, fine tremor of hands
c. Nausea, vomiting, diarrhea (due to gastric irritation)
d. increases both urination and thirst.
sedative
weakness
hands
diarrhea
urination
SIDE EFFECTS OF LITHIUM

a. NOT a _______- no CNS effect in normal individuals - MAY complain of fatigue and muscle _________.
b. blurred speech, fine tremor of _____
c. Nausea, vomiting, _________(due to gastric irritation)
d. increases both ________ and thirst.
Cautions for Lithium
a. abnormal sodium loss - patient must have normal Na+ intake or lithium will increase to toxic levels (retained in place of unavailable sodium).
**f. ** possible pathological renal change - may impair lithium elimination causing MORE toxicity and damage. Fibrosis, glomerular damage, tubal lesions can occur. Effects appear irreversible.

g. hypothyroidism can occur (sometimes irreversible)
-or diabetes insipidus

h. dangers in pregnancy: cardiovascular malformations, kidney damage, euthyroid goiter, hypoglycemia.
Antipsychotic
____________ agents may be used to treat manic episodes.

- phenothiazines commonly used initially until lithium takes effect.
- soemtimes is used INSTEAD of lithium to treat manic episodes (some paitents cannot tolerate lithium)
Antidepressants
___________ for depressive episodes.
- either tricyclics or MAO inhibitors may be needed in addition to lithium for acute depressive episodes
-CAUTION: tricyclics can cause manic relapses
-may be used instead of lithium
anticonvulsants
Some __________ are being used to treat bipolar disorder. Individuals sometimes respond well to these alternatives when they either do not respond to lithium or they cannot tolerate it.