Pharm Unit 6-9A

Front 1

antianxiety agents

Back 1

prescribed more frequently than any other class of therapeutic agent.

Most effective on a short term basis.

Ineffective if used for months.

Front 2

antianxiety agents

Back 2

What drug is used to treat anxiety?

Front 3

1. sedative-hyponotics
2. Beta blockers
3. Buspirone

Back 3

What are the different kinds of antianxiety agents?

Front 4

sedative-hyponotics

Back 4

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.

Front 5

Beta blockers

Back 5

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.

Front 6

Buspirone

Back 6

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.

Front 7

Antipsychotic agents

Back 7

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

Front 8

psychotic individual

Back 8

has mental function sufficiently impaired to inferferes with capacity to meet demands of life.
i.e. personality disintegration, antisocial behavior.

Front 9

True

Back 9

ALL antipsychotic agents BLOCK the effects of DOPAMINE. Potency correlates with this pharmacological activity.

True or false?

Front 10

DOPAMINE

Back 10

ALL antipsychotic agents BLOCK the effects of __________. Potency correlates with this pharmacological activity.

Front 11

may be the result of excessive dopaminergic activity. (probably more complicated than this theory indicates.)

Back 11

What is the hypothesis for Psychoses?

Front 12

Evidence for psychoses

Back 12

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.

Front 13

Therapeutic expectations

Back 13

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.

Front 14

1. schizophrenia
2. manic phase of manic depressive until Lithium takes effect
3. Antiemetic and hiccups

Back 14

What are the therapeutic uses for antipsychotic agents?

Front 15

therapeutic uses for antipsychotic agents

Back 15

1. schizophrenia
2. manic phase of manic depressive until Lithium takes effect
3. Antiemetic and hiccups

Front 16

Side effects for antipsychotic agents

Back 16

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

Front 17

sedation

Back 17

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.

Front 18

anticholinergic effects

Back 18

dry mouth, blurred vision, constipation, urinary retention

Front 19

antiadrenergic effects

Back 19

orthostatic hypotension, reflex tachycardia

Front 20

extrapyramidal effects

Back 20

Locomotor effects.

Especially note Tardive dyskinesia (may be permanent). May occur after single dose or after prolonged therapy.

Front 21

endocrine imbalance

Back 21

due to depression of hypothalamus

delayed ovulation and menstruation, weight gain, impotency in men, may see some feminization.

Front 22

1. phenothiazines
2. Thioxanthenes
3. Butyrophenones
4. "atypical" antipsychotics

Back 22

What are the 4 different kinds of Antipsychotic agents?

Front 23

phenothiazines

Back 23

more sedation, less extrapyramidal

useful in noncompliant patient

injection may last 2 weeks

also an antiemetic

Front 24

Thioxanthenes

Back 24

less sedation but MORE extrapyramidal

Front 25

Butyrophenones

Back 25

little sedation, more extrapyramidal; FEWER AUTONOMIC SIDE EFFECTS

Front 26

"atypical" antipsychotics

Back 26

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.

Front 27

depressants
brain

Back 27

Cautions for antipsychotics. All CNS __________ (including alcohol, barbiturates). Causes additive depression in some areas of _______.

Front 28

Lithium
Antipsychotic agents
Antidepressants
Anticonvulsants

Back 28

What drug treats bipolar disorder, mania, or manic depressive episodes?

Front 29

Lithium

Back 29

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)

Front 30

Mechanism of action for Lithium

Back 30

decreases release NE and increases reuptake

very specific in relieving manic symptoms without sedation or tranquilization

Front 31

Side effects for Lithium

Back 31

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.

Front 32

sedative
weakness
hands
diarrhea
urination

Back 32

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.

Front 33

Cautions for Lithium

Back 33

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.

Front 34

Antipsychotic

Back 34

____________ 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)

Front 35

Antidepressants

Back 35

___________ 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

Front 36

anticonvulsants

Back 36

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.