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20 Cards in this Set
- Front
- Back
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What drug classes does panic disorder respond to?
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tricyclic antidepressants (e.g. imipramine), MAOIs (e.g. phenelzine), SSRIs (paroxetine, fluvoxamine, sertraline, fluoxetine, citalopram, escitalopram), venlafaxine, and probably other newer antidepressants (e.g. mirtazapine). In addition, panic disorder responds to benzodiazepines (e.g. alprazolam, clonazepam, diazepam, lorazepam).
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What antidepressants have been demonstrated to not be effective in panic disorder?
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are trazodone (effective in some individuals) and buproprion (exacerbates panic and anxiety).
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What is the medical treatment for Generalized Anxiety Disorder (GAD)?
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buspirone, benzodiazepines, and antidepressants (e.g. imipramine, trazodone, SSRIs).
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What drug classes is Obsessive Compulsive Disorder (OCD) responsive to?
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serotonergic antidepressants (clomipramine, fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram)and venlafaxine.
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What is the treatment of choice for social anxiety disorder?
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SSRIs or MAOIs (e.g. phenelzine).
Gabapentin has also proven effective in the treatment of social anxiety disorder. |
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What is needed to Rx treat PTSD?
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Post-traumatic stress disorder (PTSD) requires both psychotherapy and medication, with tricyclics, MAOIs, and SSRIs helping as treatment adjuncts for depression, anxiety, flashbacks, and intrusive memories. Prazosin is effective for nightmares, while moodstabilizers (e.g. carbamazepine and valproate are sometimes used for impulsivity, anger,and mood lability.
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When are benzodiazepines are generally indicated?
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1. symptoms are disabling and rapid relief is very important
2. the patient is unable to tolerate or does not respond to other treatments, or 3. as an adjunct to other medications, particularly at the onset of treatment. |
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When are benzodiazepines are not effective or should be avoided?
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as a sole treatment in the presence of comorbiddepression. They should be avoided wherever possible in patients with a history ofsubstance abuse and should be used with caution in PTSD and social anxiety disorder, because of the high rate of substance abuse in these groups.
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What can you use to treat anxiety symptoms due to life stress or medical illness?
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can be treated with benzodiazepines, buspirone, gabapentin, beta-blockers (e.g. propranolol), or hydroxyzine, if medication is considered necessary.
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What are the adverse effects of buspirone?
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include dizziness, GI upset, headaches. Buspirone is nonsedatingand does not cause tolerance or dependence in animal or human studies. It does not alleviate benzodiazepine withdrawal symptoms.
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What are the side effects of benzodiazepines?
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sedation (almost universal in the first week or so of treatment), psychomotor impairment (slower reaction times, clumsiness), anterograde amnesia (lack of short-term recall for material learned while on the medication. more common with short half-life compounds). Major concerns are tolerance (need for higher dose to obtain the same effect) and withdrawal symptoms on discontinuation.
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What are the side effects of gabapentin?
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usually minimal and may include dizziness, incoordination, sedation, or nausea.
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What are the common side effects of prazosin?
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dizziness, orthostatic hypotension, fatigue, sedation, or headaches.
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What is insomnia?
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difficulty falling or staying asleep and/or non-restorative sleep (i.e. insufficient sleep with daytime fatigue/drowsiness).
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What is Zaleplon? What is its mechanims of action? What are its side effects/benefits? Metbolism?
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a pyrazolopyrimidine benzodiazepine receptor agonist, is, like zolpidem, specific for benzodiazepine 1 (omega 1) receptors. Zaleplon is rapidly absorbed and has an elimination half-life of one hour, making it most effective for initial insomnia. Zaleplon has minimal effects on sleep architecture and fewer amnestic effects,psychomotor impairment, rebound insomnia, and tolerance or dependence than benzodiazepines. Zaleplon is also metabolized in the liver, so doses should be reduced in patients who are elderly or who have hepatic dysfunction.
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What is Eszopiclone? What is its mechanism of action? Metabolism? Benefits?
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a cyclopyrrolone benzodiazepine receptor agonist, has a half-life of 6 hours, is metabolized in the liver, and is effective for both initial and middle insomnia.
has minimal effects on sleep architecture and fewer amnestic effects, psychomotorimpairment, rebound insomnia, and tolerance or dependence than benzodiazepines. |
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What is Melatonin?
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is a neurohormone produced by the pineal gland. It has been implicated in thecircadian regulation of sleep and produces hypnotic effects in humans in high doses (3-100 mg). Lower, more physiological doses may also be effective.
most useful for initial insomnia. It has few effects on sleep architecture. Melatonin may also be useful for disturbances of circadian rhythmicity such as jet lag or shift work. |
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What is Ramelteon? What is it's metabolism? Contraindications?
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a melatonin receptor agonist at MT1 and MT2 receptors, causes sleep onset within 15-20 minutes, and has a half-life of 1-2.5 hours. It is metabolized in the liver and should not be combined with fluvoxamine or other cytochrome P450 3A4 inhibitors. There is no evidence of abuse, rebound insomnia, or amnestic side effects. It can cause hyperprolactinemia.
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What are the adverse effects of benzodiazepines?
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tolerance and dependence, withdrawal symptoms (anxiety, insomnia, restlessness, tinnitus, perceptual distortions, shaking, sweating, seizures), anterograde amnesia (especially with triazolam), daytime drowsiness (especially with longer-acting agents), psychomotor impairment, impaired driving ability, disinhibition, confusion, falls and hip fractures in the elderly, impaired cognitive performance, and rebound insomnia.
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What is rebound insomnia?
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sleep disruption following the use of a hypnotic agent. Thismay be due to tolerance or to REM suppression with subsequent REM rebound
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