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100 Cards in this Set
- Front
- Back
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What are sedative-hypnotic drugs used for? (3)
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1. sleep (hypnotic)
2. calm pt (sedative) 3. general anesthesia (high doses) |
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What are 2 main types of sedative-hypnotics? (2)
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1. benzodiazepines
2. nonbenzodiazepines |
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What are other uses for sedative-hypnotic drugs besides sleep, calming and general anesthesia? (2)
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1. epilepsy
2. muscle relaxation |
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How are sedative-hypnotic drugs administered and distributed?
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orally and fairly evenly (amount of drug admin/conc of drug in plasma--vol to be evenly distrubted is 42L of body fluid)
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What type of an effect could sedative-hypnotic drugs have on the body?
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reservoir effect (drug is prevented from reaching site or leaks out later)
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How are sedative-hypnotics metabolized and excreted?
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met = liver
excreted = kidneys |
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Give a class example of sedative-hypnotic/anti-anxiety agent
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benzodiazepines = flurazepam (Dalamane)
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What does flurazepam (Dalamane), a sedative-hypnotic/anti-anxiety agent promote?
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promote sleep, esp short term or acute situations
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What 2 types of drug classes can benzodiazepines be used for?
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1. anti-seizure
2. anti-anxiety |
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What is the benefit of using flurazepam (Dalamane), a sedative-hypnotic/anti-anxiety drug?
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less chance of lethal overdoes compared to barbiturates
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What are the problems with using flurazepam (Dalamane), a sedative-hypnotic drug? (2)
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1. residual effects
2. risk for tolerance and physical dependence with long-term |
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What is the mechanism of benzodiazepines?
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increase GABA's inhibitory effects by binding to a site on GABA b-c ion channel complex (GABA receptor)
Allows Cl- in/out of cell |
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What does benzodiazepines primarily act on?
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GABAa receptor type
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What is a class example of sedative-hypnotic/nonbenzodiazepine hypnotics?
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barbiturates (which also an anti-seizure med)
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What are barbiturates used for? (2)
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1. sedative-hypnotic/nonbenz
2. anti-seizure |
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What is the primary mechanism of barbiturates?
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increase GABA's inhibitory effects by binding to GABAa receptor (similar to benzodiazepines)
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What do barbiturates do at low doses?
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affects reticular formation and limbic system to promote sleep
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What do barbiturates do at high doses?
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affects SC and other areas of the brain (hence general anesthesia)
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What are 3 different problems with using barbiturates?
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1. low TI
2. risk of dependence and abuse 3. risk of fetal overdose (used for anti-seizures for infants) |
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Name a drug that is a sedative/hypnotic/nonbenz
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zolpidem (Ambien)
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What does zolpidem (Ambien) do?
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promote sleep
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What is the mechanism of zolpidem (Ambien)?
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affects GABAa receptors, but is more selective for the subunit (alpha 1) that causes sedation
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What are 2 benefits of using zolpidem (Ambien)?
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1. effective as benzodiazepines with fewer side effects (milder residual effects)
2. less risk of dependence |
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What are the residual effects of sedative-hypnotics? (2)
--similar to hangovers |
1. drowsiness
2. decrease motor performance the following day |
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What can sedative-hypnotics lead to?
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lead to withdrawal symptoms like sleep disturbances
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What are 3 main types of anti-anxiety drugs?
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1. benzodiazepines
2. anti-depressants (increase seratonin's effects) 3. beta blockers--propanolol (Inderal) used for HTN, angina |
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What is the prototype of an anti-anxiety benxodiazepine?
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diazepam (valium)
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What is the use of diazepam (valium)?
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first line anti-anxiety drug (benzodiazepine)
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What is an adverse effect of diazepam (valium)?
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sedation
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What are 3 PT implications of sedative-hypnotic and anti-anxiety drugs?
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1. scheduling treatment during peak time (good = calm, bad = sedated)
2. increase fall risk (esp those already fall risk) 3. decrease the need for sedative-hypnotics via PT treatments (breathing ex, music, exercise, relax tech, massages) |
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What are affective d/os?
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group of mental illnesses that are characterized by a marked disturbance in mood
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What are typical presentations of affective d/os?
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1. major depressive disorder (clinical depression)
2. bipolar d/o (bipolar affective and manic depression) |
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What is major depressive d/o or clinical depression?
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a form of mental illness characterized by intense feelings of sadness and despair; lack of interest in previously enjoyable activities
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What is the pathological reason for depression? (3)
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caused by amine nt's:
1. NE 2. dopamine 3. serotonin |
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What could be the problem with amine nt's in those who suffer with depression?
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could be a problem with metabolism of nt or reuptake of the nt
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What are 3 classes of antidepressant drugs?
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1. tricyclics
2. MAOs 3. second-generation drugs (SSRIs) |
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What is the goal with antidepressant drugs?
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increase amine neurotransmission of NE, serotonin and dopamine
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How are antidepressants administered and metabolized?
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orally and metab in the liver
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What can antidepressants be used in adjunct with as far as treatment?
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chronic pain (neuropathic pain, fibromyalgia, chronic low back pain)
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What is the mechanism of tricyclic antidepressants?
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blocks reuptake of amine nt's into presynaptic terminal
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What is a drug name for tricyclic antidepressant meds?
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amitriptyline (Elavil)
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What is the use for amitriptyline (Elavil)?
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severe depression
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What are 3 adverse effects for using amitriptyline (Elavil), a tricyclic anitdepressant drug?
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1. sedation
2. central and peripheral anticholinergic effects (includes confusion and cardio effects) 3. highest potential for suicidal use (fatal overdose) |
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What is the mechanism for MAO inhibitors as an antidepressant?
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inhibits MAO, the enzyme that metabolizes amine nt's in the nerve ending
(leaves more NE, dopamine or serotonin in nerve ending) |
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When is a MAO inhibitor used for depression?
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not used frequently, but may be used if pt is not responsive to other antidepressants or has intolerable side effects from them
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What are the interactions of MAO inhibitors for depression?
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1. can lead to hypertensive crisis by drug or food interactions (e.g. fermented cheese and wine)
2. increase sympathetic activity by other drugs |
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What are 3 side effects of using MAO inhibitors for depression?
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1. CNS excitation
2. anticholinergic effects (similar to tricyclics but lesser extent) 3. risk of hypertensive crisis by food interactions (ferm cheese and wine) |
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What is the mechanism of SSRIs?
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selectively blocks serotonin reuptake
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What are 2 examples of SSRIs?
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1. fluoxetine (Prozac)
2. sertraline (Zoloft) |
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What are SSRIs often prescribed for?
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depression
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What 3 side effects of using SSRIs?
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1. GI problems
2. insomnia 3. serotonin syndrome (neuromuscular symptoms such as shivering, restlessness and dystonia) |
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What is serotonin syndrome, a side effect of SSRI?
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neuromuscular symptoms such as shivering, restlessness and dystonia
*more serotonin in cleft (less reuptake) |
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What is bipolar affective d/o?
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psychiatric d/o characterized by mood swings from one extreme (mania) to the other (depression)
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What are manic episodes?
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euphoria, hyperactivity and talkativeness in bipolar d/os
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What is the cause bipolar d/o?
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exact cause unknown
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What is the goal of treating bipolar d/o?
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to stop the start of manic episodes to decrease mood swings
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What drug class treats bipolar?
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antimanic
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What is an example drug that treats bipolar d/o?
What others treat it as well that are not antimanic drugs? |
lithium
valproic acid (anti-seizure) and risperdal (anti-psychotic) |
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What is the mechanism of lithium, an antimanic drug?
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competes with other (+) charged ions, influencing neural excitability
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Where is lithium, an antimanic drug, absorbed and excreted?
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easily in the gut and excreted from kidneys
*not metabolized |
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What is a side effect of lithium?
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accumulation in body is toxic
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Why are antiseizure and antipsychotic drugs helpful for bipolar?
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b/c acts on CNS neurons directly to prevent excitation
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What are 3 PT concerns for antidepressants and antimanics?
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1. depression can be related or unrelated to reason pt is seeing PT
2. both drugs may help pt to take a more active role in therapy 3. SE can be troublesome (several wks for meds to work, suicidal thoughts are high) |
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What is psychoses?
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group of mental d/o characterized by marked thought disturbance and impaired perception of reality (includes delusions, hallucinations, grossly disorganized thinking)
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What 4 dx are included in psychoses?
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1. schizophrenia
2. psychotic depression 3. severe paranoid d/o 4. bipolar d/o sometimes classified |
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What is schizo?
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neurodevelopmental psychotic d/o indicated by periods with marked disturbance in the thought process which may include delusions and hallucinations
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What is the drug treatment for schizo?
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anitpsychotic meds (neuroleptics)--traditional, atypical
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What can antipsychotic meds (traditional/atypical) do for schizo?
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normalize behavior and thinking during acute psychotic event and prevent recurrence of psychotic even to improve pt's QOL
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What can antipsychotic drugs also be used for aside from schizo?
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1. manic phase of bipolar (with lith)
2. PD or alzheimer's to decrease psychotic symp |
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What is the mechanism of antipsychotics?
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block central dopamine receptors (various subtypes of dopamine receptors--SE vary)
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What is the pathophysiology of schizo?
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not fully understood--thought to be overactivity of dopamine pathways in parts of the brain such as limbic system
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What drug is a traditional antipsychotic?
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haloperidol (Haldol)
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What drug is an atypical antipsychotic?
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risperidone (Risperdal)
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Compare SEs of tradition vs atypical antipsychotic
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traditional--more SE, incl extrapyramidal
atypical--fewer SE, incl less extrapyramidal |
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Compare binding properties of tradition vs atypical antipsychotic
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traditional--bind more to dopamine receptor subtypes involved in motor fx
atypical--bind less to dopamine receptor subtypes involved in motor fx (also affects nt's) |
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Compare pt variability of tradition vs atypical antipsychotic
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traditional--more pt-to-pt variability in beneficial effects
atypical--less pt-to-pt variability in beneficial effects |
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Compare the effects of traditional vs atypical antimanic drugs?
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traditional--effective, but high SE
atypical--better preventing relapse than traditional |
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What is used if traditional antimanic drugs are not effective?
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atypical
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What is often 1st choice antimanic drug for schizo?
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atypical (risperidone (Risperdal)
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What are the adverse effects and PT main concerns with mvmt when using antipsychotic drugs? (6)
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extrapyramidal:
1. abnormal mvmt patterns--tardive dyskinesia (involuntary, fragmented mvmts that are rhythmic tongue and mouth mvmts) 2. pseudoparkinsonism 3. restlessness 4. neuroleptic malignant syndrome (rigidity, problems with temp regulation) Non-motor 5. OH (esp first several days) 6. sedation |
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What is tardive dyskinesia?
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antipsychotic drug effect characterized by involuntary, fragmented mvmts, particularly rhythmic tongue and mouth mvmts
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Are tardive dyskinesias reversible?
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Sometimes if drug is stopped, but can be irreversible
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What is neuropletic malignant syndrome?
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adverse effect from antipsychotics causing rigidity and problems with regulating temp
LIFE THREATENING! |
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What is drug abuse?
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using any drug illecitly, plus any other substances that are not considered drugs
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What is drug misuse?
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not using a drug in the proper way (not following instructions, time taken, etc)
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What are some PT implications of drug abuse? (5)
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1. pt may not disclose use of drug
2. withdrawal of CNS stimulants (decrease cognition and psychomotor fx) 3. CNS depressants decrease resp drive (ethanol) 4. fall risk 5. cognitive and behavior changes |
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What class is ethanol?
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sedative-hypnotic
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What is the mechanism of ethanol?
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unclear, appears to modulate several signaling proteins including increase GABA inhibition
*there is no specific alcohol receptor |
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How is ethanol absorbed?
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quickly after ingestion, metabolized in gut and liver
ex. asian or native am. decent has decrease ability to metabolize ethanol (flushed face) |
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What are 3 acute SE of using ethanol?
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1. CNS depression
2. decreased cardiac contractility 3. vasodilation |
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What is accentuated when using ethanol with other sedative-hypnotics?
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CNS depression
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What other agents does ethanol increase the effects?
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increases vasodilators (HTN)
oral hypoglycemic (DM) agents |
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What are 5 alcohol withdrawal symptoms?
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1. insomnia
2. tremor 3. anxiety 4. seizures 5. delirium tremens (DTs) |
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How can ethanol withdrawal be treated?
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thiamine and sedative-hypnotics as well as treating electrolyte imbalances
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What are 3 major goals when monitoring a pt going through ethanol withdrawal?
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prevent:
1. DTs 2. seizures 3. arrhythmias |
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What is delirium tremens characterized by? (3)
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1. total disorientation
2. hallucinations 3. marked abnormality of vital signs |
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How many days out should DTs being monitored for ethanol withdrawal?
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2-8 days out from discontinue
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When does anxiety, insomnia and tremors appear after discontinue of ethanol?
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from time stopped to 4 days out
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When does seizures appear after discontinue of ethanol?
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from time stopped to 3 days out
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When does hallucinations appear after discontinue of ethanol?
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1/2 day to 3 days out
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