Session 3 Pharm -5- Sedative Hypnotics

Front 1

What does the following describe unpleasant state of tension, apprehension, or uneasiness

Back 1

anxiety

Front 2

What are the symptoms of severe anxiety

Back 2

tachycardia, sweating, trembling, palpitations involving sympathetic activation

Front 3

Why are anti anxiety meds considered both anxiolytic and hypnotic

Back 3

because they cause sedation as well as decrease anxiety

Front 4

What are the underlying physiologic causes of anxiety (what is happening at the neurotransmitter level)

Back 4

functional deficiency of GABA and serotonin mediated systems or over activity of circuits mediated by norepinephrine

Front 5

What is sedation

Back 5

decreased anxiety, decreased motor and mental activity

Front 6

what is hypnosis

Back 6

drowsiness and increased tendency to sleep

Front 7

If you are going to prescribe a sedative hypnotics what do you need to make sure you talk to your patient about

Back 7

make sure pt is not taking EtOH and understand not to combine them with EtOH especially if you are going to prescribe benzodiazepine

Front 8

if your pt feels restless, edgy, keyed up, tires easily, has trouble concentrating tendency for mind to go blank, irritability, increased muscle tension, trouble sleeping for over half the days in a six month period what does you pt likely have

Back 8

General Anxiety disorder GAD

Front 9

What may you want to prescribe to blunt the sympathetic symptoms of anxiety

Back 9

low dose beta blocker

Front 10

What are the four types of antidepressants list them in order of effectiveness

Back 10

SSRI/SNRI > TCAs > MAOIs

Front 11

What is the 1st line tx for SHORT TERM management of generalized anxiety disorder

Back 11

Benzodiazepines

Front 12

What adjunt therapy can you Rx to help pt while you wait for SSRIs or SNRIs to reach therapeutic effectiveness

Back 12

Benzos

Front 13

What drug can you prescribe in a low dose to help with panic attack tremors and palpitations

Back 13

Beta Blocker

Front 14

What non drug treatment may be helpful for patients with anxiety disorders

Back 14

cognitive-behavioral therapy (relaxation therapy

Front 15

What is the 1st line tx for Anxiety disorder

Back 15

Antidepressants because of broad spectrum of efficacy

Front 16

What is the 1st line tx for LONG-TERM management of GAD (generalized anxiety disorder)

Back 16

antidepressants- SNRI; venlafaxine (Effexor), SSRIs; Paroxetine (Paxil) and escitalopram (Lexapro)

Front 17

How long will it take for you to see an effect from antidepressant therapy and how long to reach full therapeutic response

Back 17

takes 2-4 weeks to see effect and 10-12 weeks to reach full therapeutic response

Front 18

What are some of the most concerning S/E of SSRIs for pts that you would want to educate them about

Back 18

sexual dysfunction and loss of libido, weight gain, d/c withdrawal effects some of the major ones also GI distress, jitteriness, headaches, sleep disturbances, sedation, inc B/P, Increased urinary retention

Front 19

What type of drug is Fluoxetine (Prozac)

Back 19

SSRI

Front 20

What type of drug is sertraline (Zoloft)

Back 20

SSRI

Front 21

What type of drug is paroxetine (Paxil)

Back 21

SSRI

Front 22

What type of drug is fluvoxamine (Luvox)

Back 22

SSRI

Front 23

What type of drug is citalopram (Celexa)

Back 23

SSRI

Front 24

What type of drug is Escitalopram (Lexapro)

Back 24

SSRI

Front 25

What type of drug is Venlafaxine (Effexor)

Back 25

SNRI

Front 26

What type of drug is duloxetine (Cymbalta)

Back 26

SNRI

Front 27

what type of drug are the following; alprazolam (Xanax), chlordiazepoxide(librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (valium), Lorazepam (Ativan, oxazepam, triazolam (Halcion)

Back 27

benzodiazepines

Front 28

Which benzo drug has the worst sedation effects and has extensive hepatic metabolism leading to a lot of drug interactions and has a hang over effect because of its metabolite

Back 28

diazepam

Front 29

What drug is 1st line tx for panic disorder

Back 29

SSRIs

Front 30

What drug type is 1st line for social anxiety disorder

Back 30

SSRIs-Paroxetine (Paxil), Sertraline (Zoloft) and SNRI- venlafaxine XR (Effexor)

Front 31

Which benzos are short acting

Back 31

triazolam and oxazepam

Front 32

which benzos are intermediate acting

Back 32

alprazolam, Lorazepam, estazolam, temazepam

Front 33

Which benzos are long acting

Back 33

diazepam, flurazepam, quazepam, chlordiazepoxide, clorazepate

Front 34

Do benzos directly bind GABA site on GABA receptor

Back 34

no they bind a site adjacent to the GABA site on the cell membrane receptor with high affinity

Front 35

What is the MOA of Benzos

Back 35

they bind receptor next to GABA receptor and open the chloride channel hyperpolarizing the cell by allowing influx of negative chloride ions. This moves cell away from threshold

Front 36

What are benefits of benzos

Back 36

effective, well tolerated, can be used PRN for situational anxiety and have a rapid onset of therapeutic effect.

Front 37

What are some drawbacks of using benzos

Back 37

sedation, cognitive, and psychomotor impairment. Interaction with alcohol. Physiologic dependence with ongoing therapy. D/C side effects, abuse potential, not effective for comorbid depression

Front 38

T/F benzos are effective for comorbid depression

Back 38

False

Front 39

What type of drug is Triazolam

Back 39

Benzodiazepines

Front 40

What type of drug is oxazepam

Back 40

benzo

Front 41

What type of drug is Lorazepam

Back 41

Benzodiazepines

Front 42

What benzo is indicated for elderly patients and why

Back 42

Oxazepam and Lorazepam- they aren't likely to accumulate with repeated dosing

Front 43

What are some of the s/e of benzos

Back 43

CNS depression, Anterograde amnesia, Respiratory depression

Front 44

How can you reverse the sedative effects of benzos

Back 44

give flumazenil it is a competitive antagonist of the benzo receptor. Can be given to treat benzo overdose. Given IV

Front 45

When are benzos contraindicated

Back 45

contraindicated in pregnancy and nursing can cause birth defects in 1st trimester

Front 46

What education do you have to give for pt taking benzos about stopping there use

Back 46

taper withdrawal or you can have a withdrawal syndrome marked by delirium, paranoia, panic, muscle twitches and convulsions

Front 47

What education do you have to give pt about using benzos and possible drug interactions

Back 47

do not use EtOH while taking benzos or any other CNS depressants like TCAs or opioids or antipsychotic agents,

Front 48

What do the following have in common with benzos erythromycin, clarithromycin, ritonavir, itraconazole, ketoconazole, nefazodone and grape fruit juice

Back 48

they all use the CYP3A4 cytochrome p450 isoenzyme for metabolism so you can have potential drug interactions with them and benzos

Front 49

You need a sedative hypnotic to treat anxiety in a pregnant women/ breast feeding woman what drug would you prescribe her that doesn't have any abuse potential

Back 49

buspirone- partial agonist at brain 5HT1a receptors, does not cause sedation, no abuse potential, slow onset of anxiolytic effects, minor psychomotor impairment and safe to use in pregnancy and lactation

Front 50

What effect does rifampin have on buspirone

Back 50

decreases plasma levels

Front 51

What effect does erythromycin and ketoconazole have on buspirone

Back 51

increases plasma levels

Front 52

What sedative hypnotic would you prescribe if you needed to help a pt suffering from insomnia that doesn't have any anxious or nervous symptoms

Back 52

zolpidem (Ambien) and Zaleplon (sonata); they have a fast onset of action, no anxiolytic, muscle relaxant or anticonvulsant properties they just are for short term treatment of insomnia