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48 Cards in this Set
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These agents calm & reduce
anxiety |
Sedative
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These agents induce drowsiness / promote sleep
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Hypnotic
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These are antianxiety meds
used to relieve / prevent anxiety |
Anxiolytic
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- may develop from various factors:
illness separation from loved ones anticipation of a stressful event often self-limited may resolve in a few weeks/months - Tx w/ a Benzodiazepine |
Acute anxiety disorder
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Nm DisOrder/
- Characterized by acute episodes of severe anxiety w/ marked psychologic & physiologic Sx -Pt may feel impending sense of doom w/ accompanied -sweating -tachycardia -Tremors -visual Sx |
Panic disorder
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Tx w/
Benzo: or Tx long term w/ Sertraline (SSRI) |
Panic disorder
Treatment? Nm Class Nm Specific Rx 2ct Plus alternative Rx |
Benzo
-Alprazolam (Zanax) -Clonazepam (Klonopin) or Tx long term w/ Sertraline (SSRI) |
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May co-exist w/ panic disorder
- Tx options: - Benzo – provide acute relief & enables Pt to benefit from psychotherapy - An Antidepressant ..... .....usually the most effective Long-term Rx for : -agoraphobia -socialphobia |
Phobic disorder
Phobics coexist with what disorder ? Most effect-Tx for ? 2ct Tx these 2 Disorders with what Rx Long term? |
Panic disorder
-Agoraphobia -Socialphobia ~SSRI |
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Used to prevent
stage fright or acute situational / performance anxiety |
Propranolol
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- Characterized by Obsessions
which are recurring or persistent thoughts & impulses & Compulsions defined as repetitive behaviors in response to obsessions - Tx w/ Antidepressants & psychotherapy |
OCD
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Chronic worry & apprehension concerning future events
Tx Short-term – benzo to relieve acute Sx & provide bridge to psychotherapy Tx Long-term |
GAD
(Generalized anxiety disorder) Tx Short-term – |
benzo
to relieve acute Sx & provide bridge to psychotherapy Tx Long-term |
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Tx-s What Disorders
-Paroxetine -Norepi/SSRI -SSRI -Venlafaxine -Duloxetine |
GAD
(Generalized anxiety disorder) Nm Rx-s 5ct |
-Paroxetine (Paxil)
-Norepi/SSRI (Venlafaxine / Duloxetine) -SSRI (Sertraline) |
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May develop after exposure to a traumatic event
i.e. Sexual assault military combat Tx w/ -SSRI -Benzo ... (...may be used to Tx associated Sx) i.e. Exaggerated startle response & flashbacks |
Posttraumatic stress disorder
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Tx w/
-SSRI -Benzo |
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- This Rx Class Produces a dose dependent
but -limited depression of the CNS Lower dose has a -sedative effect -anxiolytic effect Higher dose – produces hypnosis (sleep) - produces anesthesia |
Benzodiazepines
~Name the Benzos: 5ct ~Which is long acting? |
~ Alprazolam (Xanax) Short
~Clonazepam (Klonopin) Short ~ Diazepam (Valium) Long ~ Lorazepam (Ativan) Short ~ Midazolam (Versed) Short |
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- can produce Anterograde amnesia
~Anticonvulsant effects ~Sz Tx / disorders (Anterograde: Pt can’t remember from time Rx administered to time effects dissipate. ) |
Benzodiazepines
S/E (1ct) Positive Effects: (2ct) |
- can produce Anterograde amnesia
~Anticonvulsant effects ~Tx seizure disorders |
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Indications:
-Anxiety Disorders -ETOH withdrawal -Insomnia -Muscle Spasm -Sz -Spasticity |
Benzodiazepines
Nm Indications: 6ct |
-Anxiety disorders
-ETOH withdrawal -Insomnia -Muscle Spasm -Sz -Spasticity |
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CNS Depression:
-Motor in-coordination -Dizziness -Excessive Drowsiness. -Physical Dependence when used long term. Taper off: -seizures -Associated with: -Hypotension -Arrhythmia etc. *Pregnancy category D -Zolpidem are category B -Zaleplon are category B |
Benzodiazepines
Nm Category B Rx 2ct |
-Zolpidem are category B
-Zaleplon are category B |
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*The behavioral reinforcement produced by these drugs may contribute to their recreational abuse by polydrug abusers and to their inappropriate long-term use by pts.
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The potentiating effects of alcohol and other CNS depressants on benzodiazepines
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Specific Rx Tx-s:
*anxiety *panic disorder large doses for panic attacks cause ~sedation ~Rx Dependence |
Alprazolam
(Zanax) Used to Tx 2ct -A/E: 2ct |
*anxiety
*panic disorder large doses for panic attacks cause ~Sedation ~Rx Dependence |
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Indications for Rx:
~ Anxiety ~ ETOH detox ~ Acute Recurrent Sz ~ Severe mm spasm ~ Spasticity assoc. /c degenerative & demyelinating Dz ~ Gradually taper over several wks |
Diazepam
(Valium) Used to Tx 6ct |
~ Anxiety
~ ETOH detox ~ Acute Recurrent Sz ~ Severe mm spasm ~ Spasticity assoc. /c degenerative & demyelinating Dz ~ Gradually taper over several wks |
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Tx is
What specific Rx:? -anxiety -elderly pts -Sz |
Lorazepam
(Ativan) Tx what 3ct |
-anxiety
-elderly pts -Sz |
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~IV Route
~used as an ....Anesthetic in .... ~Endoscopy -Minor Surgeries |
Midazolam
Anesthetic for? Trade Nm? |
~Endoscopy
~Minor surgeries -Versed |
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Why newer agents
-Zolpidem have replaced older benzodiazepines for the treatment of -insomnia. |
Less adverse effects.
Shorter duration of action precludes daytime sedation. Elimination half-life is shorter so..... - less hangover effect. -Safer in pregnancy: category ? -Trade Nm? |
category B
(versus category D.) (Ambien) |
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Indicated for chronic anxiety:
-No dependence -Non Sedating take regularly takes 3-4 weeks to build up effect |
Buspirone
(Buspar) compared to benzodiazepines ~Indicated for ? 2 benefits? Howlong must you take it for results? |
chronic anxiety:
-No dependence -Non Sedating take regularly takes 3-4 weeks to build up effect |
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Low potency antipsychotic.
Significant EPS -sedation -anticholinergic effects -Orthostatic hypotension. -Prolactin Elevated -Elevated Poikilothermy |
Chlorpromazine
( Trade Nm ) Type of Rx ? List A/E:6ct |
(Thorazine)
~Low potency antipsychotic. -Significant EPS -sedation -anticholinergic effects -Orthostatic hypotension. -Prolactin Elevated -Elevated Poikilothermy- |
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High potency antipsychotic.
Long acting depot Treat Tourette’s Little Sedation Produces Most EPS. Orthostatic Hypotension Anticholinergic Effects |
Haloperidol
List info 7ct |
High potency antipsychotic.
Long acting depot Treat Tourette’s Little Sedation Produces Most EPS Orthostatic Hypotension Anticholinergic Effects |
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-Good for negative sx
-Little EPS -Agranulocytosis. -Highly sedating -Anticholinergic -Orthostatic hypotension |
Clozapine
Nm Positives? 2ct Nm S/E 4ct |
-Good for negative sx
-Little EPS -Agranulocytosis. -Highly sedating -Anticholinergic -Orthostatic hypotension |
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-Positive and negative sx relief
-better than haloperidol. -Some EPS at higher doses -Low sedating -Orthostatic Hypotension -Anticholinergic Effects. -Most significant S/E -Sedation -Weight Gain |
Olanzapine
-Most significant S/E? 2ct |
-Most significant S/E
-Sedation -Weight Gain |
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Rx A/E:
More ~EPS ~Anticholinergic ~Orthostatic Hypotension than Olanzapine -Cardiac Arrhythmia -Prolactin Elevated |
Risperidone
A/E: 5ct ~Nm the Atypicals? 3ct Nm Typicals? 2ct |
More
~EPS ~Anticholinergic ~Orthostatic Hypotension than Olanzapine -Cardiac Arrhythmia -Prolactin Elevated . clozapine, olanzapine, risperidone -Are What Class? chlorpromazine, haloperidol -Are What Class? |
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Usually develops after months or years of tx.
Abnormal oral and facial movements. In later stages: ~abnormal limb ~truncal movements. Results from supersensitivity to ?. |
~Tardive Dyskinesia
~Dopamine |
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(.5 to 1.0% Severe A/E occurs)
from antipsychotic Rx Nm Syndrome? Nm Rx? A life-threatening condition. ~Altered Consciousness ~Autonomic Dysfctn ~Diaphoresis ~Fever ~Muscle Rigidity ~Tachycardia ~Tachypnea ~Urinary & Fecal Incontinence |
-Neuroleptic Malignant Syndrome
-Haloperidol Is it a Life threatening condition? A/E:? 8ct |
Yes (it is a life threatening condition)
~Altered Consciousness ~Autonomic Dysfctn ~Diaphoresis ~Fever ~Muscle Rigidity ~Tachycardia ~Tachypnea ~Urinary & Fecal Incontinence |
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Treatment is
~stop drug cause immediately ~administer Dantrolene (to prevent further muscle abnormality) May try again if needed with atypical because there is less incidences |
Neuroleptic malignant syndrome
Treatment is? 2ct |
~stop drug cause immediately
~Administer Dantrolene (to prevent further muscle abnormality) |
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Nm Overall Class/Type of Antipsychotics
-Lower incidence of EPS extrapyramidal side effects -better tx of neg sx. Same tx of positive sx. |
Atypical Antipsychotics
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Highly effective in treating depression and several other disorders
but are associated with high incidence of adverse effects. |
Tricyclic antidepressants (tcas)
are associated with Highly effective in treating 2ct |
high incidence of adverse effects.
Highly effective in treating depression & several other disorders |
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~Autonomic side effects:
Cardiac Arrhythmias. Sedation Sz Off-label use: *sleep disorders *Chronic Px Syndromes |
TCAs
(Tricyclic antidepressants) -Nm Rx? -Autonomic side effects: 3ct -Off-label uses: 2ct |
~Amitriptyline
Cardiac Arrhythmias. Sedation Sz Off Label Uses: -Sleep disorders *Chronic Px Syndromes |
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Citalopram
Fluoxetine Sertraline |
SSRIs
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Citalopram
Fluoxetine Sertraline Nm Rx-s: 3ct |
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Rx Tx-s:
Anxiety Anorexia Bulimia Depression OCD Panic |
SSRIs
Tx-s what? 6ct |
Anxiety
Anorexia Bulimia Depression OCD Panic |
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May be preferred in Elderly patients
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Sertraline
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Nervousness
Dizziness Insomnia. Male sexual dysfunction both priapism impotence. Withdrawal symptoms if stopped abruptly |
SSRIs
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Less sedating
less autonomic and cardiac side effects. They are safer than the TCA if overdosed |
SSRIs
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Weakly inhibits - neuronal uptake of:
Dopamine Norepinephrine Serotonin. It has few anticholinergic side effects causes little sedation and rarely produces cardiovascular effects or sexual dysfunction. |
Bupropion
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Can cause
Agitation Insomnia Nausea Weight loss. Also used to help quite smoking |
Bupropion
S/E Can Cause 4ct Benefit is: |
Can cause
Agitation Insomnia Nausea Weight loss. Also used to help quite smoking |
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Strongly inhibits the reuptake of:
~norepi ~serotonin -Similar side effects as SSRI -Does not antagonize: ~muscarinic receptors ~adrenergic receptors ~histamine receptors -Produces few.... ~Autonomic S/E ~Sedative S/E ~Cardiovascular S/E |
Venlafaxine
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Strongly inhibits the reuptake of:
~norepi ~serotonin -Similar side effects as SSRI -Does not antagonize: ~muscarinic receptors ~adrenergic receptors ~histamine receptors -Produces few.... ~Autonomic S/E ~Sedative S/E ~Cardiovascular S/E |
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A mood stabilizer
primarily used to treat the manic phase does produce calming effect in the patient but maximal effect can take days to weeks. Immediate or sustained release available |
Lithium
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Has a low therapeutic index
renaly excreted sodium enhances excretion |
Lithium
therapeutic index? Excreted? Enhances excretion? |
Low
renaly sodium |
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Has a low margin of safety.
Can cause Neurotoxicity Cardiac toxicity leading to arrhythmia. N/V can be first sign of Overdose |
Lithium
A/E 3ct |
Neurotoxicity
Cardiac toxicity leading to arrhythmia. N/V can be first sign of Overdose |
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NSAIDS
Diuretics can decrease clearance increasing levels of Rx by 25% |
Lithium
Contra-Rx-s: 2ct |
NSAIDS
Diuretics |
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Alternatives to
lithium therapy ~(What Class Rx) in the treatment of bipolar disorder. |
~Antiepileptic drugs
~Alt to What Rx therapy? ~For what Disorder? |
Alternatives to
lithium therapy ~(What Class Rx) ~Bipolar Disorder. |
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a non-sedating anxiolytic
an alternative to Benzo for use w/ Pts in a chronic anxiety state. |
–buspirone
~Rx Trade Nm? ~what class? ~Sedating or non-sedating ? ~Alternative to what Class of Rx? ~For use w/ Pts with? |
~(Buspar)
~Anxiolytic ~Non-Sedating ~Benzo-s ~Chronic Anxiety . |
