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33 Cards in this Set
- Front
- Back
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what is considered generalized anxiety disorder
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ecess worry fatigue insomnia depression and other sx need 3/5 for over 1/2 the day for @ least 6 months
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with GAD, you have palpitations, tremors, tachycardia, and HTN. what can you give to treat this
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beta blockers
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what are some causes of GAD
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alternations in autonomic fxn
functional deficiency of GABA and serotonin mediated systems hyperactivity of neuroendocrine (excess NE) |
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panic attacks usually last about 30 min, peaking at 10 min. what can you give as tx for panic attacks
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benzodiazepines which cause sedation, hangover effect, and can cause abuse
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what is the long term tx for panic attakcs
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SSRI/SNRI always 1st line
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what are the roles of GABA a receptor? GABA b receptor?
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GABAa = fast, mediates mood changes, benzos specifically act on GABA a. increases cl- influx --> hyperpolarization
GABAb= slower, memory and mood, pain response. increases k+ conductance --> hyperpolarization |
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which SSRI/SNRI are FDA approved?
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venlafaxine (SNRI)
paroxetine (SSRI) escitalopram (SSRI) |
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which is the SSRI that has an extended duration of action that is a prodrug that produces a metabolite. hangs around for ~7-9 days
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fluoxetine
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which FDA approved SSRI has a controlled release MOA
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paroxetine
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what do you have to be careful about when giving kids SSRI/SNRI
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first few weeks will have suicidal ideations so watch them carefully
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what are some SE of SSRI
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sexual disturbance (go on a drug holiday)
HA, sleep disturbance, weight gain, sedation |
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how long does an antidepressant take to fully kick in ?
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10-12weeks
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which SNRI has a SE of HTN? which one do you have to be careful about giving a BPH pt d/t urinary retention
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venlafaxine = HTN
duloxetine= BPH/urinary retention |
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which benzodiazepine is indicated for elderly patients
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oxazepam and lorazepam because they are short acting and won't have the hangover effect
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which benzodiazepine is the most lipophilic/longest acting but you dont give for acute panick attacks d/t its se
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diazepam
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for acute relief of panic sx, which benzodiazepine do you give
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alprazolam and
clonazepam |
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benzos have a high addiction possiblity. do not give for over how many weeks?
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no more than 4-6 weeks
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diazepam can cause what kind of SE
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anterograde amnesia
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what causes the hangover effect in benzos
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desmethyl diazepam is the active metabolite which hangs around
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what is the MOA of benzos
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bind GABAa receptor
triggers cl- channels to open hyperpolarization enhances GABA effects |
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name the short acting, intermediate acting, and long acting benzos
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short acting- oxazepam/lorazepam
intermediate- clonazepam / alprazolam long- diazepam |
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if you od on benzos, what can you give via IV
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flumanzenil is a competetitive antagonist for benzo receptors
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what is absolutely contraindicated when taking benzos
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etoh, TCA, opioids
any CNS depressants |
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what meds should you not be taking when on benzos
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macrolides, cimetidines, azoles, grapefruit juice because these inhibit CYP34A.
benzos are metabolized by CYP34A and CYP2C19. i think they will have toxicity if you use in conjunction. |
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what are some SE of benzos
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resp depression
CNS depression- difficulty concentrating, coma, drwosiness anterograde amnesia with diazepam resp depression if given IV or in pts with pulm dz |
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T or F you can give benzos to someone that is pregnant
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technically yes, but preferrably no.
caution if used in 1st trimester don't use while nursing, can lead to CNS depression can cause cleft lip in 1st trimester can cause hypotonia and floppy baby in 3rd trimester |
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what benzo can be used to facilitate sleep
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triazolam
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when you want to take a pt off of benzos, what do you do
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taper dose over weeks- months
never stop abruptly monitor for 3 weeks after |
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T or F combo therapy is preferred
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it is better at providing rapid anxiolysis
bbetter prevention and tx of depression compared to BZD monotherapy |
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what is DOC for pregnancy and lactation for depressed pts
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buspirone
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why is buspirone so good
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it is an 5HT1a agonist and has very little SE
anxiolytic that is not chemically related to benzos. no sedation or abuse potentials |
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what can you not take buspirone with
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rifampin decreases plasma levels
erythryomycin ketoconzole increases plasma levels |
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which benzo agonist puts you to sleep
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zolpidem
zaleplon z drugs give you zzzzzzzzzzzzz's |
