Antipsychotics, Anti-Anxiety Agents Flashcards
(26 cards)
Alprazolam brand name
Xanax (XR)
Alprazolam Indication/Dosage
Management of anxiety disorders or short-term relief of anxiety/anxiety-associated depressive states: 0.25-0.5mg TID, titrated to individual needs.
Alprazolam Mechanism
Benzodiazepine
facilitate GABA, which mediates both pre- and post-synaptic inhibition in all regions of CNS
Alprazolam metabolism and excretion
Excreted in urine
Metabolized in liver by CYP3A4
Alprazolam Drug Interactions
Other CNS depressants, alcohol: increased CNS depression
3A4 Substrates alter clearance of drug
Oral contraceptives may increase effects
Alprazolam CI/precautions
CI: hypersensitivity, or narrow-angle glaucoma
Caution in patients with primary depression, psychosis, and impaired renal or hepatic function
Withdrawal can be serious, esp in patients on high doses or extended therapy. Do not stop abruptly, Decrease dose by 0.5mg q3-4 days
Alprazolam Pregnancy Category
D
Alprazolam ADR’s
Drowsiness and hypotension
Alprazolam Patient Education
Use caution operating machinery or when mental alertness is required
Avoid alcohol
May be habit forming
XR tabs - do not crush, chew, break
Do not stop abruptly, allow time for taper down.
Aripiprazole brand name
Abilify
Aripiprazole indication/dosage
Schizophrenia: start at 10-15mg daily, titrated in 2 week intervals to target range of 10-30mg daily
Acute manic and mixed episodes associated with bipolar: 15mg/day initially
Aripiprazole mechanism
exact mechanism unknown
may be due to partial agonist activity at DA D2 and 5-HT1A receptors
Aripiprazole metabolism and excretion
metabolized by CYP3A4 and 2D6 to dehydro-aripiprazole
Both are 99% plasma bound
Aripiprazole drug interactions
3A4 and 2D6 inhibitors: increase Aripiprazole serum concentrations. Decrease dose to 1/2 usual dose. Ex: quinidine, fluoxetine, paroxetine)
3A4 inducers: decrease serum concentrations. Double the usual dose in these patients (carbamazepine)
Aripiprazole CI/precautions
CI IN PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS
rare cases of NMS have occurred (hyperpyrexia, muscle rigidity, AMS, autonomic instability)
caution in patients with CV disease, history of seizures, risk for aspiration pneumonia, and who will be experiencing conditions which may contribute to elevated core temperature
Dispense smallest quantity manageable, due to suicide risk
Aripiprazole pregnancy category
C
caution in nursing mothers
Aripiprazole ADR’s
headache, anxiety, insomnia, asthenia, nausea, vomiting, constipation, weight gain, anxiety, lightheadedness, drowsiness, blurred vision.
TARDIVE DYSKINESIA is rare
Aripiprazole patient education
caution when performing tasks that require mental alertness
avoid alcohol
use appropriate precautions against heat exposure and dehydration
Buspirone brand name
BuSpar
Buspirone indication/dosage
short-term relief of anxiety symptoms.
15mg/day initially as 2 doses
increase in 5mg increments at 2-3 day intervals
normal adult dose is 5-10mg up to QID
Buspirone mechanism
not known
May be that it….
1) increases metabolism of NE in locus ceruleus
2) acts as moderate presynaptic DA agonist
3) acts as 5-HT agonist
does not effect BDZ or GABA receptors
discontinuation of therapy does not cause withdrawal!!!
Buspirone drug interactions
MAO-I coadmin may elevate BP (do not use together)
grapefruit juice may increase plasma levels and should be avoided
Buspirone CI/precautions
caution in patients with moderate-severe liver/renal impairment
possibility of dystonia, parkinsonism, TD due to DA binding
Buspirone pregnancy category
B
use caution during lactation
