Anxiolytics and antipsychotics Flashcards
(84 cards)
1
Q
Widely prescribed for anxiety, insomnia and muscle spasm
A
Benzodiazepines
2
Q
Food for short tem use and situational anxiety
A
Benzodiazepines
3
Q
Can be used with panic disorder due to quick onset
A
benzodiazepine
4
Q
Non benzodiazepine
A
Buspirone (Busbar)
5
Q
Used for treatment of anxiety disorder, but NOT panic disorder due to its slow onset
A
Buspirone (Busbar)
6
Q
Has sedative and muscle relaxant properties
A
Benzodiazepines
7
Q
Lacks sedative, skeletal muscle and anti-seizure effect
A
Buspirone (Busbar)
8
Q
Not good for pre op anxiety
A
Buspirone (Busbar)
9
Q
Does not produce dependance
A
Buspirone (Busbar)
10
Q
which has less of a tendency to form tolerance, benzos or barbituates?
A
Benzos
11
Q
Which has more tendency for abuse benzos or narcotics?
A
Narcotics
12
Q
Benzos mechanism of action
A
Facilitates the action of GABA by enhancing the affinity for GABA, they DO NOT effect GABA directly
13
Q
How do GABA receptors work?
A
GABA is an inhibatory receptor that when activated passes Cl- ions that hyperpolarize the cell and meke the mebrane resistant to excitation
14
Q
5 pharmacologic effects of Benzodiazepines
A
- Anxiolysis
- Sedation
- Anterograde Amnesia
- Anticonvulasant action
- Muscle relaxaton at the spinal level
15
Q
Benzos absorbtion
A
- highly protein bound
- highly lipid sluable
16
Q
Benzos Metabolism
A
Metabolized by CYP 450 system - caution in patients with liver disease
17
Q
Benzos elimination
A
Eliminated via the kidneys
18
Q
RARE CNS effect of Benzos
A
Paradoxical Excitement
19
Q
CNS effects of Benzos
A
- decreased CBF and decreased CMRO2
- Preserves cerebrovascular response to CO2
- Does Not procuce isoelectric EEG
- Does not attenuate ICP response to laryngoscopy
20
Q
Benzos and Respiratory Effects
A
- Dose dependant decrease in ventilation
- hypoxemia and hypoventilation enhanced in presence of opioids
- CO2 curve Flattens- does NOT shift
21
Q
CO2 curves for benzos and narcotics
A
Benzos - CO2 curve flattens and does not shift
Narcotics- CO2 curve shifts to the right
22
Q
Benzos Cardiovascular Effects
A
- At induction doses decreases SVR- so we see a drop in BP
- CO unchanged
23
Q
Benzos and Laryngoscopy
A
Even at induction doses Benzos DO NOT attenuated the SNS response to laryngoscopy
24
Q
Water soluable preperation
A
Midazolam/Versed
25
comercially prepared in organic solvents including propylene glycol and benzyl alcohol
Diazepam / Valium
26
Imidazole ring: pH 3.5 whith an open ring and when it comes to physiologic pH of 7.4 the ring closes speeding the effect of action and increasing lipid solubility
Midazolam/Versed
27
Viscous: pH 6.6-6.9
Diazepam / Valium
28
Very highh affininty for Benzo receptor on GABA
Midazolam / Versed
29
2-3 x the ptency of diazepam
Midazolam / Versed
30
Painful IV and IM injection
Diazepam / Vallium
31
90-98% protein bound
Midazolam / Versed
32
5-10x the potency of Diazepam
Lorazepam / Ativan
33
Most Potent Amnestic of the Benzos used in anesthetic practice
Lorazepam / Ativan
34
Has Propylene glycol as solvent
Lorazepam / Ativan
35
Rapid redistribution and short duration due to its lipid solubility
Midazolam / Versed
36
Metabolized by the CY P450 System
Midazolam / Versed
37
Mostly used for premedication, works well in kids
Midazolam / Versed
38
Midazolam / Versed
Premedication/ Pediatric dose:
0.5 mg/kg PO
39
Midazolam / Versed
IV sedation / Adults dose
**1 -2.5 mg**
up to **5 mg**
if patient is really anxious or large
40
Midazolam / Versed
Induction dose
**0. 1 - 0.2 mg/kg** over 30-60 sec
41
Midazolam / Versed
Maintinece dose
Incramental or Infusion
42
Highly lipid soluable and extremly long duration of action
Highly protein bound
Diazepam / Valium
43
Metabolites are Pharmacologically INACTVE
Lorazepam / Ativan
44
Lorazipam / Ativan
Elimination 1/2 time
10 - 20 hours
45
metabolism is less influenced by alterations in hepatic function, age and other drugs
Lorazepam / Ativan
46
Active metabolite of Diazepam / Valium and its Elimination 1/2 Time
Desmethyldiazepam
41 - 96 hours
47
Rapidly ablsorbed from GI tract in PO dosages
Diazepam / Valium
48
Elimination 1/2 Time Diazepam / Valium in Healty volunters
21 - 37 hours
it increases with age
49
Diazepam / Valium
Premedication / Oral dose
10 - 15 mg
50
Diazepam / Valium
Premedication / IV Dose
0.2 mg/kg - **(it reduces MAC)**
51
Diazepam / Valium
Induction dose
0.5 - 1.0 mg/kg IV
52
Diazepam / Valium
Anticonvulsant Dose
0.1 mg/kg IV
53
Why are menzos anticonvulsants?
They inhibit the limbic system in the hippocampus of the brain
54
Non- selective CNS depression
Barbituates - this is why they are not anticonvulsants
55
Lorazepam / Ativan
Premedication / PO dose
50 mcg/kg
MAX Dose 4mg
56
Drug that can cause Neuroleptic Malignant syndrome
Phenothiazines and Thioxanthenes
57
Phenothiazines and Thioxanthenes mechanism of action
Blockade of dopamine receptors in the basal ganglia and limbic portions of the forebrain
58
because Phenothiazines and Thioxanthenes interfere with dopamine they...
extrapyramidal side effects
59
Phenothiazines and Thioxanthenes acheive antiemetic effects by
Blocking the chemoreceptor trigger sone of the medulla
60
Erratic patterns of absorbtion fter PO administration, but highly lipid soluable and highly protein bound
Phenothiazines and Thioxanthenes
61
Phenothiazines and Thioxanthenes metabolism
1. oxidation in **liver** with conjugation
2. most have **inactve metabolites**
3. **T1/2 10-20** hours- longer in elderly
62
the problem with Phenothiazines and Thioxanthenes side effects is that ______________ due to the blockade of ______________ in the forebrain.
Because of this blockade the brain __________ dopamine receptors and they are _________ sensitive
The effects get worse
dopamine receptors
upregulates
MORE
63
Extrapyramidal side effecs of Phenothiazines and Thioxanthenes
1. Tardive dyskinesia
2. Acute dystonic reactions
64
1. **Abnormal involutary movements** of tongue, face, neck, extremeties.
2. Gait issues.
3. Skeletal muscle groups involved in breathing and swallowing are involved
4. occurs in 20% of patients **over 1 year of therapy** (elderly and women more susceptable)
5. **Ususally Perminent** (Must stop Treatment)
Tardive Dyskinesia caused by Phenothiazines and Thioxanthenes
65
1. Usually in the **first few weeks** of therapy
2. Acute skeletal muscle **rigidity and cramping** of face, neck, or back
3. Respiratory distress from **laryngodyskinesia** - laryngospasm that is not life threatening - have hoarsness
4. Responds well to **diphenhydramine 25- 50mg IV**
Acute dystonic reactions caused by Phenothiazines and Thioxanthenes
66
Phenothiazines and Thioxanthenes cause Cardiovascular effect, what are they, and why do they occur
1. **Decreases in BP** - due to vasomotor reflexes/ peripheral alpha adrenergic blockade
2. Relaxant effect on **smooth muscle**
3. **NO** direct cardiac depression
4. **NO**
5. Can see **prolonged QT** on ECG
67
Due to the antagonism of **\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_** and **\_\_\_\_\_\_\_\_\_** receptors, Phenothiazines and Thioxanthenes causes **\_\_\_\_\_\_\_\_\_** that develops a tolerance with chronic therapy.
Likewise, the ____________ is decreased and _______________ is acheived by _________ and does not happen at the \_\_\_\_\_\_\_\_\_\_.
1. **alpha 1**
2. **muscarinic**
3. **histamine**
4. **sedation**
5. **Seizure threshold**
6. **Skeletal muscle relaxation**
7. **CNS deprsseion**
8. **Neuromuscular Junction**
68
1. Develops over 28-48 hours
2. Hyperthemia
3. Hypertonocity of skeletal muslesInstability of autonomic NS
4. Fluctuation LOC
Neuroleptic Malignant syndrome caused by Phenothiazines and Thioxanthenes
69
Distinguishing feature fo Neuroleptic Malignant syndrome from Malignat Hypertermia.
With Neuroleptic malignant syndrome a non-depolarizing muscle relaxant will produce flaccid paralysis whein with Malignant hyperthermia it will not.
70
When interact with causes sedative effects, Ventilatory depression aand analgesic properties
Phenothiazines and Thioxanthenes and opioids
71
The ___________ stomp and __________ shuffle refet to some of the _______________ of \_\_\_\_\_\_\_\_\_\_\_\_.
Taialaxine, Thorazine
extrapyrimidal side effects
Phenothiazines and Thioxanthenes
72
Used to be used in the OR as an anti emetic
Droperodol
73
ICU delerium and anxiety
Haloperodol (Haladol)
74
Haloperridol and Droperidol are
Butyrophenones
75
Butyrophenones promarily have _________ and ___________ side effects.
CNS and Cardiovascular
76
Does Not cause Amnesia
Noes not have any anticonvulsant activity
Butyrophenomes
77
name the Butyrophenomes
haloperidol
droperidol
78
Cause extrapyrimindal effects, cerebral vasoconstrictor
Haloperidol
Droperidol
79
Haloperidol and Droperidol are _____________ that do not decresese\_\_\_\_\_\_\_\_\_.
Cerebral vasoconstrictors
Crerebral metabolic oxygen consumption
80
can cause dysphoria
Haloperidol
Droperidol
81
Haloperidol and Droperidol cardiovascular effects include, a minimal decrease in **\_\_\_\_\_\_\_\_\_** due to **\_\_\_\_\_\_\_\_\_\_\_\_**, it is a prominit **\_\_\_\_\_\_\_\_\_\_\_** that protects aginst **\_\_\_\_\_\_\_\_\_\_**induced dysrhythmias it acts by stabilizing **\_\_\_\_\_\_\_\_\_\_\_\_**. It can also cause **\_\_\_\_\_\_\_\_\_\_\_\_\_\_** and **\_\_\_\_\_\_\_\_\_\_\_\_\_** at doses as low as **\_\_\_\_\_\_\_\_\_\_\_\_\_.**
**blood pressure**; **alpha** **blockade**; **antidysrhythmic;** **epinepehrine;** **cardiac cell membranes**; **prolonged QT interval;** **torsodes de pointes**; **0.625-1.25mg.**
82
Has a black box warning, what is it?
Droperidol
All patiens must get 12 lead prior to administration of droperidol - prolonged QT
Must be monitored for 2-3 hours
83
Used to be combined with fentanyl to cause a neurolept anesthesia, but it cause a dysphoria
I used to be used often as an antiemetic
Droperidol
84
