Ch. 14 Drugs - Anxiety & Insomnia Flashcards by Savannah Griffin

Types of Anxiety Disorders

Situational anxiety
Generalized anxiety disorder (GAD)
Panic disorder
Phobias
Social anxiety disorder
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorders (PTSD)

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Regions of the brain that are associated with anxiety, expression of emotions, and a restless state.

Limbic System & Reticular Formation

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Antidepressants for Anxiety & Anxiety-Related Symptoms

SSRIs
SNRIs - atypical antidepressants
TCAs
MAOIs

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CNS Depressants for Anxiety and Anxiety-Related Symptoms

Benzodiazepines
Barbiturates
Other drugs

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Nonpharmacologic Therapies for Anxiety and Insomnia

Cognitive Behavioral Therapy
Counseling
Biofeedback Techniques
Meditation

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Short-term or behavioral insomnia is sometimes attributed to what?

Stress

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What may disturb sleep?

Food or beverages with stimulants

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Long-term insomnia is caused by what?

Depression
Manic disorders
Chronic pain

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this is caused by the discontinuation of long-used sedative drugs

Rebound insomnia

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Drugs that have the ability to relieve anxiety

Anxiolytics (Benzos)

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These drugs work by slowing down the neuronal activity in the brain

CNS Agents - Antidepressants

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4 classes of CNS depressants to treat anxiety and sleep disorders

Antidepressants
Benzodiazepines
Nonbenzodiazepines anxiolytics
Barbiturates

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A continuum ranging from relaxation, to sedation, to the induction of sleep and anesthesia

CNS depression

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These drugs treat major depression and a range of anxiety conditions

Antidepressants

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What are the primary medications to reduce symptoms of panic and anxiety?

TCAs
MAOIs
SSRIs
Atypical antidepressants that do not fall conveniently into other categories

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The most commonly prescribed antidepressant

SSRIs

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SSRI prototype drug

escitalopram (Lexapro)

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Prozac, Celexa, Paxil, & Zoloft

Examples of antidepressant drugs

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Increases the availability of serotonin at specific postsynaptic receptor sites in the CNS

SSRIs MOA

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Adverse Effects of SSRIs

Weight gain
Sexual dysfunction
Dizziness
Insomnia
Somnolence
Confusion
Seizures

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Black Box Warning of SSRIs

Increased risk of suicidal ideation and behavior in children

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Atypical Antidepressant

SNRIs - Selective Norepinephrine Reuptake Inhibitor

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Cymbalta, Efecor, trazadone

Examples of SNRIs

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Abnormal dreams
Sweating
Constipation
Dry mouth
Loss of appetite
Weight loss
Tremors
Abnormal vision
Headaches
Nausea/Vomiting
Dizziness
Loss of sexual desire
Hypertension
Tachycardia

Side effects of SNRIs

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Black Box warning for SNRIs

Increased risk of suicidal ideation

Amitriptyline, Imipramine Almost all drugs that end with suffix -mine or -line

TCAs - Tricyclic Antidepressants or Cyclic Antidepressants

among the first antidepressants developed

TCAs

Effective for depression resistant to other classes of medication, but have much more serious side effects

TCAs

TCAs contraindications

Heart attack Heat block Arrhythmia

TCAs pregnancy category

C or D

Dry mouth Blurred vision Urine retention Hypertension Angioedema Agranulocytosis Bone marrow suppression

TCAs side effects

Avoid concurrent use of what when taking TCAs

Alcohol or other CNS depressants

escitalopram (Lexapro) Prozac Celexa Paxil Zoloft

SSRIs drug examples

phenelzine

MAOI example

Patient education for MAOIs

Avoid foods containing tyramine - beer, wine, smoked or cured meats, aged cheese, certain type of beans

Why should a patient avoid tyramine if taking MAOIs?

Can cause hypertensive crisis if ingested while on MAOI

What drugs potentiate the effects of insulin and other diabetic drugs?

MAOIs

Common adverse effects of MAOIs

Orthostatic hypotension Headache Diarrhea

alprazolam (Xanax) chlordiazepoxide (Librium) clonazepam (Klonopin) clorazepate (Tranxene) diazepam (Valium) lorazepam (Ativan) oxazepam (Serax)

Benzodiazepines for Anxiety Therapy

estazolam flurazepam quazepam (Doral) temazepam (Restoril) triazolam (Halcion)

Benzodiazepines for Insomnia Therapy

Benzodiazepine drugs differ in what?

Onset and duration. They all have the same MOA and adverse effects

Preferred drug for anxiety disorders and insomnia

Benzodiazepines

Whats the relationship b/w benzodiazepines and insomnia?

Used for particularly short term insomnia caused by anxiety

Other indications for benzodiazepines

Seizure disorders Alcohol withdrawal Muscle relaxation Induction of anesthesia for procedures

Why are benzodiazepines used?

B/c they are effective while not producing life-threatening respiratory depression

Life-threatening respiratory depression of benzodiazepines can occur when?

If used in conjunction with other substances-medications, illegal drugs, and alcohol

Withdrawal symptoms occur with benzodiazepines when?

If stopped abruptly

Drugs rarely prescribed due to side effects and dependence

Barbiturates

Barbiturates are prescribed for what?

Sedative, hypnotic, and antiseizure effects

Pentobarbital Phenobarbital Secobarbital

Examples of barbiturates

Barbiturates what a high risk for what?

Psychological and physical dependence

Barbiturates drug class schedule

Schedule II drug

Barbiturates withdrawal symptoms

Severe- potentially fatal

Barbiturates have a high risk for what?

Overdose & respiratory arrest

Side effects of barbiturates

Respiratory depression and increased metabolism

drugs that are chemically unrelated to either benzodiazepines or barbiturates, but also reduce anxiety

Nonbenzodiazepine, Nonbarbiturate CNS Depressants

Nonbenzodiazepine, Nonbarbiturate CNS Depressant Drug Prototype

zolpidem (Ambien)

zolpidem (Ambien) is used mainly for what?

Treatment of social anxiety symptoms and insomnia

Adverse effects of zolpidem (Ambien) and other Nonbenzodiazepine, Nonbarbiturate CNS Depressants

Mild nausea Dizziness Diarrhea Daytime drowsiness Amnesia Sleepwalking Eating while asleep

zolpidem (Ambien) MOA

binds to GAB receptor Preserves sleep stage III Offers minor effects of REM sleep

Examples of Nonbenzodiazepine, Nonbarbiturate CNS Depressants

zolpidem (Ambien) buspirone Precedex Lunesta

Antiseizure med used for social anxiety

valproic acid (Depakote)

Beta Blockers used for social and performance anxiety

atenolol propanolol

Melatonin receptor drug used for insomnia

Ramelteon

Orexin Receptor Blocker drug used for insomnia and to help maintain sleep throughout the night

suvorexant

Ch. 14 Drugs - Anxiety & Insomnia Flashcards

(65 cards)