Exam III: Antidepressants

Question 1

What is a tranquilizer medication?

Answer 1

Medication that produces emotional calming, reduces anxiety, tension, agitation and other related emotional states

Question 2

What is a hypnotic?

Answer 2

Induction of sleep

Question 3

What is a myorelaxant?

Answer 3

Muscle relaxant

Question 4

What is status epilepticus?

Answer 4

Seizure > 5 minutes

or Repeated seizures without returning to normal consciousness between seizures

Question 5

What is euphoria?

Answer 5

Feeling of extreme happiness and well being

Question 6

What is neurosis?

Answer 6

Outdated term

Long term psychiatric disorder in which patient is in touch with reality –> condition is recognized as abnormal.

Question 7

What is neuralgia?

Answer 7

Severe burning or stabbing pain along the course of a nerve

Can be a complication of shingles

Question 8

What is psychosis?

Answer 8

Patient loses touch with reality (Symp. delusions, hallucinations, talking incoherently)

Not aware that behavior is abnormal

Question 9

“Major tranquilizers” are …?

Answer 9

Antipsychotics

Question 10

“Minor tranquilizers” are …?

Answer 10

Anxiolytics

Question 11

Name three barbiturates. What are they used for?

Answer 11

Amobarbital (Amytal®) – preoperative sedation

Pentobarbital (Nembutal®) – preoperative sedation, refractory status epilepticus

Phenobarbital (Luminal®) – antiepileptic, difficult to treat alcohol withdrawal

Question 12

What are the three main problems with barbiturates?

Answer 12

Physical and psychological dependence

Tolerance and withdrawal

Respiratory depression in overdose

Question 13

Advantages of benzodiazepines over barbiturates.

Answer 13

Versatile in their use

Generally safer, less respiratory depression/toxicity than barbiturates

Question 14

Name Benzodiazepine indications/uses. (5)

Answer 14

Anxiolytic

Antiepileptic

Myorelaxant

Sedative-hypnotic insomnia

Management of Alcohol Withdrawal Syndrome (AWS)

Question 15

Benzodiazepines are have a “ceiling effect” thus are safer than barbiturates. What does this mean?

Answer 15

At high doses barbiturates can lead to a coma.

Benzodiazepines can lead to medullary depression but plateau. Effects do not go above this level of sedation.

Question 16

Benzodiazepine mechanism of action

Answer 16

Potentiate GABA effects (inhibitory)

Question 17

Benzodiazepine withdrawal symptoms

Answer 17

Anxiety, depression

Seizures

Aches, Pain

Delirium

Question 18

Benzodiazepines can cause “Paradoxical excitation/disinhibition” as an adverse event. What does this mean?

Answer 18

Paradoxical – opposite effect of what it was intended for.

Instead of intended calming effect it may cause agitation, aggression or irritability

More common in elderly patients and those with developmental disorders (ie. autism)

Question 19

“Rebound anxiety” is a possible adverse event associated with Benzodiazepines. What is this?

Answer 19

Anxiety more intense than original levels that occurs after drug wears off

Question 20

Are fatal overdoses common for benzodiazepines?

Answer 20

Uncommon alone

More common when taken with other CNS depressants

Question 21

What benzo has a fast onset of action and a short duration of action?

This drug is also associated with a higher risk of … ?

Answer 21

Alprazolam (Xanax®)

More associated with a higher risk of substance abused and intense withdrawal symptoms

Question 22

Name the benzo that does not end in -azepam or -azolam used as an anxiolytic.

What receptors does this drug interact with?

Answer 22

Buspirone (Buspar®)

No direct effect on GABA receptors

High affinity for serotonin receptors

Moderate affinity for dopamine receptors

Question 23

Name these benzo muscle relaxants.

Cyclo
Metho
Bacl
Meta
Tiz
Cari

Answer 23

Cyclobenzaprine (Flexeril®)

Methocarbamol (Robaxin®)

Baclofen (Gablofen®, Lioresal®)

Metaxalone (Skelaxin®)

Tizanidine (Zanaflex®)

Carisoprodol (Soma®)

Question 24

Name three non-benzodiazepine anticonvulsants (-apine).

Answer 24

Carbamazepine

Oxcarbazepine

Eslicarbazepine

Question 25

Three main indications for carbamazepine.

Answer 25

Seizure disorders Bipolar disorder – as mood stabilizer Neuropathic pain

Question 26

Serious contraindication and precautions to look for in Carbamazepine.

Answer 26

Bone marrow suppression Severe rash – Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis Liver Disease Hyponatremia Interaction with many HIV medications Birth defects

Question 27

Advantages of Oxcarbazepine over Carbamazepine.

Answer 27

Less potential for developing liver disease and bone marrow suppression Less drug interactions

Question 28

Name the Non-Benzodiazepine (BZD) Sedative-Hypnotics Non-Benzodiazepine Receptor Agonists (NBRAs) called "Z-drugs".

Answer 28

Zolpidem (Ambien®) Zaleplon (Sonata®) Eszopiclone (Lunesta®)

Question 29

Doxepin indication at normal and low dose.

Answer 29

Normal - TCA antidepressant Low-dose (Silenor®) - treat insomnia (sleep maintenance)

Question 30

Non-Benzodiazepine Receptor Agonists (NBRAs) mode of action?

Answer 30

Enhance GABA activity by binding to BZD-1 receptors

Question 31

Since NBRAs do not interact with BZD-2 receptors, how do these drugs differ from benzos?

Answer 31

Minimal anxiolytic, myorelaxant, anticonvulsant properties

Question 32

Warnings and precaution for patients taking (NBRAs).

Answer 32

Complex sleep behaviors (ie. sleep walking) May worsen depression with long term use (like Benzos***) Caution with sleep apnea, COPD

Question 33

Ramelteon (Rozerem®) Drug class? MOA and indication?

Answer 33

Non-Benzodiazepine (BZD) Sedative-Hypnotics Melatonin receptor agonist Indicated for sleep onset insomnia

Question 34

At low doses Doxepin acts as an antihistamine for insomnia. How is this action related to sleep?

Answer 34

Histamine is associated with a feeling of wakefulness

Question 35

Orexin Antagonists Indication? Warnings?

Answer 35

Effective for both sleep onset and sleep maintenance Narcolepsy-like symptoms Daytime somnolence and next-day driving impairment

Question 36

What is alogia?

Answer 36

Poverty of speech

Question 37

What is avolition?

Answer 37

Total lack of motivation that makes it hard to get anything done

Question 38

What is anhedonia?

Answer 38

Inability to feel pleasure

Question 39

What is Extrapyramidal symptoms (EPS)?

Answer 39

Drug-induced movement disorders

Question 40

Most first generation Antipsychotics end in what?

Answer 40

-azine As in Chlorpromazine

Question 41

Haloperidol is a first or second gen antipsychotic?

Answer 41

First gen antipsychotic

Question 42

First gen antipsychotics as as...? (MOA)

Answer 42

D2 receptor antagonists

Question 43

How do the four dopamine tracts affect untreated schizophrenic patients? Mesolimbic, mesocortical, nigrostiatum, tuberoinfundibular

Answer 43

1. Mesolimbic system -> increased dopamine -> positive symptoms 2. Mesocortical -> decreased dopamine -> negative symptoms 3. Nigrostriatum -> dopamine level not affected 4. Tuberoinfundibular -> dopamine level not affected

Question 44

Positive symptoms for schizophrenia.

Answer 44

Delusions Hallucinations Disorganized speech, thoughts Paranoia

Question 45

Negative symptoms for schizophrenia.

Answer 45

Affective flattening Alogia Avolition Anhedonia Social withdrawal

Question 46

FGAs decrease/increase dopamine levels in which of the four dopamine tracts?

Answer 46

Decreased dopamine in all four tracts

Question 47

SGAs decrease/increase dopamine levels in which of the four dopamine tracts?

Answer 47

Decrease dopamine levels in mesolimbic Increase dopamine levels in the other three tracts