First Flashcards
1
Q
What are five causes of anxiety?
A
respiratory endocrine cardiovascular metabolic neurologic
2
Q
What are the drugs that can cause anxiety?
A
stimulants
sympathomimetics
anticholinergics/antihistaminergic
dopaminergics
3
Q
TCA is an example of a drug that can cause ____________
A
anxiety
4
Q
Meperidine is an __________ derivative
A
opioid
*anticholinergic/antihistaminic
5
Q
What does baclofen do?
A
relaxes the muscles
6
Q
Baclofen, cycloserine, hallucinogens and indomethacin can all lead to ____________
A
anxiety
7
Q
What are narcotics?
A
opioids and their derivatives only
8
Q
Hypnotics are drugs that enduce ___________
A
sleep
9
Q
Small doses of hypnotics cause _______
A
sedation
10
Q
Medium doses of hypnotics cause _________
A
hypnosis
11
Q
High dises of hypnotics cause ____________
A
surgical anesthesia
12
Q
What system is primarily depressed by sedatives?
A
respiratory
13
Q
“situational stress” insomnia is best treated by ___________
A
hypnotics
14
Q
What is the most commonly prescribed antianxiety drug?
A
benzodiazepines
*b/c of their large therapeutic index
15
Q
MOA of benzodiazepines
A
enhace neuronal GABA-mediated chloride channels
*increases permeability to chloride
16
Q
_______________ are positive allosteric modulators of the GABAa receptor
A
benzodiazepines
17
Q
Once a neuron is hyperpolarized it can no longer _________________
A
depolarize
18
Q
Chloride causes the cell to________________
A
hyperpolarize
19
Q
Alpha1 subunit causes _______
A
sedation
20
Q
Alpha2 subunit causes_________
A
anxiolysis
21
Q
Alpha3 subunit causes_________
A
processing of sensory motor information related to a schizophrenia endophenotype
22
Q
Alpha4 subunit causes _________
A
sedation, hypnotic and anesthetic effects
23
Q
Alpha5 subunit is ______
A
extrasynaptic
24
Q
Beta3 subunit causes ____________
A
sedation, hynosis and anesthesia
*pentobarbital
propofol
etomitate something
25
benzodiazepines are ____________
anxiolytics
26
_______________ is the major inhibitory neurotransmitter in the CNS
GABA
27
Benzodiazepines ___________ effect the ANS
do not
| *does not effect blood pressure
28
How do benzodiazepines relieve anxiety?
through enhacement of the inhibitory activity of GABA
29
Blood pressure is an indication of your ____________ control
autonomic
30
What benzo is commonnly used to treat panic disorders?
alprazolam
31
What benzo is commonly used to treat muscular spasms?
diazepam (fast acting)
32
What benzo is commonly used to treat seizure disorders and epilepsy?
clonazepam
| diazepam
33
What benzos are commonly used to treat conscious sedation insomnia?
flurazepam (long acting)
temazepam (intermediate)
triazolam (short)
34
Benzos are used as an ___________ in pt's with schizophrenia
adjuncts
35
What is the gold standard for treating a sustained seizure (status epilepticus) ?
diazepam
36
What is the speed of onset of oxazepam?
slowest
37
What is the fastest acting benzodiazepine?
diazepam
38
What benzodiazepam has the longest half life?
diazepam
39
What benzodiazepam has the shortest half life?
oxazepam
40
What benzodiazepam has the slowest speed of onset?
oxazepam
41
What benzodiazepams are available in IM form?
lorazepam
| midazolam
42
What is the onset of action of IV lorazepam?
1-5 minutes
43
What is the onset of action of IM lorazepam?
15-30 minutes
44
What are possible AE of parenteral administration of benzodiazepines?
```
apnea
hypotension
bradycardia
cardiac arrest
*especially in older patients
```
45
Benzodiazepines are ____________ and rapidly absorbed after oral administration
lipophyllic
46
Avoid co administration of lorazepam IM and ___________ d/t reports of related death
olanzapine IM
47
Do benzodiazepine cross the placenta?
yes
48
_____________ combined with benzodiazepine may cause severe hypotension, respiratory or cardiac arrest, loss of consciousness
clozapine
49
Smoking will __________ the effect of benzodiazepines
decreased
50
Alcohol will __________ the effect of benzodiazepines
increase
51
Antifungals will __________ the effect of benzodiazepines
increase (increased plasma concentration)
52
What are the AE of benzodiazepines?
CNS depression
disorientation, irritability
impairment of memory and recall
respiratoy depression
53
With what conditions should benzodiazepines be given cautiously?
liver disease
glaucoma
alcohol
CNS depression
54
What part of brain is involved in memory formation?
hippocampus
55
How do benzodiazepines cause memory impairment?
Effect hippocampus
56
Tolerance to benzodiazepines ________ in response to the medication side effects
Decreases
57
How is physical dependence to a drug defined?
when medication is stopped, withdrawal or discontinuation symptoms occur
58
___________ is a benzo with a high risk of withdrawal d/t the short 1/2 life
alprazolam
59
How can you prevent benzodiazepine withdrawal?
convert to longer acting agent to taper slowly
60
What is the number one benzodiazepine blocker?
flumazenil (IV)
61
MOA of flumazenil
binds competitively to benzodiazepine receptors
62
Flumazenil given with what drug may increase the risk of seizures?
TCAs and benzodiazepines
63
AE of flumazenil
agitation, confusion, sweating, n/v, blurred vision, seizure
64
Buspirone is a ___________ agonist
serotonin type 1A receptor
65
What is the risk of dependence to buspirone?
very low-none
66
Buspirone is metabolized by ______________
liver enzymes
| CYP34A
67
Buspirone may increase __________ secretion and growth hormone
prolactin
68
Buspirone may cause _ thermia
hypo
69
What is a risk of buspirone?
Risk of serotonin syndrome when co-administered with an SSRI
70
How does someone with serotonin syndrome present?
restlessness, diaphoresis, tremors
| abdominal cramps
71
MOA of zolpidem?
act on GABA, not an anticonvulsant, no w/d effect
72
Zolpidem is more selective for _________ subunit of benzodiazepine receptor complex
alpha- 1
73
Zolpidem is hepatically oxidized by ___________
CYT-P450
74
Zaleplon affects ____________ and ___________ functions
psychomotor
| congnititve
75
Zaleplon is metabolized by the ___________
liver
76
What is the 1/2 life of zolpidem?
2.5 hours
77
What is hydroxyzine?
antihistamine
| antiemetic
78
What beta blockers are commonly used to treat stage fright?
atenolol
| propranolol?
79
What is the indication for alprazalam?
panic attack, anxiety, depression
80
Flurazepam has the ___________ half life of the benzos
longest
81
What is the effect of most hypnotics on the sleep pattern?
decrease onset latency
increase NREM duration
decrease REM duration
82
What is the ultra short acting barbituate?
thiopental
83
What are the short-intermediate acting barbituates?
pentobarbital, secobarbital, amobarbital
84
What is the long acting barbituate?
phenobarbital
85
MOA of barbituates
at high concentrations, direcly activate the GABAa receptor to enhacne chloride permeability--in addition to allosteric modulation of the GABAa receptor
86
What are the membrane effects of barbituates?
nonspecific neuronal depression has been reported at highly very high (toxic) doses
87
What barbituate is often used for sedation (anesthesia)?
thiopental (inducer)
88
What is an unusual use of barbituates?
neonatal hyperbilirubinemia and kernicterus
| usually manifests the second day
89
When barbituates are excreted in the urine, they are in a ______________ form
anionic
90
AE of barbituates
hangovers, hyperalgesia, CNS excitation, hypersensitivity
91
What do barbituates do at sub-lethal dose intoxications?
ganglionic blockade
| hypotension/hypothermia
92
What is a major contraindication to barbituates?
acute intermittenet porphyria
93
In a barbituate overdose, what can you give them to alkalinizate their urine?
bicarb
94
Why do you want to alkanilize the urine in a barbituate overdose?
excreets the drug faster
95
Barbituates are a _________ inducer of cytochrome P450
potent
96
What are the sedatives/hypnotics
```
benzos
barbiturates
antihistamines
chloral hydrate
ethanol
```
97
What benzdiazepine is often used for sleep maintenance?
temazepam
98
What benzodiazepine is often used for short term treatment?
triazolam
99
What do benzidiazepines do in regards to sleep?
increase total sleep time but may prevent transition from lighter stage 2 sleep into deep restorative stages (stages 3 and 4)
