Part 7-1 (Psychopharmacology: sedative-hypnotics; antianxiety drugs; antidepressants)

Question 1

Sedative-hypnotic and anti-anxiety drug Primary goals

Answer 1

Relax patient; promote normal sleep

Decrease anxiety without causing excessive sedation

Question 2

Primary sedative-hypnotics and antianxiety drugs

Answer 2

Benzodiazepines

Question 3

Sedative-hypnotic benzodiazepines

Answer 3

Estazolam
Quazepam
Temazepam
Triazolam

Question 4

Antianxiety benzodiazepines

Answer 4

-Cause less sedation
Diazepam
Chlordiazepoxide
Lorazepam
Alprazolam

Question 5

Benzodiazepines effects

Answer 5

Increases effects of GABA by binding to GABA-A receptor

More Cl- enters neuron through GABA channel

Question 6

“Z” drugs (Sleep)

Answer 6

Zolpidem (Ambien)
Zaleplon (Sonata)
-Not benzos, but still bind to GABA receptors in different spot
-May produce fewer problems when discontinued

Question 7

Eszopiclone (Sleep)

Answer 7

Lunesta

Not a benzo, but also binds to GABA receptors

Question 8

Ramelteon (Sleep)

Answer 8

Rozerem

Melatonin receptor agonist

Question 9

Azapirones (Antianxiety)

Answer 9

Buspirone
Stimulate serotonin receptors in CNS
May decrease anxiety with less sedation and dependence
Slow onset, moderate efficacy

Question 10

Use of antidepressants as anxiolytics

Answer 10

Patients may have anxiety and depression
Antidepressents can have direct anxiolytic effects
May have fewer side effects than benzos; less addiction

Question 11

Alternative anti-anxiety drugs

Answer 11

Quetiapine: antipsychotics
Gabapentin: antiseizure
Pregablin: antiseizure
Hydroxyzine: antihistamine

Question 12

Sedative-hypotonic adverse effects

Answer 12

Residual effects; anterograde amnesia
Complex behaviors (Sleep walking/driving)
Rebound effect
Falls
Tolerance and dependence
Benzos may be linked to Alzheimer disease

Question 13

Anti-anxiety drug adverse effects

Answer 13

Rebound effect (Increased anxiety when drug stopped)
Falls
Tolerance and dependence
Benzos may be linked to Alzheimer disease

Question 14

Sleep/anti-anxiety drug rehab concerns

Answer 14

Do not treat the underlying cause

Benefits vs Sedation

Question 15

Depression

Answer 15

Most common mental illness
Sadness that is incapacitating
Neurochemical basis

Question 16

Depression drug strategy

Answer 16

Depression cause by defect in biogenic amines

Drugs increase or prolong the effects of one or more amine neurotransmitters

Question 17

Biogenic amines

Answer 17

Norepinephrine
Dopamine
Serotonin

Question 18

Types of antidepressants

Answer 18

1. Selective serotonin reuptake inhibitors
2. Serotinin norepinephrine reuptake inhibitors
3. Tricyclics
4. Monoamine oxydase inhibitors
5. Others

Question 19

SSRIs

Answer 19

Fluoxetine (Prozac)
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluvoxamine

Question 20

SNRIs

Answer 20

Desvenlafaxine
Duloxetine
Venlafaxine

Question 21

Tricyclics

Answer 21

Shit ton of these drugs

Named for chemical structures

Question 22

MAO inhibitors

Answer 22

Isocarboxazid
Phenelzine
Tranylcypromine

Question 23

Other antidepressents

Answer 23

Nefazodone & Trazodone: block serotonin receptors and reuptake
Bupropion: NE and dopamine reuptake inhibitor
Mirtazapine: may block presynaptic NE receptors

Question 24

Mechanisms of antidepressents

Answer 24

Prolong the effects of amine neurotransmitter by either:

a. Inhibiting reuptake of amine neurotransmitters (SSRI/SNRI/Tricyclics)
b. Decreasing neurotransmitter breakdown (MAO)

Question 25

How do increased monoamines treat depression?

Answer 25

Drugs increase activity of amine neurotransmitters Increased NT activity increases production of brain derived neurotrophic factor BDNF stimulates growth of neurons in hippocampus

Question 26

Tricyclics adverse effects

Answer 26

``` Sedation Anticholinergic effects Orthostatic hypotension Arrythmias Seizures Fatal OD ```

Question 27

MAO Inhibitors adverse effects

Answer 27

CNS excitation | Increased BP

Question 28

SSRI/SNRI adverse effects

Answer 28

Generally well tolerated May increase seizures Some GI problems

Question 29

Serotonin Syndrome

Answer 29

``` Possible with all antidepressants Occurs when CNS serotonin recepters overstimulated Increased HR/BP Confusion Hallucations Dystonias/Dyskinesias GI problems *Can be fatal if unchecked* ```

Question 30

Antidepressants off label prescribed for...

Answer 30

Chronic pain

Question 31

Antidepressant rehab concerns

Answer 31

Time lag before beneficial effects Chance of increased depression during initial tx period Recognize and acknowledge mood changes

Question 32

Treatment of bipolar syndome

Answer 32

Classic tx: lithium Prevents manic episodes Mechanisms unclear

Question 33

Lithium

Answer 33

An element that is not degraded by the liver Have to rely on kidneys to eliminate it from body Can accumulate rapidly

Question 34

Lithium toxicity levels

Answer 34

Maintenance phase: .6-1.2 mEq/L Acute manic episode: 1.0-1.5 mEq/L Toxicity begins at 1.5 mEq/L Requires tx at >2.0 mEq/L

Question 35

Mild Lithium toxicity

Answer 35

metal taste tremor nausea weak

Question 36

Moderate lithium toxicity

Answer 36

``` vomiting diarrhea more tremor incoordinated blurred vision ```

Question 37

Severe lithium toxicity

Answer 37

Confusion/hallucinations nystagmus dysarthria fasciculations

Question 38

Other bipolar treatments

Answer 38

Antiseizure drugs | Antipsychotics