Pharm110 Chp 28 Anxiolytics and Other phychiatric agents

Question 1

Psychotherapeutic agents and treatments

Answer 1

Treat emotional and mental disorders
-Whens a persons ability to cope with their environment is seriously impaired

Types of agents

• Anxiolytics (anxiety)
• Antidepressants (depression)
• Antimanics (mania)
• Antipsychotics (psychoses)

Question 2

Anxiolytic groups

Answer 2

• Barbiturates
• Carbamates
• Antihistamines
• Benzodiazepines

Question 3

Barbiturates

Answer 3

Prefix "barbatol"
Oldest drugs used as anxiolytics
-Depress CNS
-Suppress REM sleep
-Hang over effect
-induce hepatic microsomal enzymes
-most toxic anxiolytic, lead to overdose
-lack of anxiety effectiveness evidence

Question 4

Carbamates

Answer 4

Prefix “mate”

• Depress CNS
• Similar to barbiturates
• rapid tolerance
• dependence
• severe withdrawal

Question 5

Hydroxyzine pamoate (Vistaril)
Antihistamines

Answer 5

e. g. Hydroxyzine pamoate (Vistaril)
- Depress CNS
- Sedative effect supports use as anxiolytic
- less potent anticholinergic effects
- used for pruritic dermatoses

Question 6

Benzodiazepines

Answer 6

Prefix "am" and "pam"
Action
-First line drug for anxiety
-Sedate and muscle relaxation
-Relatively little drowsiness
-Do not suppress REM
Adverse effects
-Accumulate in body
-Serious withdrawal symptoms
-Long half life in body
-Tolerance to sedative and euphoric action, but not to anxiolytic action
-Withdrawal symptoms (nervousness, anxiety, seizures)
-Never stop abruptly, taper off 
Antagonist agent
Flumazenil (Romazicon)

Question 7

Antidepressants

Answer 7

3 groups

• SSRI’s (selective serotonin reuptake inhibitors)
• TCS’s (Tricyclic antidepressants)
• MAOI’s (Monoamine oxidase inhibitors)

Question 8

Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil)

SSRI’s (selective serotonin reuptake inhibitors)

Answer 8

Prefix “tine” and “line”
e.g. Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil)
Action
-1st line for mild to moderate depression
-Interfere reuptake of serotonin by presynaptic nerve cell
Adverse effects
-Decreased libido, agitation, insomnia

Question 9

Imipramine, clomipramine

TCA’s (Tricyclic antidepressants)

Answer 9

Prefix “mine” and “tine”
e.g. Imipramine, clomipramine
Action
-Treat moderate to severe depression
-Block reuptake of norepinephrine and serotonin at presynaptic neuron
Adverse effects
-Sedation and anticolinergic effects (dry mouth, constipation, tachycardia, ejaculatory and erection issues)
-Orthostatic hypotension
-Abrupt stop may cause nausea, headache, malaise

Question 10

isocarboxazid, Phenelzine sulfate

MAOI’s (Monoamine Oxidase Inhibitors)

Answer 10

e.g. isocarboxazid, Phenelzine sulfate
Action
-Last resort drug for depression
-Inhibits monoaime oxidase that normally breaks down serotonin
Adverse effects
-Interact with wide variety of meds
-Anticholinergic effects and weight gain
-Foods rich in Tyramine (aged protein, cheeses, pickled fish) may cause hypertensive crisis with MAOI's.

Question 11

Antidepressant implications

Answer 11

• Toxic to geriatric pts.
• Ortho hypotension, sedation, anticholinergic
• Not a rapid response (2-4 weeks for effect)
• Given IM in large muscle mass
• May cause somnolence (not aroused), greatest reason to stop med
• Sedative effect, except for SSRI’s, which are better admin’d in the am.
• High fiber diet, with no Tyramine
• Visitors could bring food with Tyramine
• High suicide potential
• May lack energy while on meds to carry out suicide until not on meds
• Ensure pt. swallows meds and does not pocket

Question 12

Lithium

Antimanics

Answer 12

e.g Lithium
Action
-Mood stabilizer
-Therapeutic serum level 0.6-1.2mEq/L, should be checked every 1-2 months.
Adverse effects
-Metallic taste in mouth
-Diuretics and low sodium may increase toxicity
Signs of toxicity
-Lethargy, Apathy, Hand tremors, Diminished concentration, Slight muscle weakness

Question 13

Chlorpromazine (Thorazine)
Atypicals: Olanzapine (Zyprexa), Risperidone (Risperdal)
Antipsychotics

Answer 13

e.g. Chlorpromazine (Thorazine)
Atypicals: Olanzapine (Zyprexa), Risperidone (Risperdal), less likely to cause EPS.
Treat- Schizophrenia, Organic psychoses, Manic phase of bipolar affective disorders
Called “Major Tranquilizers”
Action
-Reduce excessive dopamine activity in brain
-Block postsynaptic dopamine receptors
Adverse effects
-Sedation (most common)
-Low seizure threshold
-Anticholinergic effects
-Ortho hypotension
EPS (Extrapyramidal Symptoms)
Most dramatic adverse effects
-Dyskinesias (lip smacking, eye blinking)
-Akathisia (extreme restlessness, inability to sit still)
-Dystonia (strong muscle contractions, unusual twisting of body parts, extremely painful)
-Tardive dyskinesia (after 2 years of med, longer on med less likely to reverse)