Pharm2 6 Neuro pt2 Flashcards Preview

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Flashcards in Pharm2 6 Neuro pt2 Deck (38)
1

Anxiety is most frequently divided into two common but distinctly different categories:

Generalized anxiety disorder
Panic disorder
(There are many others including phobias, OCD, PTSD, performance anxiety, test anxiety, and others)

2

Difficult to control, excessive anxiety
Last 6 or more months
Interferes with normal day to day functions or causes considerable distress

General anxiety disorder

3

Intermittent, intense, immediate episodes of fear, terror resulting in changing of behavior to avoid attacks
May be associated with hyperventilation, mimic heart attack

Panic Disorder

4

What CLASS is the Prototypical Anxiolytic/CNS Depressant? What route of admins does it exist in? (4)

Benzodiazepines
Available PO, PR, IV, IM

5

“Benzos” are used primarily for many anxieties
Also used to do what? (2)

break active, grand mal seizures, emergent sedation

6

Regarding Benzos, outpatient requires ____.
Quantities monitored carefully by State
Cannot be “phoned in”

"triplicates"

they are habituating, addictive

7

What is the prototypical benzodiazepine?

Alprozolam (Xanax®)

8

Alprozolam (Xanax®)
Indications
Mechanism of action

Indications: Short-term treatment of anxiety, panic attacks
Mechanism of action: Bind to gama-amino butyric acid (GABA) receptor-chloride channels molecules increasing the effect of GABA, a natural inhibitor neurotransmitter

9

Alprozolam (Xanax®)
Adverse Effects
Contraindications

Adverse Effects: CNS depression, drowsiness, dizziness, memory impairment, ataxia, hypotension, withdrawal seizures, dependence, esp. in elderly, debilitated, concomitant ETOH use
Contraindications: Allergy, glaucoma, drug/ETOH abuse, suicidal tendencies

10

Short term behavioral insomnia is frequently associated with ___. What else? (2)

stress
Exogenous consumption, esp. caffeine, ETOH, tobacco
Change in routine, travel, time zones

11

Long-term insomnia may be due to (3)

seconday to pain, psych problems, medication side fx

12

Insomnia
Epidemiology:
Which gender is it more common?
Occurs in # out of # adults annually
As you age, you typically need __ sleep

F > M
1 in 3 adults annually
less sleep

13

What are largest category of drugs sold?

OTC sleep aides
(Tylenol PM, Unisom, Nytol, etc.)

14

Prototypical CNS Hypnotic for sleep:

Zolpidem (Ambien®)

15

Zolpidem (Ambien®)
Indications
Mechanism of action

Indications: Short-term treatment of insomnia, to treat (not induce) daytime sedation by regulating sleep cycles
Mechanism of action: hypnotic with intermediate-term benzodiazepine-like action suppressing brain impulses through limbic and reticular activating system

16

Zolpidem (Ambien®)
Adverse Effects
Contraindications

Adverse Effects: Dizziness, daytime drowsiness, amnesia, “drugged feeling”
Contraindications: Allergy, compromised respiratory function, concomitant ETOH use, depression, debilitated/elderly, inability to get > 7 hours of uninterrupted sleep

17

Prototypical CNS Hypnotic for sleep:

Zaleplon (Sonata®)

18

Zaleplon (Sonata®)
Indications
Mechanism of action

Indications: Short-term treatment of insomnia, to treat (not induce) daytime sedation by regulating sleep cycles
Mechanism of action: hypnotic with short-term benzodiazepine-like action suppressing brain impulses through limbic and reticular activating system

19

Zaleplon (Sonata®)
Adverse Effects
Contraindications

Adverse Effects: Dizziness, daytime drowsiness, amnesia, parathesias, “drugged feeling”
Contraindications: Allergy, severe hepatic impairment, compromised respiratory function, concomitant ETOH use, depression, debilitated/elderly

20

With Doxazocin, what must you warn them when they start taking it?

Hypotension ESPECIALLY WITH THE 1ST few doses.

21

Most Benzos are schedule ___

III

22

By far the most prescribed of Benzos:

Xanax

23

If dosed high enough, xanax (benzos) can have what effect?

It takes all the highs and lows away, if dosed high enough.

24

What occurs in Benzos (Xanax) to differing degrees?

*memory impairment for all the Benzo’s, to different degrees. You need to document that you told them not to drive for this

25

Benzo's and seizures info:
Why be careful when taking someone off this who was taking it for seizures

Benzo’s raise seizure threshold – prevent them from happening.
So if they have a propensity and you LOWER the Benzo, then they’re at higher risk of the seizure.

26

Besides Xanax, name 3 other benzo's and their routes of admin:
Which one is a unique route of admin? (and what is it?)

Valium (PO, IV), Adovan (IM, IV), Midazolam (IM, IV)

Valium is PO (and injectable like the others)

27

Name 2 much longer lasting Benzo's than Xanax

Valium & Adovan

28

Which Benzo is shortest-acting?

Midazolam (Versed)
Much shorter acting

29

Flunitrazepam aka Roofies are technically in what class of drugs?

Benzo's

30

Besides meds, if they have insomnia, what else can you do to help 'em?

tell them they need a food diary. Identify things containing caffeine

31

Why can alcohol cause insomnia?

B/c it wears off, you sober, and you can't fall back asleep

32

What soda contains the most caffeine?

Mountain Dew

33

Time zone counseling (w/o meds)

ever day adjust your clock about an hour so you adjust to the time zone. If it’s only a day, stay on your local time.

34

Drug tx for ppl who moved half way around the world and/or needs to stay up to work their shift (police officers, fire fighters, & PA’s!)

Modafonil, Armodafonil

35

with insomnia, Advise patient to do what b4 you resort to drugs?

- Sleep hygiene – go to bed ‘cleanly’ the same time every night. No caffeine, no exercise, food, and with a soft light read a book – not a magazine/catalog for 20 min, then turn the light off. If 20 min pass and you can’t fall asleep, then you give them the sleep aide. Should not have a tv/radio in the bedroom

36

What is the main ingredient (and therefore an alternative choice) in OTC sleep aides like Tylenol PM, Unisom, Nytol?

Diphenhydramine

37

___ hits the Benzo receptor even though it isn't a Benzo.

Ambien

38

What's a unique adverse effect for Ambien & Sonata? (sleep meds)

Drugged-feeling