Pharm2 6 Neuro pt2

Question 1

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

Answer 1

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

Question 2

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

Answer 2

General anxiety disorder

Question 3

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

Answer 3

Panic Disorder

Question 4

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

Answer 4

Benzodiazepines

Available PO, PR, IV, IM

Question 5

“Benzos” are used primarily for many anxieties

Also used to do what? (2)

Answer 5

break active, grand mal seizures, emergent sedation

Question 6

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

Answer 6

“triplicates”

they are habituating, addictive

Question 7

What is the prototypical benzodiazepine?

Answer 7

Alprozolam (Xanax®)

Question 8

Alprozolam (Xanax®)
Indications
Mechanism of action

Answer 8

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

Question 9

Alprozolam (Xanax®)
Adverse Effects
Contraindications

Answer 9

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

Question 10

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

Answer 10

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

Question 11

Long-term insomnia may be due to (3)

Answer 11

seconday to pain, psych problems, medication side fx

Question 12

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

Answer 12

F > M
1 in 3 adults annually
less sleep

Question 13

What are largest category of drugs sold?

Answer 13

OTC sleep aides

Tylenol PM, Unisom, Nytol, etc.

Question 14

Prototypical CNS Hypnotic for sleep:

Answer 14

Zolpidem (Ambien®)

Question 15

Zolpidem (Ambien®)
Indications
Mechanism of action

Answer 15

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

Question 16

Zolpidem (Ambien®)
Adverse Effects
Contraindications

Answer 16

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

Question 17

Prototypical CNS Hypnotic for sleep:

Answer 17

Zaleplon (Sonata®)

Question 18

Zaleplon (Sonata®)
Indications
Mechanism of action

Answer 18

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

Question 19

Zaleplon (Sonata®)
Adverse Effects
Contraindications

Answer 19

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

Question 20

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

Answer 20

Hypotension ESPECIALLY WITH THE 1ST few doses.

Question 21

Most Benzos are schedule ___

Answer 21

III

Question 22

By far the most prescribed of Benzos:

Answer 22

Xanax

Question 23

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

Answer 23

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

Question 24

What occurs in Benzos (Xanax) to differing degrees?

Answer 24

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

Question 25

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

Answer 25

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.

Question 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?)

Answer 26

Valium (PO, IV), Adovan (IM, IV), Midazolam (IM, IV) Valium is PO (and injectable like the others)

Question 27

Name 2 much longer lasting Benzo's than Xanax

Answer 27

Valium & Adovan

Question 28

Which Benzo is shortest-acting?

Answer 28

Midazolam (Versed) | Much shorter acting

Question 29

Flunitrazepam aka Roofies are technically in what class of drugs?

Answer 29

Benzo's

Question 30

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

Answer 30

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

Question 31

Why can alcohol cause insomnia?

Answer 31

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

Question 32

What soda contains the most caffeine?

Answer 32

Mountain Dew

Question 33

Time zone counseling (w/o meds)

Answer 33

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.

Question 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!)

Answer 34

Modafonil, Armodafonil

Question 35

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

Answer 35

- 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

Question 36

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

Answer 36

Diphenhydramine

Question 37

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

Answer 37

Ambien

Question 38

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

Answer 38

Drugged-feeling