Sedatives.Anticonvulsants.Antidepressants Flashcards
(191 cards)
1
Q
DOC for acute anxiety
A
benzodiazepines
2
Q
DOC for GAD
A
benzodiazepines
buspirone
3
Q
drugs used for panic disorder
A
SSRIs
4
Q
drugs used for phobias
A
SSRIs
5
Q
drugs used for OCD
A
SSRIs
6
Q
drugs used for PTSD
A
antidepressants
7
Q
drugs used for short term insomnia
A
sedative hypnotics
8
Q
DOC for enuresis
A
TCA
9
Q
major inhibitory neurotransmitter
A
GABA
10
Q
what kind of channels associated with GABA receptors?
A
Cl-
11
Q
hydroxyzine
A
antihistamine used as anti-anxiety med
12
Q
drug that produces inhibition independent of GABA
A
barbituates
13
Q
marked CNS depressant
causes euphoria
controlled drug
A
barbituate
14
Q
drug used for induction of anesthesia
A
short-acting barbituate
thiopental
15
Q
long-acting barbituates used for?
A
phenobarbital
anticonvulsants
16
Q
kinetics of barbituates
A
induce CYP450s
liver metabolism
17
Q
SEs of barbituates
A
CNS depression
paradoxical excitement
severe physio/psych dependence
18
Q
CIs of barbituates
A
enhance porphyrin synthesis
pulmonary insufficiency
supra-additive effects (w/ other depressants)
pregnancy
19
Q
withdrawal with barbituates?
A
yes
can be severe
20
Q
toxicity of barbituates
A
low margin of safety with no ceiling effect
supra additive w/ other depressants
21
Q
do we give stimulates with barbituate overdose?
A
no
increases mortality rate
22
Q
how do we treat barbituate overdose?
A
diuresis and alkalization of the urine
23
Q
benzos with no intermediate metabolites
A
lorazepam
oxazepam
24
Q
metabolism of benzos
A
liver
CYP3A4
25
benzos with long duration
diazepam
| flurazepam
26
benzos with intermediate duration of action
alprazolam
| oxazepam/lorazepam
27
benzos with very short duration of action
midazolam
28
benzos: dependent or independent on GABA?
dependent
| binds to receptors--increase affinity--prolonged action
29
benzos: ceiling effect?
yes
30
anxiety DOC
benzodiazepines
31
sedatives used for insomnia
flurazepam
| temazepam
32
"hangover" effect
flurazepam
| temazepam
33
sedatives/anxiolytics for status epilepticus
diazepam
| lorazepam
34
what benzo can cause anterograde amnesia?
midazolam
| used in prep for anesthesia
35
benzo used for mm relaxation
diazepam
36
what benzos are used to taper withdrawal?
chlordiazepoxide
diazepam
lorazepam
37
SE of benzos
CNS depression
paradoxical excitement
supra-additive
sleep related behaviors
38
disinhibition of suppressed behavior
benzos
| especially in elderly
39
dependence with benzos?
yes but pts don't usually increase dose
40
CIs for benzodiazepines
pregnancy
sleep apnea
elderly
41
withdrawal of benzos
abrupt discontinuation= rebound insomnia/anxiety= taper slowly
42
benzos ooverdose
generally safe= long deep sleep
43
benzodiazepine antagonist
flumazenil
44
reverses effects of benzos?
flumazenil
45
flumazenil SE
triggers withdrawal and seizures in patients who are physically dependent on benzos
46
CIs of flumazenil
hx of seizures
47
"Z"drugs
zolpidem
zaleplon
eszopiclone
48
effects of z drugs
sedative
| no anxiolytic, convulsant, mm relaxant
49
MOA of Z drugs
bind to subtype of GABA receptor to increase GABA-medated inhibiton
50
use of z drugs?
insomnia
51
unique aspect of eszopiclone
long half-life=long-term treatment
52
what may increase half life of z drugs?
severe hepatic dz
53
SE of z drugs
```
GI
CNS
sleep-related behaviors
rebound insomnia (after discontinuation)
withdrawal sxs
```
54
suvorexant MOA
antagonist at orexin receptors
55
SE of suvorexant
HA
| abnormal dreams
56
CI in pts with narcolepsy
suvorexant
57
melatonin analogue
ramelteon
58
how does ramelteon work?
promotes sleepiness w/o GABA effect
59
kinetics of ramelteon
addative sedation with other depressants
60
SE of ramelteon
drowsiness
dizziness
nausea
61
MOA of chloral hydrate
acts similarly to barbituates on GABA receptor
62
safety of chloral hydrate
low margin: high doses induce respiratory and vasomotor depression
63
long term SE of chloral hydrate
liver damage
| fatal intoxication
64
benefit of chloral hydrate
cheap but not used often
65
buspirone MOA
partial agonist postsynaptic
full agonist at presynaptic
decreased 5-HT cell signaling/release
66
how long does it take to see buspirone effects?
2 weeks
67
additive effects with buspirone?
no
| no mm relaxant, sedative, anticonvulsant properties
68
anxiolytic with low addiction potential
buspirone
69
jerking x60 sec
| no LOC
simple partial seizure
70
impairment of consciousness <2 min
| automatic mvmt-lip smacking, hand wringing
complex partial
71
loss of consciousness
| originated from partial seizure
partial with secondary generalized tonic-clonic
72
loss of consciousness
| tonic rigidity followed by tremor followed by clonic violent jerking
tonic clonic
73
staring
| generally <30 sec
absence seizure
74
brief shock-like muscle contraction
myoclonic seizure
75
absence seizures associated with what channels?
voltage gated Ca channels
76
anticonvulsants that increase GABA transmission
phenobarbital
| benzos
77
anticonvulsants that inhibit sodium channels
phenytoin
carbamazepine
lamotrigine
valporate
78
anticonvulsants that inhibit thalamic calcium channels
ethosuximide
| valproic acid
79
which anticonvulsants induce CYP450s?
phenytoin
carbamaxepine
phenobarbital
80
phenytoin MOA
prolonging inactivation of Na channel
81
why is fosphenytoin IM injection?
water soluble
82
phenytoin elimination
first order at low levels then zero order at max capacity
83
drug interactions with phenytoin
warfarin
| OCP
84
what increases metabolism of phenytoin?
carbamazapine
85
SE of phenytoin
gingival hyperplasia
hirstuism
teratogenic
86
DOC for partial seizures
carbamazepine
87
carbamazepine MOA
inhibits sodium channels-- decreases transmitter release
88
other uses for carbamazepine
trigeminal neuralgia
| bipolar d/o
89
pharmacokinetics of carbamazepine
induces liver enzymes--drug interactions
| induces its own metabolism
90
drug interactions with carbamazapine
phenytoin
ethosuximide
valproic acid
91
what drugs inhibit carbamazaepine metabolism?
cimetidine
fluoxetine
isoniazid
erythromycin
92
SE of carabamazapine
```
GI
double vision, ataxia
blood dyscrasias
teratogenic
SJS
```
93
test for SJS
HLA-B1502
94
phenobarbital MOA
prolongs opening of GABAa receptor chloride channel
95
phenobarbital anticonvulsant uses
partial and generalized tonic-clonic
96
phenobarbital CI
pregnancy
97
lamotrigine MOA
inactivates voltage dependent Na channels
98
lamotrigine uses
partial seizures add on
| absence seizures in children
99
SE of lamotrigine
dizzy, HA
teratogenic
hypersensitiivity
100
gabapentin MOA
GABA analogue
| may increase GABA release
101
gabapentin use
adjunct for partial and generalized tonic-clonic
| neuropathic pain
102
gabapentin SE
```
dizzy, drowsy
ataxia, HA
tremor
weight gain
teratogenic
```
103
pregabalin MOA
GABA analogue
| binds to voltage-gated sodium channel-inhibt excitatory NT
104
pregabalin uses
```
anticonvulsant w/ sedative properties
neuropathic pain
fibromyalgia
post-op pain
pruritus
restless leg syndrome
```
105
SE of pregabalin
```
peripheral edema
dizzy
fatigue
weight gin
xerostomia
ataxia
blurred vision
GI
Cat C
```
106
topiramate MOA
inhibits voltage-dependent Na channels-- enhance GABA currents
107
topiramate use
broad spectrum
| inhibit spread of seizures
108
SE of topiramate
```
dizziness
sedaion
nervous
confusion
Cat C
decreased OCP
```
109
levetiraceam MOA
reduces glutamate release while increasing GABA release
110
levetiraceam use
partial, myoclonic, generalized tonic-clonic
111
SE of levetiraceam
dizziness
somnolence
ataxia
asthenia
112
tiagabine MOA
inhibits uptake of GABA
113
tiagabine use
adjunct for partial sizures
114
SE of tiagabine
nervousness
dizziness, tremor
Cat C
115
vigabatrin MOA
irreverisble inhibitor of GABA rransaminase which breaks down GABA
116
vigabatrin use
refrctory adult complex partial seizures
| infantile spasm
117
SE of vigabatrin
constriction of visual field, retinal damage
drowsy
dizzy
weight gain
118
CI of vigabatrin
pre-existing mental illness
119
DOC for absence seizures
ethosuximide
120
ethosuximide MOA
reduces low threshold Ca2+ current in thalamus
121
SE of ethosuximide
GI
SJS
Cat C
122
valproic acid MOA
inhibits Na channels=increased GABA
123
valproic acid use
absence seizures
124
DOc for combo of absence and generalized tonic-clonic seizures
valproic acid
125
other uses for valproic acid
bipolar
| migrain prophylaxis
126
SE of valproic acid
GI
hepatotoxicity
SJS
Cat D
127
CI of valproic acid
liver diz
128
drug interactions of valproic acid
inhibits own metabolism at low doses
| inhibits metabolism of phenytoin, carbamazepine
129
clonazepam use
*benzo*
| absence seizures
130
clonazepam SE
sedation
| tolerance to antiseizure effect
131
drugs used for status epilepticus
diazepam
| lorazepam
132
DOC for status epilepticus
diazepam
133
monoamine hypothesis of depression
enhancement of monoamine neurotransmission
134
neurotrophic hypothesis of depression
los of neutrophic agents contribute
| BDNF
135
neuroendocrine hypothesis of depresion
dysregulation of the HPA axis
| increased glucocorticoid release and decrease in brain glucocorticoid receptor activity
136
TCA MOA
inhibit uptake of Ne and 5HT
| block muscarinic, alpha adrenergic and histamine receptors
137
tertiary amine TCA OMA
inhibit 5HT and Ne reuptake
138
secondary amine TCA MOA
more effect on NE reuptake
| fewer CV effects, sedation
139
drug interactions with TCAs
common
| metabolized by CYPs in liver
140
CNS SE of TCAs
drowsy, sedating
memory, cognition-anticholinergic effect
decreased seizure threshold
141
peripheral SE of TCAs
```
cardiac arrhythmias-TdP
postural hypotension
weight gain
anticholinergic effects
SIADH-hyponatremia
sexual dysfunction
```
142
why is there postural hypotension with TCAs?
alpha1 blockade
143
uses of TCA
```
depression
panic d/o
chronic pain
fibromyalgia
enuresis
```
144
what can we use for enuresis?
imipramine
145
anticholinergic SE are more common with what TCAs?
tertiary
146
can TCAs be used in pregnancy?
yes
147
TCA overdose
very dangerous
| TdP
148
severe hypotension
agitation
neuromuscular excitability
seizuresq
TdP
| TCA Od
149
TCA drug interactions
serotonin syndrome w/ MOAI
| fluoxetine (+other SSRIs) compete for metabolism=toxic levels
150
issues with TCA and SSRI together
compete for metabolism=toxic levels of TCA
151
TCA +sympathomimetic drugs
hypertension
152
TCAs and CNS depressants
potentiate sedation
153
```
restlessness
mm twitching
hyperreflexia
sweating
proceeds to hyperpyrexia, convulsions
```
serotonin syndrome
154
DOC for depression
SSRI--citalopram
155
SSRIs that inhibit CYP2D6
*fluoxetine
| paroxetine
156
uses of SSRIs
```
depression
panic d/o
OCD
social anxiety
bulimia
EtOHism
```
157
preferred SSRI in elderly
sertraline
158
issues with fluoxetine
inhibits CYP2D6
| impairs BG in DM
159
agoraphobia DOC
SSRI
160
OCD DOC
paroxetine
161
social anxiety DOC
paroxetine
162
SE of SSRIs
Gi
CNS stimulation
sexual dysfunction/libido
photosensitivity
163
SSRIs with higher occurence of anxiety/insomnia
fluoxetine
| sertaline
164
SSRI that may cuase sedation
paroxetine
165
drug interactions with SSRIs
```
serotonin syndrome- MAOI, St. johns Wort
TCAs
Warfarin
phenytoin, carbamazapine
beta blockers
opioids
```
166
venlafaxine MOA
5HT and NE reuptake inhibitors
167
uses of venlafaxine
depression
neuropathic pain
post-menopausal hot flashes
168
duloxetine MOA
5HT and NE reuptake inhibitors
169
SE of duloxetine
hepatotoxicity
| acute angle closure glaucoma
170
MAO A
metabolizes NE, 5HT and DA in CNS AND GI tract
171
MAO B
metabolizes DA in the CNS ONLY
172
GI effects: MAOA or MAOB?
MAO A
173
phenelzine MOA
inhibits both MAOA and MAOB
174
drug of last choice for depression
phenelzine
175
selegiline MOA
irreversibly inhibits only MAOB
176
use for selegiline
Parkinson's
177
how long do MAOI effects last?
1-3 weeks after d/c because long half life and irreversible inhibition
178
SE of MAOI
HTN crisis
orthostatic hypotension
weight gain
anticholinergic effects
179
HTN crisis with MAOI
inhibition in GI tract=accumulation of tyramine--> release catecholamines--> crisis
180
how do we treat HTN crisis caused by MOAI?
alpha blocker
181
MAOI drug interactions
sympathomimetic--HTN
| mepiridine, dextromethorphan, TCA, SSRI=serotonin syndrome
182
buproprion MOA
inhibits reuptake of DA
183
Zyban
extended release buproprion used for smoking cessation
184
SE of buproprion
seizures
185
mirtazapine
blocks presynaptic alpha2 receptors= increased release of NE and 5HT
186
mirtazapine SE
drowsiness-histamine blocker
187
atomoxetine MOA
SNRI
188
non-stimulant treatment for ADHD
atomoxetine
189
SE of atomoxetine
GI
| insomnia
190
trazadone MOA
5 HT2a receptor antagonist
191
use of trazadone
often sleep aid or pain mgmt
