WK 3 - PHARM slides

Question 1

Safest and most effective for depression, anxiety…

Answer 1

SSRIs
Fluoxetine

Selective
Serotonin
Reuptake
Inhibitors

Question 2

What is the MOA of SSRIs?
Fluoxetine

Answer 2

inhibits serotonin reuptake

not allowing to go into cells so floating around in blood

Question 3

What are the SSRIs (-tine)
fluoxetine used for?

Answer 3

DEPRESSION

bipolar, OCD, Panic, bulimia, premenstrual dysphoric disorders

Question 4

Which is safer?

TCA, MAOI, SSRI

Answer 4

SSRI

better tolerated and just as effective as TCA and MAOI

Question 5

Is the suicide risk higher or lower when taking SSRIs?

Answer 5

Higher - patient starts feeling better but still has suicidal ideas and now hows the energy to follow through with plan

Question 6

What are the side effects of SSRIs, Fluoxetine?

Answer 6

Suicide Risk
Sexual dysfunction
weight gain
Serotonin syndrome
withdrawal symptom if stopped abruptly
Bruxism

Question 7

Bruxism - what is it and what should you do about it?

Answer 7

Clenching teeth, headache

See a dentist to get a guard

Question 8

S/S of serotonin syndrome…

Answer 8

agitation
confusion
anxiety
fever
diaphoresis
tremors

Question 9

How long before beginning to feel therapeutic effects of fluoxetine (SSRIs)?

Answer 9

2 or more weeks

Question 10

Fluoxetine drug interactions…

Answer 10

MAOI - 14 day gap stoppage before giving fluoxetine

Stop PROZAC 5 weeks before starting MAOI

Do NOT combine with TCA or Lithium

Monitor response to warfarin

Question 11

SSRIs & SNRIs

What is the difference?

Answer 11

They have the same effect

But…

SSRI = safer

SNRI - added norepinephrine

Question 12

SNRI -Serotonin Norepinephrine reuptake inhibitors. MOA-

(-ine)
Venlafaxine
Duloxetine

Answer 12

inhibits serotonin and norepinephrine reuptake

Question 13

Venlafaxine adverse effects:

Answer 13

neonatal withdrawal syndrome with late pregnancy use

withdrawal syndrome of stopped abruptly

do NOT take with MAOIs

Question 14

Duloxetine adverse effects

Answer 14

Liver toxicity -

no ETOH
no Liver disease patients

Question 15

TCA = Tricyclic Antidepressants

MOA

Imipramine
amitriptyline

Answer 15

increase effects of serotonin and norepinephrine in the CNS

Question 16

Side effects of SNRIs

duloxetine
venlafaxine.

Answer 16

Serotonin Syndrome (St. John’s wort)
fatigue,
insomnia
constipation
nausea
decreased libido
suicide risk

Question 17

Indications of SNRIs

duloxetine
venlafaxine. (-ine)

Answer 17

Depression, anxiety, neuropathic pain

Question 18

TCA = Tricyclic Antidepressants

Adverse effects

Imipramine
amitriptyline

Answer 18

Dangerous - (SSRI more safe)

• Cardiac toxicity and risk of overdose
• MOST COMMON - orthostatic hypotension
• Anticholinergic effects (can’t see, pee, spit, poop - BUT you do sweat)
• Tachycardia
• arrhythmias
• seizures
• hypomania
• suicide risk

Question 19

How many doses is lethal for TCAs?

Imipramine?

Answer 19

8 times the daily dose

only give one week supply to patients

Dosing is best once daily at bedtime due to sedation effects

Question 20

MAOIs - when in the treatment of depression would you bring in, how effective are they, and how safe are they?

Answer 20

Later choice

effective

Dangerous

Question 21

What should you avoid if on MAOIs that cause hypertensive crisis?

Answer 21

foods rich in TYRAMINE

fermented
aged cheese
cured meats
avocado
bananas
red wine
caffeine
pepperoni

Question 22

Hypertensive crisis - s/s =

Answer 22

SEVERE HEADACHE

extremely high BP
Stroke - bleed
Confusion
Lethargy

Question 23

What is the drug of choice for Atypical depression?

depression with a temporary mood boost

Answer 23

MAOIs

Question 24

When taking MAOIs you should avoid…

Answer 24

ALL meds that have not been approved by DR

Question 25

Atypical Antidepressants - Bupropion (wellbutrin) what is in contrast with SSRIs?

Answer 25

Atypical antidepressants do not cause weight gain or sexual dysfunction appears to increase sexual desire and pleasure

Question 26

what are the two reasons for using Buproprion?

Answer 26

Atypical Depression Smoking Cessation BE APPROPriate and don't smoke

Question 27

Bupropion MOA =

Answer 27

decreased reuptake of dopamine and norepinephrine

Question 28

Adverse side effects of Bupropion =

Answer 28

Seizures Suicide risk small risk of hallucination and delusions so do not take if you have a psychotic disorder

Question 29

Most common side effects of Buproprion =

Answer 29

agitation, headache, dry mouth, constipation, weight loss, blurred vision, dizziness, tachycardia

Question 30

What are the 5 most common anxiety disorders?

Answer 30

GAD Panic Disorder OCD PTSD Social anxiety disorder

Question 31

Difference between general anxiety and panic attacks

Answer 31

general = doom, guilty panic = no self worth

Question 32

What drugs are used for anxiety disorders?

Answer 32

SSRIs SNRIs Benzodiazepines Respond well to both psychotherapy and drug therapy. Or just psychotherapy

Question 33

For Anxiety disorders - which drugs are for short term and long term?

Answer 33

Short Term = Benzodiazepines Long Term = SSRIs & SNRIs

Question 34

what types of disorders for SSRI?

Answer 34

All anxiety disorders Do not have to have depression to use No potential for abuse

Question 35

What types of disorders for benzodiazepines?

Answer 35

GAD Panic Disorder potential for abuse

Question 36

Benzodiazepines - suffixes

Answer 36

-pam -lam

Question 37

What are the side effects for Benzodiazepines?

Answer 37

Everything lower... * sedation * amnesia * muscle relaxant * respiratory depression create worsening hypoxemia (COPD pt ex) and hypoventilation, exacerbates sleep apnea Knocks out respiratory drive

Question 38

What route has effects on heart when giving benzodiazepines?

Answer 38

PO = no effect on heart IV = profound hypotension and cardiac arrest

Question 39

Benzodiazepines MOA = diazepam lorazepam alprazolam

Answer 39

enhances GABA effects on CNS Safer than Barbiturates

Question 40

Benzodiazepines - what to know about their half-lifes?

Answer 40

Very long half-lifes

Question 41

What happens with onset and duration of benzodiazepines?

Answer 41

Inset and duration of action accumulate

Question 42

When to use benzodiazepines?

Answer 42

for Anxiety insomnia seizures muscle spasms alcohol withdrawals

Question 43

Adverse effects of Benzodiazepines?

Answer 43

CNS depression Low BP Respiratory Depression Sedation amnesia PAM takes lorazePAM for her anxiety. She does not drive her BENZ anymore because BENZos cause sedation

Question 44

What is the antidote for Benzos for sedation effects?

Answer 44

flumazenil will not reverse respiratory depression dependance is low

Question 45

Buspirone does not have CNS effect uses:

Answer 45

GAD

Question 46

Compare Benzodiazepines and Buspirone?

Answer 46

Buspirone has the same effect as Benzodiazepines but... NO abuse potential NO effects on the CNS

Question 47

Adverse effects of Buspirone

Answer 47

dizziness nausea headache lightheadedness excitiement

Question 48

Drug/Food interactions for Buspirone

Answer 48

Grapefruit Juice Erythromycin ketoconazole

Question 49

Drugs of choice for panic disorders

Answer 49

SSRI. (preferred) SNRI TCA MAOI Benzos = 2nd line

Question 50

OCD = drugs and definition

Answer 50

compulsions that consume at least one hour per fay and interfere with daily activities Drugs -- SSRIs. with behavioral therapy

Question 51

Social anxiety disorders - defintion and therapy

Answer 51

intense irrational fear of being scrutinized, embarrassed, humiliated. Psychotherapy and/or SSRI Benzos for performance anxiety = benzos. (one before public speaking, for example)

Question 52

PTSD - Psychotherapy and drugs

Answer 52

Trauma focused therapy Stress inoculation training SSRI TCA or MAOI