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Session 3 Pharm- 5

Pharm -5- Sedative Hypnotics

What does the following describe unpleasant state of tension, apprehension, or uneasiness anxiety
What are the symptoms of severe anxiety tachycardia, sweating, trembling, palpitations involving sympathetic activation
Why are anti anxiety meds considered both anxiolytic and hypnotic because they cause sedation as well as decrease anxiety
What are the underlying physiologic causes of anxiety (what is happening at the neurotransmitter level) functional deficiency of GABA and serotonin mediated systems or over activity of circuits mediated by norepinephrine
What is sedation decreased anxiety, decreased motor and mental activity
what is hypnosis drowsiness and increased tendency to sleep
If you are going to prescribe a sedative hypnotics what do you need to make sure you talk to your patient about make sure pt is not taking EtOH and understand not to combine them with EtOH especially if you are going to prescribe benzodiazepine
if your pt feels restless, edgy, keyed up, tires easily, has trouble concentrating tendency for mind to go blank, irritability, increased muscle tension, trouble sleeping for over half the days in a six month period what does you pt likely have General Anxiety disorder GAD
What may you want to prescribe to blunt the sympathetic symptoms of anxiety low dose beta blocker
What are the four types of antidepressants list them in order of effectiveness SSRI/SNRI > TCAs > MAOIs
What is the 1st line tx for SHORT TERM management of generalized anxiety disorder Benzodiazepines
What adjunt therapy can you Rx to help pt while you wait for SSRIs or SNRIs to reach therapeutic effectiveness Benzos
What drug can you prescribe in a low dose to help with panic attack tremors and palpitations Beta Blocker
What non drug treatment may be helpful for patients with anxiety disorders cognitive-behavioral therapy (relaxation therapy
What is the 1st line tx for Anxiety disorder Antidepressants because of broad spectrum of efficacy
What is the 1st line tx for LONG-TERM management of GAD (generalized anxiety disorder) antidepressants- SNRI; venlafaxine (Effexor), SSRIs; Paroxetine (Paxil) and escitalopram (Lexapro)
How long will it take for you to see an effect from antidepressant therapy and how long to reach full therapeutic response takes 2-4 weeks to see effect and 10-12 weeks to reach full therapeutic response
What are some of the most concerning S/E of SSRIs for pts that you would want to educate them about sexual dysfunction and loss of libido, weight gain, d/c withdrawal effects some of the major ones also GI distress, jitteriness, headaches, sleep disturbances, sedation, inc B/P, Increased urinary retention
What type of drug is Fluoxetine (Prozac) SSRI
What type of drug is sertraline (Zoloft) SSRI
What type of drug is paroxetine (Paxil) SSRI
What type of drug is fluvoxamine (Luvox) SSRI
What type of drug is citalopram (Celexa) SSRI
What type of drug is Escitalopram (Lexapro) SSRI
What type of drug is Venlafaxine (Effexor) SNRI
What type of drug is duloxetine (Cymbalta) SNRI
what type of drug are the following; alprazolam (Xanax), chlordiazepoxide(librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (valium), Lorazepam (Ativan, oxazepam, triazolam (Halcion) benzodiazepines
Which benzo drug has the worst sedation effects and has extensive hepatic metabolism leading to a lot of drug interactions and has a hang over effect because of its metabolite diazepam
What drug is 1st line tx for panic disorder SSRIs
What drug type is 1st line for social anxiety disorder SSRIs-Paroxetine (Paxil), Sertraline (Zoloft) and SNRI- venlafaxine XR (Effexor)
Which benzos are short acting triazolam and oxazepam
which benzos are intermediate acting alprazolam, Lorazepam, estazolam, temazepam
Which benzos are long acting diazepam, flurazepam, quazepam, chlordiazepoxide, clorazepate
Do benzos directly bind GABA site on GABA receptor no they bind a site adjacent to the GABA site on the cell membrane receptor with high affinity
What is the MOA of Benzos they bind receptor next to GABA receptor and open the chloride channel hyperpolarizing the cell by allowing influx of negative chloride ions. This moves cell away from threshold
What are benefits of benzos effective, well tolerated, can be used PRN for situational anxiety and have a rapid onset of therapeutic effect.
What are some drawbacks of using benzos sedation, cognitive, and psychomotor impairment. Interaction with alcohol. Physiologic dependence with ongoing therapy. D/C side effects, abuse potential, not effective for comorbid depression
T/F benzos are effective for comorbid depression False
What type of drug is Triazolam Benzodiazepines
What type of drug is oxazepam benzo
What type of drug is Lorazepam Benzodiazepines
What benzo is indicated for elderly patients and why Oxazepam and Lorazepam- they aren't likely to accumulate with repeated dosing
What are some of the s/e of benzos CNS depression, Anterograde amnesia, Respiratory depression
How can you reverse the sedative effects of benzos give flumazenil it is a competitive antagonist of the benzo receptor. Can be given to treat benzo overdose. Given IV
When are benzos contraindicated contraindicated in pregnancy and nursing can cause birth defects in 1st trimester
What education do you have to give for pt taking benzos about stopping there use taper withdrawal or you can have a withdrawal syndrome marked by delirium, paranoia, panic, muscle twitches and convulsions
What education do you have to give pt about using benzos and possible drug interactions do not use EtOH while taking benzos or any other CNS depressants like TCAs or opioids or antipsychotic agents,
What do the following have in common with benzos erythromycin, clarithromycin, ritonavir, itraconazole, ketoconazole, nefazodone and grape fruit juice they all use the CYP3A4 cytochrome p450 isoenzyme for metabolism so you can have potential drug interactions with them and benzos
You need a sedative hypnotic to treat anxiety in a pregnant women/ breast feeding woman what drug would you prescribe her that doesn't have any abuse potential buspirone- partial agonist at brain 5HT1a receptors, does not cause sedation, no abuse potential, slow onset of anxiolytic effects, minor psychomotor impairment and safe to use in pregnancy and lactation
What effect does rifampin have on buspirone decreases plasma levels
What effect does erythromycin and ketoconazole have on buspirone increases plasma levels
What sedative hypnotic would you prescribe if you needed to help a pt suffering from insomnia that doesn't have any anxious or nervous symptoms zolpidem (Ambien) and Zaleplon (sonata); they have a fast onset of action, no anxiolytic, muscle relaxant or anticonvulsant properties they just are for short term treatment of insomnia
Created by: smaxsmith