Pharm -5- Sedative Hypnotics
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| What does the following describe unpleasant state of tension, apprehension, or uneasiness | anxiety
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| What are the symptoms of severe anxiety | tachycardia, sweating, trembling, palpitations involving sympathetic activation
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| Why are anti anxiety meds considered both anxiolytic and hypnotic | because they cause sedation as well as decrease anxiety
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| 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
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| What is sedation | decreased anxiety, decreased motor and mental activity
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| what is hypnosis | drowsiness and increased tendency to sleep
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| 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
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| 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
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| What may you want to prescribe to blunt the sympathetic symptoms of anxiety | low dose beta blocker
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| What are the four types of antidepressants list them in order of effectiveness | SSRI/SNRI > TCAs > MAOIs
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| What is the 1st line tx for SHORT TERM management of generalized anxiety disorder | Benzodiazepines
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| What adjunt therapy can you Rx to help pt while you wait for SSRIs or SNRIs to reach therapeutic effectiveness | Benzos
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| What drug can you prescribe in a low dose to help with panic attack tremors and palpitations | Beta Blocker
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| What non drug treatment may be helpful for patients with anxiety disorders | cognitive-behavioral therapy (relaxation therapy
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| What is the 1st line tx for Anxiety disorder | Antidepressants because of broad spectrum of efficacy
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| 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)
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| 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
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| 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
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| What type of drug is Fluoxetine (Prozac) | SSRI
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| What type of drug is sertraline (Zoloft) | SSRI
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| What type of drug is paroxetine (Paxil) | SSRI
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| What type of drug is fluvoxamine (Luvox) | SSRI
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| What type of drug is citalopram (Celexa) | SSRI
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| What type of drug is Escitalopram (Lexapro) | SSRI
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| What type of drug is Venlafaxine (Effexor) | SNRI
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| What type of drug is duloxetine (Cymbalta) | SNRI
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| what type of drug are the following; alprazolam (Xanax), chlordiazepoxide(librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (valium), Lorazepam (Ativan, oxazepam, triazolam (Halcion) | benzodiazepines
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| 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
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| What drug is 1st line tx for panic disorder | SSRIs
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| What drug type is 1st line for social anxiety disorder | SSRIs-Paroxetine (Paxil), Sertraline (Zoloft) and SNRI- venlafaxine XR (Effexor)
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| Which benzos are short acting | triazolam and oxazepam
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| which benzos are intermediate acting | alprazolam, Lorazepam, estazolam, temazepam
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| Which benzos are long acting | diazepam, flurazepam, quazepam, chlordiazepoxide, clorazepate
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| 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
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| 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
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| What are benefits of benzos | effective, well tolerated, can be used PRN for situational anxiety and have a rapid onset of therapeutic effect.
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| 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
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| T/F benzos are effective for comorbid depression | False
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| What type of drug is Triazolam | Benzodiazepines
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| What type of drug is oxazepam | benzo
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| What type of drug is Lorazepam | Benzodiazepines
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| What benzo is indicated for elderly patients and why | Oxazepam and Lorazepam- they aren't likely to accumulate with repeated dosing
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| What are some of the s/e of benzos | CNS depression, Anterograde amnesia, Respiratory depression
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| 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
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| When are benzos contraindicated | contraindicated in pregnancy and nursing can cause birth defects in 1st trimester
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| 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
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| 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,
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| 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
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| 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
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| What effect does rifampin have on buspirone | decreases plasma levels
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| What effect does erythromycin and ketoconazole have on buspirone | increases plasma levels
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| 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
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