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Pharm Anxiety Depression
KYCOM Block 12
99
Pharmacology
Graduate
11/17/2013

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Term
what are the constraints that make anxiety normal
Definition
brief
event related
unconcious, no control
Term
what are symptoms of anxiety
Definition
muscle tone
sweating
tachycardia
tachypenia
weakness
irritability
fatigue
Term
what are the two rules of diagnozing generalized anxiety disorder
Definition
symptoms >6 mo
3+ symptoms from the list
Term
what are the symptoms of generalize anxiety disorder
Definition
excessive anxiety
worry that is difficult to control
feeling on edge
poor concentration/ mind blanking
restlessness, fatigue, sleep disturbance
muscle tension, irrtability
social, occupation, functional impairment
poor coping abilities
Term
what is the non-medication tx for generalized anxiety disorder
Definition
psycho-education
short term councling
stress management
psycho-therapy
exercise
Term
what medications are used to tx acute anxiety, why, what redigmen
Definition
BZD for 2 weeks
most effective, safe, rapid
Term
what medications are used to treat chronic anxiety (4)
Definition
SSRI, SNRI, TCA, buspirone
Term
what medication is used to tx anxiety in kids under 12 (1)
Definition
anti-histamines
Term
what medications are used to treat anxiety in elderly (3)
Definition
burpirone
lorazepam
osazepam
Term
what medications are used to tx anxiety in hepatic failure (2)
Definition
lorazepam
osezepam
Term
what is the map of tx for chronic anxiety
Definition
venlafaxine or SSRI
no effect: switch
no effect: imipramine, busprione, hydroxyzine, pregalbalin, duloxetine
no effect: BZD 2-4 weeks
Term
what are syptoms of panic disorder
Definition
depersonalization
de-realization
fear of loosing control
fear of going crazy
fear of dying
abdominal distress, chest pain, chills, dizzy, choking, hot flashes, palpitations, nausea, paresthesias, SOB, sweating, tachycardia, trembling
Term
what is the non-medication tx for panic disorder
Definition
avoid percipitating substances (caffiene, stimulants)
cognative behavorial therapy
self help books
exercise
Term
what medicine is used for acute/urgent panic dosorder
Definition
BDZ
Term
what is the map of tx for chronic panic disorder
Definition
SSRI or venlafaxine
no effect: switch or try imipramine
no effect: BZD, pindolol, anti-depressant
Term
what are the signs of SAD
Definition
intense irrational persistant fear of being negativley evaluated, scrutinized, or embarrased
fear of adressing group, eating with others, interacting with authority, talking to strangers, using public toiles

blushing, butterflies, diarrhea, sweating, tachycardia, trembling
Term
what are the two types of SAD, describe them
Definition
generalized: avoids wide range of social stituations

non-generalized: fear limited to specific situations
Term
what is the non-medicine tx for SAD
Definition
cognative behavorial therapy for several months in a group
Term
what medicines are used to tx SAD
Definition
antidepressants: SSRI (paroxetine), SNRI
BZD (clonazepam)
GABA analog: gabapentin, pregabaline
B-blocker for "performance" one hour prior
Term
what are the conditions for diagnosis of PTSD
Definition
exposure to traumatic event (witness, experienced, confronted with sutation possible harm) with response of fear, helplessness, horror
Term
what is the map of tx for PTSD
Definition
SSRI (sertaline) for 12 mo
no response: different SSRI, venlafaxine XR
no response: TCA, mirtazapine
Term
signs of OCD
Definition
patients are secretative, hard to diagnosed
often have eczema, chapped skin
compulsive hand washing or teeth brushing
Term
OCD tx
Definition
therapy, SSRI
Term
what anxiety drug can be used in those with substance abuse problems
Definition
busprione
Term
benzodiazapine MOA
Definition
y-aminobutyric acid (GABA) opens Cl channel causing hyperpolarization at post-synapse inhibiting action potential

drug binds to receptors next to GABA receptors increasing GABA affinity (allosteric modulation) causing more Cl channel opening and further inhibition
Term
what are the two types of BDZ and what are they involved with
Definition
BZ1: deals with sleep
BX2: deals with memory, cognative function, muscles, anti-convulsant, ataxia, emotion, anxiolytic
Term
which BDZ has a different MOA, why
Definition
chlorazepate: prodrug that turns into active metabolite
Term
what are the short acting BDZ, how long
Definition
3-8h
osazepam
Term
what and the intermediate acting BDZ, how long
Definition
Lorazepam
alprazolam
10-20h
Term
what are the long acting BDZ, how long
Definition
chlordiazepoxide
diazepam
chlorazepate
1-3d
Term
can you use BDZ in pregnancy, why
Definition
no, crosses placenta and breast milk
Term
what are the main side effects ob BDZ
Definition
drowsiness
confusion
ataxia and fine motor loss
congative impairment (long term recall, new learning)
potentiate alcohol (CNS depressant)
tolerance with time
withdwarl
Term
what occurs in BDZ withdrawl
Definition
anxiety
insomnia
irritability
weakness

severity is drug and dose dependant
avoid with titration
Term
where does BDZ distribute to
Definition
lipid soluble: goes to brain and perused organs first
Term
where and when and how is BDZ metabolized
Definition
metabolized to water soluble in liver before elimination

oxidation, hydroxylation, conjugation with glucuronic acid
Term
where and when is BDZ excreted
Definition
after metabolized in urine
Term
what BDZ have different metabolism, why
Definition
lorazepan and oxazepam bipass liver oxidation and have shorter half life
Term
what substances can reduce oxidation of BDZ in liver
Definition
liver disease
cimetidine
contraceptives
Term
what drug is a benzodiazepine antagonist
Definition
fulmazenil
Term
how does fulmazenil work
Definition
binds to sites to competitavly antagonize allosteric effect of BDZ
Term
why would you use fulamazenil
Definition
BDZ over dose or side effects
Term
what drug is a azapirone
Definition
buspirone
Term
MOA buspirone
Definition
partial agonist to 5HT receptors in limibc which activate G receptors and open K channel hyperpolarizing and decreasing firing
Term
side effects of buspirone
Definition
little CNS depression, motor effect, muscle relaxing, anti-convulsant

no physical dependance or withdrawl

headache, dizziness
Term
which anxiety drugs have slowest onset
Definition
buspirone, SSRI
2 weeks
Term
what are two SSRI are for anxiety
Definition
paroxentine
sertaline
Term
SSRI MOA
Definition
inhibit re-uptake of serotonin at transporter
blocking removal increases concentration at synaptic cleft
Term
SSRI side effects
Definition
no dependance, withdrawl, CNS depression alcohol potentiation

insomnia, tremor, palpitations, vasldilation, NVD, loss of lobido

paroxetine: postural hypotension

anorexia, nausea, vomiting, diarrhea

loss of libido, sexual dysfunction
Term
SSRI distribution
Definition
protein bound
Term
SSRI metabolizm and excretion
Definition
metabolized in liver
excreted in feces and urine
Term
what drugs alter SSRI
Definition
cimetidine increase half life
MAOI can be fatal (wait 14 d for switch)

TCA inhibits metabolism

tryptophan increases serotonin effect

warfarin increases bleeding risk
Term
what drug is a SNRI (3)
Definition
venlafaxine
duloxetine
desvenlafaxine
Term
MOA SNRI
Definition
block serotonin and NE re-uptake transporters
Term
side effects SNRI
Definition
simillar to SSRI

hypertension

do not abruptly DC, slowly titrate due to BP effects
Term
what are the anti-histamine anxiety drugs
Definition
Piperazine Deratives...
Hydroxyzine HCl
Kydroxyzine Pamoate
Term
MOA anti-histamine anxiety drugs
Definition
antagonizes H1 receptor (excitatory) located in hippocampus and cortex
Term
side effects of anti-histamine anxiety drugs
Definition
sedation
do not combine with alcohol
Term
MOA mirtazapine
Definition
blocks pre-synaptic autoreceptors for NE and 5HT and increases NE and 5HT at synapse
Term
in who is depression most common
Definition
women
Term
define unipolar depression
Definition
no family history
Term
what is the most common form of depression
Definition
unipolar
Term
what are signs of depression
Definition
affective, cognative, motor, somatic
prominent and persistent symptoms
anhedonia
insomnia
fatigue
worthlessness andguild
inability to concentrate
thoughts of death or suicide
Term
define anhedonia
Definition
loss of interest in activities
Term
what is the prognosis of depression
Definition
usually does not reoccur once subsides
10-15% suicide
40-50% improve with tx
Term
what do you do if someone has reoccuring depression
Definition
prophlyactic tx
Term
signs of manic depression
Definition
eophoric mooods
pressured speech
psychomotor aggitation
distractability
insomnia
severe depression spells
Term
why shouldnt you use paroxetine in eldery
Definition
postural hypotension
Term
which SSRI are for depression
Definition
citalopram
escitalopram
paroxetine
sertaline
fluxetine
Term
which SSRI are for SAD, PTSD, OCD, which is PTSD DOC
Definition
paroxetine
sertaline - PTSD DOC
Term
uses of SNRI
Definition
depression
chronic anxiety
chronic panic
SAD
PTSD
Term
uses of piperazine derivatives
Definition
chronic anxiety
Term
side effects of Mirtazapine
Definition
sedation
1% incidence of agranulocytosis
Term
use of mirtazapine
Definition
chronic anxiety
depression
PTSD
Term
MOA trazodone
Definition
inhibit serotonin reuptake (less than SSRI)
Term
trazodone side effects
Definition
little anticholinergic, hypotension, and CV effects

more safe than TCA
Term
trazodone use
Definition
depression
Term
bupropion MOA
Definition
inhibit dopamine and NE reuptake
Term
buproion side effects
Definition
stimulating, dont take at bed time
Term
use buproion
Definition
depression
Term
what are the atypical anti-depressants
Definition
bupropion
trazodone
mirtazapine
Term
3 tricyclic antidepressants
Definition
imipramine
amitripryline
clomipramine
Term
MOA TCA
Definition
block NA and serotonin reuptake transporter on nerve
Term
uses TCA
Definition
depression
chronic anxiety
bedwetting - imipramine
chronic panic
PTSD
Term
side effects of TCA
Definition
no mood elevation in normal pt
unmasks manic behavior in bipolar - watch out

narrow theraputic index (5-6x is lethal)

sedation, light headed, hypotension, weight gain

anticholinergic: dry mouth, blurred vision

amine inhibit and anticholinergic: postural hypotension, tachycardia, flat T wave, supress depolarization
Term
what drugs interact with TCA, what happens
Definition
quinidine class I antiarrhytmic: dangerous with flat T wave side effect

MAOI: HTN, convulsion, coma

adrenergics: potentiate, stop amine removal

ethanol: toxic sedation (CNS depression)
Term
what drugs are MOI
Definition
tranylcypromine
phenelzine
Term
normal function of MAO
Definition
mitochondria enzymes that break down dopamine and serotonin in liver and brain
Term
what are the types of MAO, where are they
Definition
A: everywhere
B: stratum
Term
MOA MAOI
Definition
suicide inhibiton of MAO increases NT in cleft
Term
interactions with MAOI
Definition
SSRI
trazodone
venlafaxine
warfarin
OTC decongestants
tryamine

cause serotonin syndrom
Term
signs of serotoniin syndrome
Definition
seizure, coma, death
Term
where is tryamine found, what does it normally do in body
Definition
cheese, liver, beer, wine

inactivated by MAO in gut
Term
why is tryamine bad with MAOI
Definition
MAO normally breaks it down so now it builds up in nerves causing headache, nausea, HTN, arrhytmia, stroke
Term
use of MAOI
Definition
depression
Term
5 drugs used for manic depression
Definition
lithium salts
carbamazepine - anticonvulsant
valproic acid - anticonvulsant
gabapentin - anticonvulsant, neurotic pain relief
risperidone
Term
MOA lithium salts
Definition
membrane stabilization
can replace Na in AP but isnt enough to run the pumps

Alters IP3
Term
side effects of lithium salts
Definition
no sedation, euphoria, depression

low theraputc index need to monitor blood levels

nephrgenic diabetes insipidus
contraindicated in sick sinus syndrome
reversable hypothyroidism and goiter
tremor
Term
signs of lithium salt overdose
Definition
seizure, circulatory collapse
Term
interactions with lithium salts and their side effect
Definition
thiazide diruetics
MAOI- MALIGNANT HTN
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