Shared Flashcard Set

Details

Anxiety & Insomnia
n/a
114
Pharmacology
Graduate
04/04/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
Sedative-hypnotics
outcomes & uses
Definition
Depress CNS function, some more generalized.
anxiety (anxiolytics/tranquilizers) insomnia (hypnotics)
Term
Sedative-hypnotic
groups
Definition
Barbiturates
Benzodiazepams
Benzodiazepam-like
Term
Barbiturates
pitfalls
Definition
Along with general CNS depressant are drug of choice suicides.
-High abuse
-Significant tolerance & physical dependence
-Induce synthesis of hepatic drup-metabolizing enzymes (decreases response to other drugs)
Term
Barbiturates
MOA
Definition
Relatively non-selective depression of CNS function by binding to GABA receptor channel complex. Enhance inhibitory actions of GABA AND directly mimic the actions of GABA
Term
Barbiturates
uses
Definition
Daytime sedation, induction sleep, supress seizure, general anesthesia, manic, delirium, colic, pylorospasm & whoooping cough restlessness. Kids anxiety preprocedure, amphetamine OD, tetnus seizure, eclampsia, epilepsy, decrease mortality in head injury(pentobarb coma=reduces brain requirement for 02 & glucose preserving CNS function)
Term
Barbiturates
classifications & uses
Definition
Ultrashort acting (anesthesia)
Short-intermediate acting (hypnotics)
Long acting (seizure)
Term
Barbiturates
kinetics
Definition
Low therapeutic index. Classifications based on duration of action. Duration of action based on lipid solubility. Increased lipid solubility, decrease duration (rapid onset). Except high lipid all barbs have long 1/2 lives. Because of mimicing GABA=no celing to depression effect
Term
Barbiturates
effects
Definition
CNS-sedation>sleep>anesthesia
CV-decrease BP & HR(toxic profound hypotension & shock by depressing myocardium, VSM, & all electric tissue)
Induce hepatic enzymes-accelerates drug metabolism through stimulating synthesis of porphyrin thus stimulating synthesis of hepatic microsomal enzymes.
Tolerance(to sedative & hypnotic, little to resp depression)Tolerance to other CNS depressants & dependence.
Term
Barbiturates
side effect
Definition
Resp. depression, suicide, abuse, teratogenic, exacerbation of porphyria, hangover(next day sedation,impaired judgment, reduced motor skills), paradoxical excitement, hyperalgesia and direct pain
Term
Tolerance
Definition
Reduced drug responsiveness that develops over the course of repeated drug use.
Term
Dependence
Definition
adaptive neurochemical changes that occur in response to chronic drug exposure
Term
Addiction
Definition
Behavior pattern characterized by continued drug use despitephysical, psychological, or social harm
Term
Abstinence syndrome to barbiturates
Definition
Early-weakness, restless, insomnia, hyperthermia, orthostatic hypotension, confusion, disorientation.
Day 3-convulsions, psychotic delirium followed by exhaustion, CV collapse, death
Total 8 days
Term
Weaning phenobarb
Definition
over 10days-3wks
Term
Selective CNS depressant barb
Definition
phenobarb
Term
Barbiturates for seizures
Definition
phenobarb, mephobarb
Term
Barbiturates for anesthesia
Definition
Pentobarb, brevital
Term
Barbiturates for sleep
Definition
Too many side effects-replaced by benzos
Term
Barbiturates
Mechanism for resp depression
Definition
-Depression of brainstem neurogenic resp drive
-Depression of chemoreceptive mechanisms that control respiratory drive
Term
Barbiturates prone to abuse
Definition
short-intermediate acting (secobarbital)
Term
Acute intermittent porphyia
s/s
Definition
N/V, abdominal colic, neuromuscular disturbances, and disturbed behavior.
Term
Barbiturate
Contraindications
Definition
Hx intermittent porphyia
Term
Barbiturate
interactions
Definition
CNS depressants, Accelerated metabolism of drugs (warfarin, oral contraceptions, phenytoin
Term
Barbiturate
toxicity
Definition
OD can be fatal.
S/S Respiratory depression, coma, pinpoint pupils(may later dilate as hypoxia sets in), hypotension, hypthermia, Death from pulmonary complications and renal failure
Term
Barbiturate
Toxicity tx
Definition
ICU-Remove barbs,maintain o2 to brain. gastric lavage/saline cathartic, hemodialysis, alkanizing urine, IVF & dopamine, bear hugger, (DO NOT USE CNS stimulants, narcan ineffective)
Term
Benzodiazepines
uses
Definition
First drug for anxiety & insomnia, general anesthesia, seizures, muscle spasm, alcohol withdrawl
Term
Benzodiazepines
CNS effects
Definition
depress(sedate>hypnosis>stupor)
decrease anxiety d/t effects on limbic system, promote sleep d/t effects on cortical areas sleep/wake, muscle relax d/t effects supraspinal motor areas & cerebellum. Antegrade amnesia d/t effect on hippocampus
Term
Benzodiazepines
CV effects
Definition
Only in IV administration-Hypostension that can result in cardiac arrest
Term
Benzodiazepines
respiratory effects
Definition
Weak resp depressant. Can be a problem in pt with existing resp issues. Worsen hypoxemia in COPD. increase sleep apnea exacerbations, turn snoring into sleep apnea
Term
Benzodiazepines
MOA
Definition
Potentiate existing GABA, intenstify GABA effect
Term
GABA
Definition
inhibitory neurotransmitter
Term
Benzodiazepines
kinetics
Definition
Highly lipid soluble. Extensive metabolic alterations, metabolites are active, liver dysfunction can prolong and intensify responses. Accumulate with repeat dosing. Differ from one another in respect to time course (onset & duration). Kinetics determine which is used for what.
Term
Benzodiazepines
selection:
Fall asleep
stay asleep
Definition
fall asleep-rapid onset-triazolam
stay asleep-slow onset-estazolam
sleep agents:restoril,doral, flurazepam
Term
Benzodiazepines
selection
anxiety
Definition
xanax, librium, klonopin, clorazepate, valium, ativan, oxazepam
(start low-go slow)(not to exceed 4-6mths)
Term
Benzodiazepines
selection
muscle spasm
Definition
Valium
Term
Benzodiazepines
selection
alcohol withdrawl
Definition
librium, tranxene, valium, ativan, oxazepam
Term
Benzodiazepines
selection
perioperative
Definition
Valium, ativan, Versed
Term
Benzodiazepines
side effects
Definition
drowsy,ataxia,sedation,disoriented, confusion, lighthead,irritability, aggression, incoordination, dec. concentration, anterograde amnesia, sleep driving & other behaviors like eating, calling, sex. Paradoxical effects (insomnia, excitatory, euphoria, heightened anxiety, rage), Resp. depression, abuse, weakness, HA, blurred vision, vertigo, N/V/D,epigastric distress, neutropenia, jaundice, Pregnancy D/X
Term
Most likely to cause anterograde amnesia
Definition
Triazolam
Term
Benzodiazepines
drug interactions
Definition
CNS depressants, antacids, tagament, SSRI, oral contraceptives, theophylline
Term
Benzodiazepines
tolerance & dependence
Definition
No tolerance to anxiolytic effects, low tolerance to hypnotic effects. Tolerance to antiseizure effects. Cross tolerance from alcohol & barbs
Dependence-Mild withdrawl with short term use at therapeutic dose. Anxiety, insomnia, sweating, tremors, dizzy.
Long-term/high-dose withdrawl panic, paranoia, delirium, HTN, muscle twitches>convulsions
Term
Withdrawl Symptoms worst with these type Benzodiazepines
Definition
short duration, xanax worst
Term
Weaning benzos
Definition
Taper dose over weeks>mths, sub a long 1/2 life drug
Term
Benzodiazepines
Pt teaching
Definition
Avoid abrupt DC
Term
Benzodiazepines
toxicity
Definition
PO-drowsy, lethargy, confusion
IV-profound hypotension, respiratory arrest, cardiac arrest
tx:gastric lavage, resp support, IVF, NE or BP med support
Flumazeril
Term
Flumazeril
Definition
Competitve benzo receptor antagonist. Reverse sedative effects, but not resp effects. May cause convulsions.
IV admin-1st 0.2/30sec, 2nd 0.3 and then 0.5
Term
Ambien
MOA
Definition
Binds to benzo receptor on GABA receptor limited to benzo1 subtype (not effective anxiolytic or muscle relaxant)
Term
Ambien
kinetics
Definition
extensive metabolism to inactive compounds, 1/2 life 2.4h, rapid onset, med duration. Dose adjust in elderly and liver dysfunction
Term
Ambien
side effects
Definition
daytime drowsy, dizzy, sleep driving & other behaviors
Term
Ambien
interactions
Definition
CNS depressants
Term
Sonata
MOA
Definition
Binds to benzo1 receptor of GABA. Rapid onset and short duration
Term
Sonata
Side effects
Definition
HA, nausea, drowsy, dizzy, myalgia, abd. pain, sleep driving behavior, physcial dependence minimal-mild rebound insomnia x1 day
Term
Sonata
interactions
Definition
cimetidine-reduce dose (reduce dose in live impair)
Term
Lunesta
MOA
Definition
Binds selective to benzo1 of GABA. No length of time limit.
Term
Lunesta
kinetics
Definition
Extensive hepativ metabolism CYP, 1/2 life 6h. decrease dose in elderly and liver impair
Term
Lunesta
side effects
Definition
Bitter aftertaste, HA, somnolence, dizzy, dry mouth, rebound insomnia x1 day after DC, sleep driving and behavior, anaphlyaxis.
Term
Melatonin
Definition
Pineal gland hormone that regulates circadian clock. Secretion supressed in light, stimulated in dark. Only hormone available OTC. 0.3-1mg 1-2h a HS. Side effects in >2mg hangover, HA, nightmares, hypothermia, transient depression
Term
Ramelteon
MOA
Definition
Melatonin agonist. Activation of melatonin receptors
Term
Ramelteon
use
Definition
Chronic insomnia, rapid onset, short duration
Term
Ramelteon
kinetics
Definition
Food reduces absorption esp high fat, extensive 1st pass CYP, active metabolites, Avoid in hepatic impair
Term
Ramelteon
side effects
Definition
Somnolence, dizzy, fatigue, sleep behaviors, hallucinations, agitation, mania, increase prolactin, decrease testosterone, amenorrhea, galactorrhea, decrease libido & fertility, severe allergic react, dyspnea, throat contrict, teratogenic in rats
Term
Ramelteon
interactions
Definition
Luvox, CNS depressants
Term
Chloral hydrate & meprobarnate
side effects
Definition
Nonselective CNS depressants
drowsiness,tolerance & physical dependence, teratogenic, epigastric distress, nausea, flatulence (mix liquid w/juice)
Term
Chloral hydrate & meprobarnate
precautions
Definition
avoid driving or other dangerous activities
Term
Chloral hydrate & meprobarnate
interactions
Definition
CNS depressants
Term
Chloral hydrate & meprobarnate
toxicity
Definition
Resp. depression, coma, miosis, hypotension.
TX-like barb toxicity
Term
Chloral hydrate & meprobarnate
withdrawl
Definition
sleep disruptions and nightmares
abrupt withdrawl delirium and seizures
Term
Managing insomnia
Definition
Tx specific causes, use non-drug tx first, then benzo, or nonbenzo short term
Term
Insomnia
Non-drup tx
Definition
avoid naps, regular sleep schedule, decrease caffeine, restful activity before bed, environmental factors-corrct or compensate, cognitive behavior/sleep hygiene
Term
Sleep hygiene
Definition
Dont stay in bed too long, blackout shades, lower temp, exercise daily (not p 7p), outdoor time every day, decrease fluid in eve, avoid alcohol and tobacco, light snack HS, Avoid TV & computers at HS. If not asleep in 20 minutes get out of bed, bedroom is for sleep
Term
Anxiety
Definition
Uncomfortable state with psychological and physical components caused by real or potential danger that threatens security of individual
Term
Psychological symptoms of anxiety
Definition
Fear, apprehension, dread, uneasy
Term
Physical symptoms of anxiety
Definition
Tachycardia, palpitations, trembling,dry mouth, sweating, weakness, fatigue, SOB
Term
Common element of anxiety disorders
Definition
Unhealthy level of anxiety. Persistent, excessive, abnormal, irrational, impairs normal daily function.
Term
Types of anxiety disorders
Definition
General anxiety disorder (GAD)
Panic
OCD
Social anxiety
PTSD
Specific phobias
Term
Soicetal consequences of anxiety
Definition
physical and occupational disabilities, 4.4 days/month lost work, higher utilization of PCP and GI
Term
Medical conditions assoc w/Anxiety
Definition
CV, endocrine/metabolic, neurologic, respiratory, anemias, lupus, vestibular disorder
Term
Medications assoc w/Anxiety
Definition
Anticonvulsants, antidepressants, antHTN, antibiotics, bronchodilators, corticosteroids, DA, herbals, NSAIDs, stimulants, sympathomimetics, thyroid hormones. Drug toxicities, Drug withdrawls
Term
Anxiety
patho
Definition
(theories)
Abnormal neurotransmitter function (NE, GABA, serotonin)
Hypersensitive autonomic nervous system
GABA inhibit of NE and serotonin
overactive serotonin
Term
Anxiety
Assessment
Definition
Differential dx (medical, drugs)
H&P
MMSE
Labs
Tox screen
Term
Drug families to treat anxiety
Definition
Benzos
SSRI
BusBar, Effexor, Cymbalta
Term
GAD
characteristics
Definition
Chronic uncontrollable unrealistic/excessive worry about several activities >6mth. Least likely to remit, usually another psych condition exists. .
Term
GAD
s/s
Definition
Vigilence, tension, apprehension, poor concentration, difficulty falling asleep or staying asleep, tremble, muscle tension, restless, autonomic hyperactivity (palpitation, tachycardia, sweating, cold clammy hands). Impair social, occupational, or other functional areas.
Term
GAD
Non pharm tx
Definition
Non drug supportive therapy, cognitive behavior therapy, biofeedback, relaxation techniques
Term
GAD
drug tx
Definition
1st line Benzos-rapid relief (intermittent or adjunt)
(All other are delayed relief)
2nd line-BuSpar
1st line long-term management:Effexor XR, Paxil, Lexapro, Imipramine for those who fail SSRIs
Cymbalta
Should be 12mths or longer
Term
Panic Disorder
characteristics
Definition
Chronic waxing and waning of series of unexpected panic attacks involve intense terrifying fear similar to that caused by life-threatening danger. One month of concern of reoccurance or consequences accompanied by significant behavior changes.
Term
Panic Disorder
s/s of attack
Definition
20-30min.(4 or more symptoms)Palpitations, sweating, trembiling, SOB, smothering sensation, feeling choking, chest pain, nausea, abd. distress, dizzy, lightheaded, chills, heat sensation, paresthesias, derealization or depersonalization, losing control/going crazy feeling, fear of dying.
Term
Panic Disorder
adverse impact
Definition
Depression, Alchohol abuse, high use of health services, higher risk suicide, 50% become agorophobic.
Term
Panic Disorder
phases & goals
Definition
Acute-Reduce symptoms (1-3mths)
Continuation-Complete & extend tx response. Max response, minimize side effects. (2-4mths)
Mantenance-3-12mths. Attempt to DC drug at 8mths, if unable then reattempt q3mths
Term
Panic Disorder
drug tx
Definition
Benzo's until SSRI starts to work-Xanax ideal for rapid relief
(All 4 antidepressant families take 6-12wks to work)
1st line:SSRIs-Paxil, Prozac, Zoloft
2nd line TCA, 3rd MAOIs
Term
Social Anxiety Disorder
Characteristics
Definition
Intense irrational persistent fear of situations may be scrutinized by others, or may do something embarrassing/humiliating. Adults may be able to recognize this is irrational. Avoidance utilized
Term
Social Anxiety Disorder
s/s
Definition
Fears:scrutinized by others, embarrassed, humiliated. Physical: blush, butterflies, diarrhea, sweating, tachycardia, trembling
Term
Social Anxiety Disorder
types
Definition
Generalized
Non-generalized
Term
Social Anxiety Disorder
situations inducing fear
Definition
public speaking, eating or writing in front of others, interact w/authority, talking w/strangers, public toilets
Term
Social Anxiety Disorder
Drug tx
Definition
Benzo's (Klonopin-taper when DC) with antidepressant and/or psychotherapy
Benzos used when low risk for abuse, for rapid relief, and when unresponsive to other tx.
1st line-SSRI (Paxil & Zoloft)
2nd line-Effexor 3rd- MAOI
Other drug:propranolol
Term
Differentiating Anxiety types
Social Anxiety Disorder vs Panic
Social Anxiety Disorder vs GAD
Definition
SAD vs Panic
panic-fear of symptoms
SAD-fear of situation/embarrassment
SAD vs GAD
GAD-social fears small part of multi fears
SAD- Comorbid mood, anxiety, or substance abuse proceded fear and is assoc w/increase suicide ideation
Term
Specific phobias
presentation
Definition
To specific object or situation, free of symptoms in between
Term
Specific phobias
tx
Definition
Behavioral therapy
unresponssive to drugs, drugs may be detrimental
Term
Anxiety Treatment
Goals
Definition
Reduce severity, duration, frequency
Improve overall functioning
Prevent symptoms
Improve QOL
Term
Anxiety Teatment
Non-pharmacological
Definition
Counseling
stress management
Paychotherapy
Meditation
Exercise
Avoid caffeine, stimulants, diet pills
Term
Anxiety Treatment
Pharmacological
Definition
1st line Benzos
BusPar
Antidepressants
BB
Term
Benzodiazepines
In anxiety tx
Definition
Rapid relief of acute anxiety symptoms
-symptom relief w/o solving problem
Short term use (4-6mths)
Start low, go slow
Taper down
Potential for abuse, tolerance, physcial dependence
Term
BuSpar
MOA
Definition
Binds to serotonin receptors (no GABA affect)
Term
BuSpar vs Benzos
Definition
BuSpar-less sedating, no additive CNS depressent concerns if concurrent use of alcohol or other sedative drugs, less abuse, effective in cognitive symptoms of anxiety, but take 2-4wks to be effective. Benzos offer quicker relief,can be used PRN & are more effective in relieving anxiety.
Term
BuSpar
kinetics
Definition
Extensive 1st pass metabolism
Term
BuSpar
side effects
Definition
Dizzy, nausea, HA, nervous, lightheaded, excitement
Term
BuSpar
Interactions
Definition
Erythromycin, ketoconazole, grapefruit juice
Term
BuSpar
indications
Definition
Anxiety. Specifically those who fail other therapy, can not tolerate sedation/pscyhomotor benzo affects, and those with hx substance abuse
Term
OCD
characteristics
Definition
Persistent obsessions & compulsions w/distress consume at least 1h/day & interfere w/daily living. Pts know behavior is excessive and senseless, but cannot stop
Term
Obsession
Definition
Recurrent, persistent thought, impulse, or mental image. Unwanted and distressing, comes involuntarily to mind, despite trying to ignore
Term
Compulsion
Definition
Ritualized behavior or mental act, driven to perform in response to obsession to prevent a horrible event from occurring
Term
OCD
tx
Definition
Combo behavioral and drug. If severe deep brain stimulation.
Drugs-SSRI, anafranil
Term
PTSD
characteristics
Definition
Traumatic event elicits immediate fear reaction, helplessness or horror. Reexperiences the event, avoids reminders of event, and a persistent state of heperarousal
Term
PTSD
tx
Definition
Trauma based therapy, stress inoculation training. Drug tx-evidence strongest for SSRIs Paxil and Zoloft
Supporting users have an ad free experience!