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
|
|
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
|
|
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
|
|
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
|
Definition
patients are secretative, hard to diagnosed
often have eczema, chapped skin
compulsive hand washing or teeth brushing |
|
|
Term
|
Definition
|
|
Term
| what anxiety drug can be used in those with substance abuse problems |
|
Definition
|
|
Term
|
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
|
|
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
|
|
Term
|
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
|
Definition
|
|
Term
|
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
|
|
Term
| what are two SSRI are for anxiety |
|
Definition
|
|
Term
|
Definition
inhibit re-uptake of serotonin at transporter
blocking removal increases concentration at synaptic cleft |
|
|
Term
|
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
|
Definition
|
|
Term
| SSRI metabolizm and excretion |
|
Definition
metabolized in liver
excreted in feces and urine |
|
|
Term
|
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
|
Definition
venlafaxine
duloxetine
desvenlafaxine |
|
|
Term
|
Definition
| block serotonin and NE re-uptake transporters |
|
|
Term
|
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
|
Definition
| blocks pre-synaptic autoreceptors for NE and 5HT and increases NE and 5HT at synapse |
|
|
Term
| in who is depression most common |
|
Definition
|
|
Term
| define unipolar depression |
|
Definition
|
|
Term
| what is the most common form of depression |
|
Definition
|
|
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
|
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
|
|
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
|
|
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
|
Definition
depression
chronic anxiety
chronic panic
SAD
PTSD |
|
|
Term
| uses of piperazine derivatives |
|
Definition
|
|
Term
| side effects of Mirtazapine |
|
Definition
sedation
1% incidence of agranulocytosis |
|
|
Term
|
Definition
chronic anxiety
depression
PTSD |
|
|
Term
|
Definition
| inhibit serotonin reuptake (less than SSRI) |
|
|
Term
|
Definition
little anticholinergic, hypotension, and CV effects
more safe than TCA |
|
|
Term
|
Definition
|
|
Term
|
Definition
| inhibit dopamine and NE reuptake |
|
|
Term
|
Definition
| stimulating, dont take at bed time |
|
|
Term
|
Definition
|
|
Term
| what are the atypical anti-depressants |
|
Definition
bupropion
trazodone
mirtazapine |
|
|
Term
| 3 tricyclic antidepressants |
|
Definition
imipramine
amitripryline
clomipramine |
|
|
Term
|
Definition
| block NA and serotonin reuptake transporter on nerve |
|
|
Term
|
Definition
depression
chronic anxiety
bedwetting - imipramine
chronic panic
PTSD |
|
|
Term
|
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
|
Definition
tranylcypromine
phenelzine |
|
|
Term
|
Definition
| mitochondria enzymes that break down dopamine and serotonin in liver and brain |
|
|
Term
| what are the types of MAO, where are they |
|
Definition
|
|
Term
|
Definition
| suicide inhibiton of MAO increases NT in cleft |
|
|
Term
|
Definition
SSRI
trazodone
venlafaxine
warfarin
OTC decongestants
tryamine
cause serotonin syndrom |
|
|
Term
| signs of serotoniin syndrome |
|
Definition
|
|
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
|
Definition
|
|
Term
| 5 drugs used for manic depression |
|
Definition
lithium salts
carbamazepine - anticonvulsant
valproic acid - anticonvulsant
gabapentin - anticonvulsant, neurotic pain relief
risperidone |
|
|
Term
|
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 |
|
|
