NAME THE DRUG CLASS

MOA: nonselective inhibition of metabolism of monamines by blocking action of monoamine oxidase.

NAME THE CLASS OF DRUGS:

ADVERSE EFFECTS: suicide risk, HTN crisis, orthostatic hypotension (due to NE), dizziness, blurry vision, dry mouth, HA, sedation, insomnia, nausea, wt gain, sexual dysfunction, main psychosis, acute liver failure

NAME THE DRUG CLASS

MOA: block the reuptake of monoamines from synaptic cleft, ALSO blocks, cholinergic, histaminergic, adrenergic postsynaptic receptor sites

NAME THE DRUG CLASS of Antidepressants

Adverse reactions: orthostatic hypotension, sedation, diaphoresis, cardiac toxicity, seizures, mania, wt gain,

NAME THE DRUG CLASS

MOA: selectively blocks the reuptake of serotonin from the synaptic cleft

NAME THE DRUG CLASS

MOA: selectively blocks reuptake of serotonin and NE from synaptic cleft

NAME THE DRUG:

MOA: weak DA and NE reuptake inhibitor

Contraindications: bulimia or anorexia, withdrawal from EtOH or sedatives

USE: depression, nicotine withdrawal

extrapyramidal s/e

Haloperidol (Haldol) and Chlorpromazine (Thorazine)

EtOH is cross-dependant with what 2 classes of drugs?

What does this mean therapeutically?

EtOH is cross-dependant with Benzos and Barbituates.

Therapeutically, one can be substituted for the other when dependency or withdrawal occurs.

_____________ increase the inhibitory effect of GABA by increasing the Cl- influx and only work if GABA is present and bound to receptors.

_____________ do not need GABA to be present to keep the Cl- channel open

Benzodiasepines increase the inhibitory effect of GABA by increasing the Cl- influx and only works if GABA is present and bound to receptors.

Barbiturates do not need GABA to be present to keep the Cl- channel open

name the effect associated with the Benzodiazepine site of action.

Limbic system (amygdala): 

Reticular formation: 

Cortex: 

Spinal Cord: 

name the effect associated with the Benzodiasepine site of action.

Limbic system (amygdala):  antianxiety effect, decrease papez circuit

Reticular formation:  sedation / hypnosis

Cortex:  anticonvulsant effect

Spinal Cord:  skeletal muscle relaxation

what class of benzo's do not form active metabolites and do not have left-over (residual effect) the next day and only require phase 2 biotransformation?

name 2

short-acting benzo's

Ozazepam

Trizolam (Halcion)

which class of benzo's form multiple active metabolites and require phase 1 oxidation/hydrolation and phase 2 biotransformation before elimination?

which phase decreases with age?

name 2 drugs from this class

long-acting benzo's

Diazepam

Flurazepam

phase 1 oxidation decreases with age

long acting benzo's

diezapam

flurazepam

Name the type of amnesia:

_____________ amnesia:  can't recall event before a certain point in time (long-term memory)

____________ amnesia:  can't recall event after some point in time, poor recall of events (new memory)

Which type is associated with benzo use?

Name the type of amnesia:

Retrograde amnesia:  can't recall event before a certain point in time (long-term memory)

Anterograde amnesia:  can't recall event after some point in time (new memory)**Assoicated with benzo's

sedation (initially)

lightheadedness

ataxia

mental confusion

respiratory depression (drug I/A)

dependency / abuse potential

anterograde amnesia

Adverse Effects of what drugs?

______________ is a benzodiasepine competitive antagonist and is used to reverse depression in midazolam OD.

This drug can preciptate anxiety and panic attacks, withdrawal, and/or convulsion in what type of pts?

Flumasenil (Romazicon) is a benzodiasepine competitive antagonist and is used to reverse depression in midazolam OD.

This drug can preciptate anxiety and panic attacks, withdrawal, and/or convulsion in epileptic pts being treated w/ benzos or dependent pts

insomnia, tremors, sweating, and anxiety are withdrawla Sx of what drugs?

which class will have w/d reaction quicker?

benzos

short-acting benzos will have w/d reaction quicker, long-acting rxn may take weeks

MOA:  partial agonist on postsynaptic 5HT serotonin receptors (decreases serotonin activity)

PK:  1st pass metabolism

drug?

which of the following is a short-acting benzo and has the AdRx of rebound insomnia, daytime anxiety, psychiatric/behavioral changes, and early morning awakenings?

Lorazepam

Oxazepam

Triazolam

Diazepam

which of the following benzos is indicated for the tx of skeletal muscle spasms associated with degenerative disorders (MS, CP)?

Temazepam

Diazepam

Lorazepam

Flurazepam

which class of drugs helps a pt fall asleep faster by decreasing NREM1, increases NREM2, decreases NREM3 and NREM4 (SWS) and is aggrivating to sleep apnea?

Anti-seizure Drug: __________

Off-label Use:  antiarrhythmic, trigeminal neuralgia, bipolar

Anti-seizure Drug: __________

Off-label Use: trigeminal neuralgia, bipolar

Anti-seizure Drug: __________

Off-label Use: dementia, agitation, persistant hiccups

Anti-seizure Drug: __________

Off-label Use: pain with shingles, bipolar, essential tremor, migraines, neurtoxic pain syndrome (sciatica), hot flashes, RLS, phantom limb pain

Anti-seizure Drug: __________

Off-label Use: spascity, migraines, mood disorders, infantile spasms

Anti-seizure Drug: __________

Off-label Use: bipolar, wt loss, nerve pain

Typical Neuroleptics

blockade of D2 receptors

__________: face, neck, UE spasm

__________: bradykinesia, ridigity, tremors, shuffling gait

__________: motor restlessness

EPS effects of typical neuroleptics

dystonia : face, neck, UE spasm

parkinsonism : bradykinesia, ridigity, tremors, shuffling gait

akathisia : motor restlessness

Dementia Related Psychosis

Increased mortality risk in elderly dementia patients on typical and/or atypical antipsychotics. Most deaths due to CV or infectious events.

What must you do before you start a pt on Quetiapine, Aripiprazole, Ziprasidone, Haloperidol, or Risperidone?

ALL neuroleptics cause hemolytic, endoctine, metabolic s/e

Order baseline labs:

CBC w/ diff

Lipids

fasting glucose

EKG (prologed QT)

monitor every 6 months

EKG yearly

Atypical Neuroleptics

due to 5HT (seratonin) blockade

galactorrhea, amenorrhea, infertility, gynecomastia

wt gian and insulin resistance...DM

hyperlipidemia

"metabolic syndrome"

neuroendocrine effects of what drugs?

increased levels of the neurotransmitter will cause psychosis.

where is it produced?

what will decreased levels cause?

Dopamine (DA)

Substantia Nigra / Hypothalamus

decreased = Parkinson's disease and depression

what NT is associated with wellbeing and homeostasis and is associated with depression, OCD, anxiety, and psycosis when deficient?

Where is it produced/Receptors?

Serotonin (5 HT)

Raphe Nucleus / Limbic System

What NT is associated with attention, memory, and arousal?

Deficiency = what disorder?

Produced by/Receptors?

Norepinephrine (NE)

Deficiency = depression

Pons / Hypothalamus

MOA:  blocks adenosine receptors which increases dopaine and serotonin.

MOA:  blocks reuptake of dopamine, serotonin, norepinephrine.

drug?

cocaine

chronic use depletes dopamine

what drugs are used for short-term and long-term (off-label) tx of cocaine withdrawal?

short term (2)

long term (3)

short-term:  benzo's and atypical neuroleptics

long-term (off label):  Wellbutrin, topamax, provigil

amphetamines

adderall

ritalin

concerta

what stimulant drug inhibits the reuptake of NE?

indications?

Atomoxetine (Strattera)

indications:  ADHD when ritalin is C/I

How do the following types of drugs affect the sleep cycle:

Hypnotics:

Benzos:

Barbiturates:

How do the following types of drugs affect the sleep cycle:

Hypnotics:  ↑ time in Stage 2

Benzos:  ↓ Stage 4 and slighlty ↓  REM

Barbiturates: ↓ REM

_____________ act on the reticular activating system, decreasing cortical activity, causing sedation/hypnosis.

what centers are depressed first with anesthetic doses?  (name the order 1st to last)

Barbiturates act on the reticular activating system, decreasing cortical activity, causing sedation/hypnosis.

higher centers depressed first

cortex → thalamus → hypothalamus → pons → spinal cord → medulla → vital centers

usually medualla → spinal cord for all other anesthetic agents

barbiturates and benzos facilitate GABA to increase Cl- influx, leading to hyperpolarization.

which of the 2 does not have a ceiling effect so the more of the drug you give, the more response you get?

Barbiturates

phenobarbital or pentobarbital

Clozapine (Clozaril)

reserved for severe schizo pts unresponsive to other tx

What neuroleptic is a 1st line antipsychotic, has low potential for EPS, minimal sedation, and is used in the tx of bipolar depression, tourette's, and autism?

what s/e are most problematic?

Risperidone (Risperdal)  -- Atypical neuroleptic

galactorrhea (inc. prolactin) 40% of pts

tension HA

migraine HA

Migraine and cluster HA

ABORTIVE

phenytoin, carbamazepine, depakote, neurontin, and topamax are anti-seizure drugs that can be used for the tx of what mood disorder?

Depacote

Neurontin

Tiagabine