-
Kinds of anxiety disorders (5)
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- OCD
- Social anxiety disorder (social phobia)
- PTSD
-
Benzodiazapines act as... (4)
- anticonvulsant
- antianxiety
- sedative-hypnotics
- muscle relaxants
-
What does GABA do?
- body's natural valium
- inhibitory neurotransmitter
- -induces skeletal muscle relaxation
- -causes sedation
- -depresses CNS function
-
What causes a benzodiazapine to cause anti-anxiety effects rather than hypnotic?
dose
-
Benzodiazapine protoptypes (3)?
Valium (not used as much anymore)--diazapam
- Ativan (lorazepam)
- Xanax (alprazolam)
-
Benefits of benzodiazapines?
- safer than general CNS depressants
- less potential for abuse
- -less tolerance and physical dependence
- fewer drug interactions
-
what drug-drug interaction is most important to watch for with benzodiazepines?
other CNS depressants
-
Why don't you give the antidote to benzodiazapines (Romazicon) to a patient with a history of seizures?
it can induce seizures
-
which route of benzodiazapines requires the closest monitoring of vital signs? Which should you watch most particularly?
- IV
- watch for cardiac issues (bradycardia, cardiac arrest)
- hypotension
-
what should you watch for when combining benzodiazapines and opiates?
respiratory depression
-
AE's of benzodiazapines
anterograde amnesia (not always considered adverse when used for surgery)
CNS depression
sleep driving
effects opposite to what it's supposed to do (increased anxiety, etc)
-
benzodiazapines have greater effect on cardiac and blood pressure when given by which route?
IV (rather than PO)
-
when are benzodiazapines used?
- General anxiety disorder
- Panic disorder
- -short-term management of anxiety
- -stabilize sever anxiety
- Social anxiety disorder
-
What is the typical long-term management strategy for GAD?
buspirone and antidepressants
-
What are the advantages of buspirone?
- less sedation
- doesn't increase effects of CNS depressants
- lower potential for abuse
-
disadvantages of buspirone
what do you do to manage them?
- takes longer to achieve peak and steady state
- initial response: 1 week
- Peak: several weeks
benzodiazapines can be used to stabilize anxiety initially until buspirone kicks in
-
what can buspirone be used to treat?
General anxiety disorder
-
common AE's of buspirone
- dizziness
- insomnia
- fatigue
- rapid heart rate/chest pains/heart palpitations
- hyperventilation
- headache
-
patient education for buspirone during intial phase of treatment
wait to operate machinery and activities requiring alertness and psychomotor coordination until CNS effects are known
-
What outcome goals should you have for treatment with buspirone?
- increased sense of well-being
- reduction in feelings of anxiety
-
how do MAO Inhibitors work?
inhibit monoamine oxidase, an enzyme that metabolizes neurotransmitters like NE, seratonin and dopamine. When those are more available to receptors, it alleviates depression.
-
What can MAOI's be used to treat?
- atypical depression
- depression (not first choice)
- OCD
- bulimia nervosa
- panic attacks
-
why are MAOI's so troublesome?
They interact with pretty much everything!
Many drugs and foods
-
what are some AE's of MOAI's?
- Hypertensive crisis
- orthostatic hypotension
- CNS stimulation
-
what foods should be avoided when on MAOI's?
- foods high in tyramine:
- aged cheese
- soy sauce
- aged meats
- pickled fish
- tofu (soy curd)
- sauerkraut
- tap beer
- red wine
-
What drugs can be used to treat depression?
- SSRIs
- SNRIs
- MAO Inhibitors
- TCAs
- Wellbutrin (Bupropion)
- St. John's Wort
-
What does SSRI stand for? How's it work?
Selective Serotonin Reuptake Inhibitors
stop serotonin reuptake so it's more available in the brain
CNS excitation
-
What's the prototype SSRI?
Prozac
-
medical term for antianxiety
anxiolytic
-
anterograde amnesia
- can't form new memories after event that caused amnesia
- long-term memories are intact
good for surgery
-
which drug class can cause anterograde amnesia?
benzodiazapines
-
how is a drug selected for depression?
by safety, side effects, drug interactions, tolerability, preference and cost
all are equally effective
-
how soon do antidepressants work?
- initial response: 1-3 weeks
- max response: 12 weeks
-
what's the major consideration when treating with antidepressants?
what should you monitor?
- suicide risk
- Black Box warning
Monitor for thoughts of suicide, worsening mood, changes in behavior (esp in people less than 25)
-
What syndrome is a potential AE of SSRIs?
Serotonin Syndrome
-
S/S of seratonin syndrome?
- mental and musculoskeletal
- agitation, confusion, anxiety
- hallucinations
- seizures
- incoordination
- hyperreflexia
- fever
-
Tricyclic antidepressants MOA
- block reuptake of norepinephrine
- (similar to antipsychotics)
also block acetylcholine and histamine
-
Effects of tricyclic antidepressants due to inhibition of reuptake of seratonin and NE
- cardiac dysrhythmias
- antihistaminic
- sedative: confusion, agitation
- anticholinergic: dry mouth, urine retention
- vasodilation: flushing, hyperthermia
-
MOA of Monoamine Neurotransmitters and Tyramine (MOA's)
- convert monamine neurotransmitters and foods with tyramine into inactive substances so they can't break down norepinephrine and seratonin
- -NE
- -dopamine
-
If MOA's aren't working, how should you go about switching to another drug?
discontinue 2 weeks before starting on another antidepressant
-
what AE may occur if a patient is taking an MOA and eats foods rich in tyramine?
hypertensive crisis
|
|
