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general anxiety disorder is excess anxiety that isnt easily managed, interferes with life and has multiple triggers.
describe the signs/symptoms of GAD:
which branch of the ANS is stimulated by these s/sx:
- restlessness
- fatigue
- muscle tension
- jitteriness
- difficulty concentrating
- dry cough
- increased BP and pulse
- insomnia
sympathetic stimulation
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episodes of terror, impending doom and increasing sympathetic stimulation describe:
panic disorder
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abnormal fear created by a situation or an ojbect is called:
phobia
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recurrent thought or actions without pupose that interfere with fxn'ing are called:
OCD
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anxiety caused by reliving a traumatic event is called:
PTSD
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when anxiety significantly interferes with fxn, drugs are usually prescribed.
list the 2 types of drugs usually prescribed:
- anxiolytics
- anti-depressants
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describe the general mechanism in which antidepressants decrease anxiety:
antidepressants decrease anxiety by: altering NE and serotonin levels
different anti-depressants have different side effects, and drugs with side effects similar to the person's s/sx should be avoided.
ex: prozac can be quite stimulating and this is inferior to paxil for depression with anxiety.
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the antidepressant meds that used to reduce the symptoms of panic and anxiety have been:
list (3):
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the potnetial warning signs of suicide in adults and children should be assesed when:
- a the beginning of an antidepressant tx
- when doses are changed
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antidepressants NOT recommended for pt's with hx of heart attack, heart block, or arrhythmia's are:
list the anticholinergic effects these antidepressants have:
TCA's
- anitcholinergic effectsdry mouth
- blurred vision
- urine rentention
- HTN
-
safer than other classes of antidepressants; less common sympathomimetic effects (increased HR and HTN) and fewer anticholinergic effects are the:
SSRI's
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this class of antidepressants are rarely used b/c of the potential for serious side effects, and many drug and food interactions (tyramine) are called:
MAOI's
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although about 15 benzodiazepines are available, all have the same action and adverse effects... how do they differ:
differ primarily in their onset and duration of action
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how are benzodiazepines are categorized:
schedule IV drugs
although they produce considerably less phyiscal dependence and result in less tolerance than the barbiturates
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acting by binding to the GABA receptor, these drugs intensify the effect of GABA, which is a natural inhibitorya neurotransmitter found throughout the brain:
benzodiazepines
most are metabolized in the liver and excreted in the urine
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pt care for benzodiazepines:
asses for factors that increase anxiety
determine other drugs used, espeically those that affect the CNS
becust benzo's decrease the respiratory drive asses for:
asses for dementia due to:
- becust benzo's decrease the respiratory drive asses for:
- history of Rx or alcohol abuse/dependancy, suicide attemtps,
- or if they have sleep apnea or breathing disorders
- dementiacan further cause confusion
- sedate excessively
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for benzodiazepine overdoes, what is the antidote:
flumaxenil (romazicon)
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what is the pregnancy category for benzodiazepine's:
- pregnancy categorgy: D
- dont use in breast feeding or in children
in the elderly, these drugs have great potential to cause injury and due to decreased metabolism and excretion, overdose is more likely
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the risk of psychological and phyiscal dependence is high for barbiturates, due to this what category are they:
schedule II
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withdrawal syndrome is extremely severe and can be fatal.
overdose results in profound respiratory depression, hypotension, and shock
what is the class of antidepressants:
barbiturates
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what is the MOA of barbiturates:
bind to GABA receptors, intensifying the effect of GABA throughout the brain
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what are the effects of barbiturates at low doses:
reduce anxiety and cause drowsiness
-
what are the 2 effects of barbiturates at moderate doses:
what is the mechansim at the moderate dose:
- inhibit seizure activity and promote sleep
- mechansim: inhibiting brain impulses traveling throught the limbic system and the recticular activing system
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barbiturates stimulate the microsomal enzymes in the liver that metabolize meds, as a result:
they can stimulate their own metabolism as well as that of 100's of other drugs that uses these enzymes for breakdown
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repeated or chronic use of barbiturates can develop tolerance as well as:
cross tolerance to other CNS depressants such as opoids
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a condition characterized by a pt's inability to fall asleep or remain asleep is called:
insomnia
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list 3 reasons for long term insomnia:
- depression
- manic disorders
- chronic pain
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meds that depress the CNS, and have the ability to sedate or relax a pt are called:
sedatives
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meds that have the ability to induce sleep are called:
hypnotics
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list 2 CNS depressants that are prescribed for their anxiolytic effects:
- buspirone (BuSpar)
- zolpidem (ambien)
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what is the MOA for zolpidem (ambien):
facilitate GABA-mediated CNS depression in the limbic, thalamic, and hypothalamic regions
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what is the pregnancy category of zolpidem (ambien):
what is the contraindication:
- pregnancy category: B
- contraindication: lactating women should not take this drug
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what is the administration of zolpidem (ambien) onset:
- rapid onset: 7-27 mins
- give immediately before bedtime
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list the rx-rx interactions of zolpidem (ambien):
- increased sedation when used concurrently with other CNS depressants
- phenothiazines augment CNS depression
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use zolpidem (ambien) with caution in individuals with a high risk of suicide becuase:
there is a potential for intentional overdose
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list the adverse effects of zolpidem (ambien):
- stopping it can cause rebound insomnia
- amnesia
- somnambulism (sleepwalking)
- other activities preformed during sleep
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has properties similar to those of zolpedem (ambien), but has a longer half life (2x as long)
this gives an advantage of maintaining sleep and decreasing early morning awakenings (2AM):
eszopicoline (lunesta)
disadvantage: more likely to cause daytime sedation
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this drug is useful for people who can fall alseep, but awake early in the morning (2AM):
sometimes used for travel purposes:
zaleplon (sonata)
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a melatonin receptor agonist that has been shown to mainly improve sleep induction is:
ramelteon (rozerem)
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