pharm:anti anxiety

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  1. 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
  2. episodes of terror, impending doom and increasing sympathetic stimulation describe:
    panic disorder
  3. abnormal fear created by a situation or an ojbect is called:
  4. recurrent thought or actions without pupose that interfere with fxn'ing are called:
  5. anxiety caused by reliving a traumatic event is called:
  6. when anxiety significantly interferes with fxn, drugs are usually prescribed.

    list the 2 types of drugs usually prescribed:
    • anxiolytics
    • anti-depressants
  7. 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.
  8. the antidepressant meds that used to reduce the symptoms of panic and anxiety have been:

    list (3):
    • TCA's
    • MAOI's
    • SSRI's
  9. 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
  10. antidepressants NOT recommended for pt's with hx of heart attack, heart block, or arrhythmia's are:

    list the anticholinergic effects these antidepressants have:

    • anitcholinergic effects
    • dry mouth
    • blurred vision
    • urine rentention
    • HTN
  11. safer than other classes of antidepressants; less common sympathomimetic effects (increased HR and HTN) and fewer anticholinergic effects are the:
  12. 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:
  13. 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
  14. how are benzodiazepines are categorized:
    schedule IV drugs

    although they produce considerably less phyiscal dependence and result in less tolerance than the barbiturates
  15. acting by binding to the GABA receptor, these drugs intensify the effect of GABA, which is a natural inhibitorya neurotransmitter found throughout the brain:

    most are metabolized in the liver and excreted in the urine
  16. 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

    • dementia
    • can further cause confusion
    • sedate excessively
  17. for benzodiazepine overdoes, what is the antidote:
    flumaxenil (romazicon)
  18. 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
  19. the risk of psychological and phyiscal dependence is high for barbiturates, due to this what category are they:
    schedule II
  20. withdrawal syndrome is extremely severe and can be fatal.

    overdose results in profound respiratory depression, hypotension, and shock

    what is the class of antidepressants:
  21. what is the MOA of barbiturates:
    bind to GABA receptors, intensifying the effect of GABA throughout the brain
  22. what are the effects of barbiturates at low doses:
    reduce anxiety and cause drowsiness
  23. 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
  24. 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
  25. repeated or chronic use of barbiturates canĀ develop tolerance as well as:
    cross tolerance to other CNS depressants such as opoids
  26. a condition characterized by a pt's inability to fall asleep or remain asleep is called:
  27. list 3 reasons for long term insomnia:
    • depression
    • manic disorders
    • chronic pain
  28. meds that depress the CNS, and have the ability to sedate or relax a pt are called:
  29. meds that have the ability to induce sleep are called:
  30. list 2 CNS depressants that are prescribed for their anxiolytic effects:
    • buspirone (BuSpar)
    • zolpidem (ambien)
  31. what is the MOA for zolpidem (ambien):
    facilitate GABA-mediated CNS depression in the limbic, thalamic, and hypothalamic regions
  32. what is the pregnancy category of zolpidem (ambien):

    what is the contraindication:
    • pregnancy category: B
    • contraindication: lactating women should not take this drug
  33. what is the administration of zolpidemĀ  (ambien) onset:
    • rapid onset: 7-27 mins
    • give immediately before bedtime
  34. list the rx-rx interactions of zolpidem (ambien):
    • increased sedation when used concurrently with other CNS depressants
    • phenothiazines augment CNS depression
  35. use zolpidem (ambien) with caution in individuals with a high risk of suicide becuase:
    there is a potential for intentional overdose
  36. list the adverse effects of zolpidem (ambien):
    • stopping it can cause rebound insomnia
    • amnesia
    • somnambulism (sleepwalking)
    • other activities preformed during sleep
  37. 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
  38. this drug is useful for people who can fall alseep, but awake early in the morning (2AM):

    sometimes used for travel purposes:
    zaleplon (sonata)
  39. a melatonin receptor agonist that has been shown to mainly improve sleep induction is:
    ramelteon (rozerem)
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pharm:anti anxiety
anti anxiety drugs
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