Term
Sedative-hypnotics
outcomes & uses |
|
Definition
Depress CNS function, some more generalized.
anxiety (anxiolytics/tranquilizers) insomnia (hypnotics) |
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Term
|
Definition
Barbiturates
Benzodiazepams
Benzodiazepam-like |
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Term
|
Definition
Along with general CNS depressant are drug of choice suicides.
-High abuse
-Significant tolerance & physical dependence
-Induce synthesis of hepatic drup-metabolizing enzymes (decreases response to other drugs) |
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Term
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Definition
| Relatively non-selective depression of CNS function by binding to GABA receptor channel complex. Enhance inhibitory actions of GABA AND directly mimic the actions of GABA |
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Term
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Definition
| Daytime sedation, induction sleep, supress seizure, general anesthesia, manic, delirium, colic, pylorospasm & whoooping cough restlessness. Kids anxiety preprocedure, amphetamine OD, tetnus seizure, eclampsia, epilepsy, decrease mortality in head injury(pentobarb coma=reduces brain requirement for 02 & glucose preserving CNS function) |
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Term
Barbiturates
classifications & uses |
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Definition
Ultrashort acting (anesthesia)
Short-intermediate acting (hypnotics)
Long acting (seizure) |
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Term
|
Definition
| Low therapeutic index. Classifications based on duration of action. Duration of action based on lipid solubility. Increased lipid solubility, decrease duration (rapid onset). Except high lipid all barbs have long 1/2 lives. Because of mimicing GABA=no celing to depression effect |
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Term
|
Definition
CNS-sedation>sleep>anesthesia
CV-decrease BP & HR(toxic profound hypotension & shock by depressing myocardium, VSM, & all electric tissue)
Induce hepatic enzymes-accelerates drug metabolism through stimulating synthesis of porphyrin thus stimulating synthesis of hepatic microsomal enzymes.
Tolerance(to sedative & hypnotic, little to resp depression)Tolerance to other CNS depressants & dependence. |
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Term
|
Definition
| Resp. depression, suicide, abuse, teratogenic, exacerbation of porphyria, hangover(next day sedation,impaired judgment, reduced motor skills), paradoxical excitement, hyperalgesia and direct pain |
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Term
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Definition
| Reduced drug responsiveness that develops over the course of repeated drug use. |
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Term
|
Definition
| adaptive neurochemical changes that occur in response to chronic drug exposure |
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Term
|
Definition
| Behavior pattern characterized by continued drug use despitephysical, psychological, or social harm |
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Term
| Abstinence syndrome to barbiturates |
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Definition
Early-weakness, restless, insomnia, hyperthermia, orthostatic hypotension, confusion, disorientation.
Day 3-convulsions, psychotic delirium followed by exhaustion, CV collapse, death
Total 8 days |
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Term
|
Definition
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|
Term
| Selective CNS depressant barb |
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Definition
|
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Term
| Barbiturates for seizures |
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Definition
|
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Term
| Barbiturates for anesthesia |
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Definition
|
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Term
|
Definition
| Too many side effects-replaced by benzos |
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Term
Barbiturates
Mechanism for resp depression |
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Definition
-Depression of brainstem neurogenic resp drive
-Depression of chemoreceptive mechanisms that control respiratory drive |
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Term
| Barbiturates prone to abuse |
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Definition
| short-intermediate acting (secobarbital) |
|
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Term
Acute intermittent porphyia
s/s |
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Definition
| N/V, abdominal colic, neuromuscular disturbances, and disturbed behavior. |
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Term
Barbiturate
Contraindications |
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Definition
|
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Term
|
Definition
| CNS depressants, Accelerated metabolism of drugs (warfarin, oral contraceptions, phenytoin |
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Term
|
Definition
OD can be fatal.
S/S Respiratory depression, coma, pinpoint pupils(may later dilate as hypoxia sets in), hypotension, hypthermia, Death from pulmonary complications and renal failure |
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Term
|
Definition
| ICU-Remove barbs,maintain o2 to brain. gastric lavage/saline cathartic, hemodialysis, alkanizing urine, IVF & dopamine, bear hugger, (DO NOT USE CNS stimulants, narcan ineffective) |
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Term
|
Definition
| First drug for anxiety & insomnia, general anesthesia, seizures, muscle spasm, alcohol withdrawl |
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Term
Benzodiazepines
CNS effects |
|
Definition
depress(sedate>hypnosis>stupor)
decrease anxiety d/t effects on limbic system, promote sleep d/t effects on cortical areas sleep/wake, muscle relax d/t effects supraspinal motor areas & cerebellum. Antegrade amnesia d/t effect on hippocampus |
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Term
Benzodiazepines
CV effects |
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Definition
| Only in IV administration-Hypostension that can result in cardiac arrest |
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Term
Benzodiazepines
respiratory effects |
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Definition
| Weak resp depressant. Can be a problem in pt with existing resp issues. Worsen hypoxemia in COPD. increase sleep apnea exacerbations, turn snoring into sleep apnea |
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Term
|
Definition
| Potentiate existing GABA, intenstify GABA effect |
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Term
|
Definition
| inhibitory neurotransmitter |
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Term
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Definition
| Highly lipid soluble. Extensive metabolic alterations, metabolites are active, liver dysfunction can prolong and intensify responses. Accumulate with repeat dosing. Differ from one another in respect to time course (onset & duration). Kinetics determine which is used for what. |
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Term
Benzodiazepines
selection:
Fall asleep
stay asleep |
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Definition
fall asleep-rapid onset-triazolam
stay asleep-slow onset-estazolam
sleep agents:restoril,doral, flurazepam |
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Term
Benzodiazepines
selection
anxiety |
|
Definition
xanax, librium, klonopin, clorazepate, valium, ativan, oxazepam
(start low-go slow)(not to exceed 4-6mths) |
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Term
Benzodiazepines
selection
muscle spasm |
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Definition
|
|
Term
Benzodiazepines
selection
alcohol withdrawl |
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Definition
| librium, tranxene, valium, ativan, oxazepam |
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Term
Benzodiazepines
selection
perioperative |
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Definition
|
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Term
Benzodiazepines
side effects |
|
Definition
| drowsy,ataxia,sedation,disoriented, confusion, lighthead,irritability, aggression, incoordination, dec. concentration, anterograde amnesia, sleep driving & other behaviors like eating, calling, sex. Paradoxical effects (insomnia, excitatory, euphoria, heightened anxiety, rage), Resp. depression, abuse, weakness, HA, blurred vision, vertigo, N/V/D,epigastric distress, neutropenia, jaundice, Pregnancy D/X |
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Term
| Most likely to cause anterograde amnesia |
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Definition
|
|
Term
Benzodiazepines
drug interactions |
|
Definition
| CNS depressants, antacids, tagament, SSRI, oral contraceptives, theophylline |
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Term
Benzodiazepines
tolerance & dependence |
|
Definition
No tolerance to anxiolytic effects, low tolerance to hypnotic effects. Tolerance to antiseizure effects. Cross tolerance from alcohol & barbs
Dependence-Mild withdrawl with short term use at therapeutic dose. Anxiety, insomnia, sweating, tremors, dizzy.
Long-term/high-dose withdrawl panic, paranoia, delirium, HTN, muscle twitches>convulsions |
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Term
| Withdrawl Symptoms worst with these type Benzodiazepines |
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Definition
| short duration, xanax worst |
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Term
|
Definition
| Taper dose over weeks>mths, sub a long 1/2 life drug |
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Term
Benzodiazepines
Pt teaching |
|
Definition
|
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Term
|
Definition
PO-drowsy, lethargy, confusion
IV-profound hypotension, respiratory arrest, cardiac arrest
tx:gastric lavage, resp support, IVF, NE or BP med support
Flumazeril |
|
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Term
|
Definition
Competitve benzo receptor antagonist. Reverse sedative effects, but not resp effects. May cause convulsions.
IV admin-1st 0.2/30sec, 2nd 0.3 and then 0.5 |
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Term
|
Definition
| Binds to benzo receptor on GABA receptor limited to benzo1 subtype (not effective anxiolytic or muscle relaxant) |
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Term
|
Definition
| extensive metabolism to inactive compounds, 1/2 life 2.4h, rapid onset, med duration. Dose adjust in elderly and liver dysfunction |
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Term
|
Definition
| daytime drowsy, dizzy, sleep driving & other behaviors |
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Term
|
Definition
|
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Term
|
Definition
| Binds to benzo1 receptor of GABA. Rapid onset and short duration |
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Term
|
Definition
| HA, nausea, drowsy, dizzy, myalgia, abd. pain, sleep driving behavior, physcial dependence minimal-mild rebound insomnia x1 day |
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Term
|
Definition
| cimetidine-reduce dose (reduce dose in live impair) |
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Term
|
Definition
| Binds selective to benzo1 of GABA. No length of time limit. |
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Term
|
Definition
| Extensive hepativ metabolism CYP, 1/2 life 6h. decrease dose in elderly and liver impair |
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Term
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Definition
| Bitter aftertaste, HA, somnolence, dizzy, dry mouth, rebound insomnia x1 day after DC, sleep driving and behavior, anaphlyaxis. |
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Term
|
Definition
| Pineal gland hormone that regulates circadian clock. Secretion supressed in light, stimulated in dark. Only hormone available OTC. 0.3-1mg 1-2h a HS. Side effects in >2mg hangover, HA, nightmares, hypothermia, transient depression |
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Term
|
Definition
| Melatonin agonist. Activation of melatonin receptors |
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Term
|
Definition
| Chronic insomnia, rapid onset, short duration |
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Term
|
Definition
| Food reduces absorption esp high fat, extensive 1st pass CYP, active metabolites, Avoid in hepatic impair |
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Term
|
Definition
| Somnolence, dizzy, fatigue, sleep behaviors, hallucinations, agitation, mania, increase prolactin, decrease testosterone, amenorrhea, galactorrhea, decrease libido & fertility, severe allergic react, dyspnea, throat contrict, teratogenic in rats |
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Term
|
Definition
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Term
Chloral hydrate & meprobarnate
side effects |
|
Definition
Nonselective CNS depressants
drowsiness,tolerance & physical dependence, teratogenic, epigastric distress, nausea, flatulence (mix liquid w/juice) |
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Term
Chloral hydrate & meprobarnate
precautions |
|
Definition
| avoid driving or other dangerous activities |
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Term
Chloral hydrate & meprobarnate
interactions |
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Definition
|
|
Term
Chloral hydrate & meprobarnate
toxicity |
|
Definition
Resp. depression, coma, miosis, hypotension.
TX-like barb toxicity |
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Term
Chloral hydrate & meprobarnate
withdrawl |
|
Definition
sleep disruptions and nightmares
abrupt withdrawl delirium and seizures |
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Term
|
Definition
| Tx specific causes, use non-drug tx first, then benzo, or nonbenzo short term |
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Term
|
Definition
| avoid naps, regular sleep schedule, decrease caffeine, restful activity before bed, environmental factors-corrct or compensate, cognitive behavior/sleep hygiene |
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Term
|
Definition
| Dont stay in bed too long, blackout shades, lower temp, exercise daily (not p 7p), outdoor time every day, decrease fluid in eve, avoid alcohol and tobacco, light snack HS, Avoid TV & computers at HS. If not asleep in 20 minutes get out of bed, bedroom is for sleep |
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Term
|
Definition
| Uncomfortable state with psychological and physical components caused by real or potential danger that threatens security of individual |
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Term
| Psychological symptoms of anxiety |
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Definition
| Fear, apprehension, dread, uneasy |
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Term
| Physical symptoms of anxiety |
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Definition
| Tachycardia, palpitations, trembling,dry mouth, sweating, weakness, fatigue, SOB |
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Term
| Common element of anxiety disorders |
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Definition
| Unhealthy level of anxiety. Persistent, excessive, abnormal, irrational, impairs normal daily function. |
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Term
| Types of anxiety disorders |
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Definition
General anxiety disorder (GAD)
Panic
OCD
Social anxiety
PTSD
Specific phobias |
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Term
| Soicetal consequences of anxiety |
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Definition
| physical and occupational disabilities, 4.4 days/month lost work, higher utilization of PCP and GI |
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Term
| Medical conditions assoc w/Anxiety |
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Definition
| CV, endocrine/metabolic, neurologic, respiratory, anemias, lupus, vestibular disorder |
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Term
| Medications assoc w/Anxiety |
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Definition
| Anticonvulsants, antidepressants, antHTN, antibiotics, bronchodilators, corticosteroids, DA, herbals, NSAIDs, stimulants, sympathomimetics, thyroid hormones. Drug toxicities, Drug withdrawls |
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Term
|
Definition
(theories)
Abnormal neurotransmitter function (NE, GABA, serotonin)
Hypersensitive autonomic nervous system
GABA inhibit of NE and serotonin
overactive serotonin |
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Term
|
Definition
Differential dx (medical, drugs)
H&P
MMSE
Labs
Tox screen |
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Term
| Drug families to treat anxiety |
|
Definition
Benzos
SSRI
BusBar, Effexor, Cymbalta |
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Term
|
Definition
| Chronic uncontrollable unrealistic/excessive worry about several activities >6mth. Least likely to remit, usually another psych condition exists. . |
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Term
|
Definition
| Vigilence, tension, apprehension, poor concentration, difficulty falling asleep or staying asleep, tremble, muscle tension, restless, autonomic hyperactivity (palpitation, tachycardia, sweating, cold clammy hands). Impair social, occupational, or other functional areas. |
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Term
|
Definition
| Non drug supportive therapy, cognitive behavior therapy, biofeedback, relaxation techniques |
|
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Term
|
Definition
1st line Benzos-rapid relief (intermittent or adjunt)
(All other are delayed relief)
2nd line-BuSpar
1st line long-term management:Effexor XR, Paxil, Lexapro, Imipramine for those who fail SSRIs
Cymbalta
Should be 12mths or longer |
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Term
Panic Disorder
characteristics |
|
Definition
| Chronic waxing and waning of series of unexpected panic attacks involve intense terrifying fear similar to that caused by life-threatening danger. One month of concern of reoccurance or consequences accompanied by significant behavior changes. |
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Term
Panic Disorder
s/s of attack |
|
Definition
| 20-30min.(4 or more symptoms)Palpitations, sweating, trembiling, SOB, smothering sensation, feeling choking, chest pain, nausea, abd. distress, dizzy, lightheaded, chills, heat sensation, paresthesias, derealization or depersonalization, losing control/going crazy feeling, fear of dying. |
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Term
Panic Disorder
adverse impact |
|
Definition
| Depression, Alchohol abuse, high use of health services, higher risk suicide, 50% become agorophobic. |
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Term
Panic Disorder
phases & goals |
|
Definition
Acute-Reduce symptoms (1-3mths)
Continuation-Complete & extend tx response. Max response, minimize side effects. (2-4mths)
Mantenance-3-12mths. Attempt to DC drug at 8mths, if unable then reattempt q3mths |
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Term
|
Definition
Benzo's until SSRI starts to work-Xanax ideal for rapid relief
(All 4 antidepressant families take 6-12wks to work)
1st line:SSRIs-Paxil, Prozac, Zoloft
2nd line TCA, 3rd MAOIs |
|
|
Term
Social Anxiety Disorder
Characteristics |
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Definition
| Intense irrational persistent fear of situations may be scrutinized by others, or may do something embarrassing/humiliating. Adults may be able to recognize this is irrational. Avoidance utilized |
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Term
Social Anxiety Disorder
s/s |
|
Definition
| Fears:scrutinized by others, embarrassed, humiliated. Physical: blush, butterflies, diarrhea, sweating, tachycardia, trembling |
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Term
Social Anxiety Disorder
types |
|
Definition
Generalized
Non-generalized |
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Term
Social Anxiety Disorder
situations inducing fear |
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Definition
| public speaking, eating or writing in front of others, interact w/authority, talking w/strangers, public toilets |
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Term
Social Anxiety Disorder
Drug tx |
|
Definition
Benzo's (Klonopin-taper when DC) with antidepressant and/or psychotherapy
Benzos used when low risk for abuse, for rapid relief, and when unresponsive to other tx.
1st line-SSRI (Paxil & Zoloft)
2nd line-Effexor 3rd- MAOI
Other drug:propranolol |
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|
Term
Differentiating Anxiety types
Social Anxiety Disorder vs Panic
Social Anxiety Disorder vs GAD |
|
Definition
SAD vs Panic
panic-fear of symptoms
SAD-fear of situation/embarrassment
SAD vs GAD
GAD-social fears small part of multi fears
SAD- Comorbid mood, anxiety, or substance abuse proceded fear and is assoc w/increase suicide ideation |
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Term
Specific phobias
presentation |
|
Definition
| To specific object or situation, free of symptoms in between |
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Term
|
Definition
Behavioral therapy
unresponssive to drugs, drugs may be detrimental |
|
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Term
|
Definition
Reduce severity, duration, frequency
Improve overall functioning
Prevent symptoms
Improve QOL |
|
|
Term
Anxiety Teatment
Non-pharmacological |
|
Definition
Counseling
stress management
Paychotherapy
Meditation
Exercise
Avoid caffeine, stimulants, diet pills |
|
|
Term
Anxiety Treatment
Pharmacological |
|
Definition
1st line Benzos
BusPar
Antidepressants
BB |
|
|
Term
Benzodiazepines
In anxiety tx |
|
Definition
Rapid relief of acute anxiety symptoms
-symptom relief w/o solving problem
Short term use (4-6mths)
Start low, go slow
Taper down
Potential for abuse, tolerance, physcial dependence |
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Term
|
Definition
| Binds to serotonin receptors (no GABA affect) |
|
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Term
|
Definition
| BuSpar-less sedating, no additive CNS depressent concerns if concurrent use of alcohol or other sedative drugs, less abuse, effective in cognitive symptoms of anxiety, but take 2-4wks to be effective. Benzos offer quicker relief,can be used PRN & are more effective in relieving anxiety. |
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|
Term
|
Definition
| Extensive 1st pass metabolism |
|
|
Term
|
Definition
| Dizzy, nausea, HA, nervous, lightheaded, excitement |
|
|
Term
|
Definition
| Erythromycin, ketoconazole, grapefruit juice |
|
|
Term
|
Definition
| Anxiety. Specifically those who fail other therapy, can not tolerate sedation/pscyhomotor benzo affects, and those with hx substance abuse |
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Term
|
Definition
| Persistent obsessions & compulsions w/distress consume at least 1h/day & interfere w/daily living. Pts know behavior is excessive and senseless, but cannot stop |
|
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Term
|
Definition
| Recurrent, persistent thought, impulse, or mental image. Unwanted and distressing, comes involuntarily to mind, despite trying to ignore |
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Term
|
Definition
| Ritualized behavior or mental act, driven to perform in response to obsession to prevent a horrible event from occurring |
|
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Term
|
Definition
Combo behavioral and drug. If severe deep brain stimulation.
Drugs-SSRI, anafranil |
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|
Term
|
Definition
| Traumatic event elicits immediate fear reaction, helplessness or horror. Reexperiences the event, avoids reminders of event, and a persistent state of heperarousal |
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Term
|
Definition
| Trauma based therapy, stress inoculation training. Drug tx-evidence strongest for SSRIs Paxil and Zoloft |
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