quiz 5

where are benzodiazepines/antidepressants metabolized

liver through oxidative enzymes

where are benzodiazepines/antidepressants execreted

kidneys

side effects of benzodiazepines as SEDATIVE (6)

• drowsiness

• poor motor performance

• poor balance

• memory problems

• dependence/addiction

• withdrawal

how do benzodiazepines work

increase effect of GABA → produces relaxation

what drugs are considered nonbenzodiazepines

barbiturates

what do benzodiazepines end in

• -pam

• -lam

what do barbiturates end with

-barbital

what are barbiturates also used for

• hypnotic/sleep properties

• general anesthesia

what are benzodiazepines also used for (4)

• sleep

• anxiety

• sometimes muscle relaxation

• both

side effects of barbiturates

addictive → can lead to drug abuse

other nonbenzodiazepines mechanism of action

enhance GABA receptor activity

what drug is used to promote sleep that has fewer side effects

• other nonbenzodiazepines

• NOT BARBITUATES

• NOT BENZODIAZEPINES

what are other drugs that facilitate sleep (5)

• antihistamines

• antidepressants

• antipsychotics

• anticonvulsants

• opioid analgesics

how do benzodiazepines work as ANTIANXIETY

• boost effect of brain’s endogenous inhibitory neurotransmitter (GABA)

• increase inhibition in SC → skeletal muscle relaxation

side effects of benzodiazepines as ANTIANXIETY (4)

• sedation

• addiction

• abuse

• withdrawal

how does buspirone work

• increases effects of serotonin in specific areas of brain

• is an agonist that stimulates receptors

what antianxiety drug has less motor and sedation side effects

buspirone

what antianxiety drug does NOT lower risk for tolerance, dependence, and abuse

benzodiazepines

what drugs are considered first line anxiety meds

some antidepressants

what are considered “other” antianxiety drugs

• beta-blockers

• antipsychotics

• anticonvulsants

• antihistamines

what treats acute anxiety

benzodiazepines

how do barbiturates work

CNS depressant with a chemical origin of barbituric acid

how does SSRIs work

block reuptake of serotonin in presynaptic terminal @ key locations in brain → allows serotonin to stay in synaptic cleft → exerts effects for longer

what drugs for affective disorders are the first choice

SSRI

how do SNRIs work

decreases serotonin and norepinephrine reuptake w/o effect on dopamine synapses

what can SNRIs also be used for

• chronic pain

• OA

• peripheral neuropathies

• fibromyalgia

side effects of SSRI and SNRI (3)

• nausea

• vomiting

• diarrhea/constipation

how are the sedation/CV side effects of SSRIs and SNRIs

• less sedation effects compared to tricyclic antidepressants and others

• low incidence of CV problems and anticholinergic effects

how do tricyclics work

block reuptake of any amine neurotransmitters in presynaptic terminal → tend to affect synapses in all 3 primary amines

when are tricyclics used

when ppl fail to respond to other antidepressants or for specific pain syndromes

side effects of tricyclics (4)

• SEDATION

• anticholinergic effects

• increased seizure risk

• increased CV problems

HIGHEST potential for lethal overdose → cardiac arrhythmias

how do monoamine oxidase inhibitors work

allow neurotransmitters to remain in synaptic cleft and continue to exert a effect

side effects of monoamine oxidase inhibitors (2)

• high BP

• CNS excitation → restlessness, irritability, agitation, and sleep loss

• high incidence of side effects

• can be dangerous if taken w/ foods that contain tyramine

benefit of MAO inhibitors

lower anticholinergic effects than tricyclics

how do trazodone and nefazodene work

• block serotonin receptors while inhibiting serotonin reuptake

• may normalize serotonin influence in the brain

what is trazodone also be used for (5)

• insomnia

• anxiety

• chronic pain

• sexual dysfunction

• eating disorders

how does bupropion work

dopamine and norepinephrine reuptake inhibitor

what antidepressant that can be used to treat pain

duloxetine

what is the primary drug used to treat bipolar

lithium

what is an issue with lithium

• NOT METABOLIZED → accumulation can be an issue

• absorbed in GI tract

side effect of lithium

lithium toxicity = tremor, fatigue, weakness, GI disturbances, ECG changes, polyuria, polydipsia

other drugs used to treat bipolar disorder (2)

• antiseizures

• antipsychotics

how do these other drugs for bipolar disorder work

prevent neuronal excitation and stabilize mood → prevent manic symptoms

how do antipsychotics work

block dopamine receptors

extrapyramidal symptoms of antipychotics (6)

• tardive dyskinesia

• pseudoparkinsonism

• akathisia

• dyskinesia

• dystonia

• neuroleptic malignant syndrome

what extrapyramidal symptom can use a beta blocker to reduce its effect

akathisia

what can tardive dyskinesia lead to

dysphagia

nonmotor effects of antipsychotics (7)

• weight gain

• increased plama lipids

• diabetes

• sedation effects

• anticholinergic effects: blocks AcH from binding to receptors in nervous system → disrupts parasympathetic

• orthostatic hypotension

• withdrawal

what is tardive dyskinesia

several involuntary and fragmented movements (mouth, tongue, jaw)

Goal of antipsychotics

Normalize dopamine and serotonin in the brain

classification of sedative hypnotics

• benzodiazepines

• non benzodiazepines

classification of anti anxiety drugs (3)

• benzodiazepines

• buspirone

• other

classification of antidepressants/affective disorder drugs (4)

• SSRIs

• SNRIs

• MAO inhibitors

• other

what can antipsychotics also b used for

• antiemetic

• dementia

examples of other antidepressants/ affective disorder drugs

• trazodene

• nefazodone

• bupropion

• amphetamines

examples of tricyclics

• amitriptyline

• nortriptyline

when can a high dose of tricyclics be administered

acute manic episode