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Pharm Study Guide

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15 views

Pharm Study Guide

Uploaded by

hidalgo100202
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Corticotrophin- releasing factor (CRF) stimulates anxiety

Biology of anxiety- imbalance of neurotransmission


What neurotransmitters are out of balance with anxiety?- neponephrine (excess excitable) GABA
(calming). More neninepheine than GABA
Anxiety sub disorders- generalized anxiety disorder, OCD, PTSD, social anxiety, and panic disorder

Benzodiazepines —> drug class


Most common group of anti anxiety
Examples: valium and xanax
Short term use ONLY, abuse potential

Diazepam (valium) —> drug name


-Enhances GABA
-Muscle relaxer
-long half life (20-100 hours)
5-7 days for steady state

Adverse effects of diazepam:


-CNS depressant
-Confusion
-Disinhibition
-Depression
-Overdose (slow breathing, coma)

Caution with:
Older adults

Black box warning:


Avoid opioids can cause overdose and lead to death

Patient teaching:
-don’t drive
-difficulty breathing
-confusion
-dry mouth

Non benzo hypontic agents —> class


-Sleep aid
-Take immediately before going to bed
Examples: lunesta and ambien

Eszopicolone (lunesta) —> name schedule IV


-For insomnia
-acts on GABA receptors

Adverse effects for lunesta


-behavioral changes, aggression
-depression
-hallucinations
-suicidal ideation
-anterograde amnesia (biggest one)

Zolpidem (ambien) schedule IV


Insomnia
Similar effects as diazepam

Adverse effects of Ambien


-similar to eszopicolone
Herbal supplements:
St. johns worth is herbal equivalent to SSRI
Valerian root is equal to benzo
Ashwuaganda is good for low level anxiety control

SSRI is first line for chronic anxiety management


Older adults have issues with valium because their half life is longer

Types of depression- major and mild depression, adjustment disorder


Etiology of depression- immune system, alteration can cause depression monamine neurotransmitter
dysfunction, mess up serotonin, neuroendocrine factors , genetic, environmental, life events

Best treatment for anxiety/ depression is exercise

Drug therapy for depression have an increase risk of suicide

SSRI (selective serotonin reuptake inhibitor) (makes aeration in more available)


-first line therapy for depression and has less side effects
-serotonin is needed in order to balance the body, if electrical signals cannot find a way with enough
serotonin then it will find another way which causes anxiety/depression

Fluoxetine (prozac)
-First line therapy
-less side effects than benzodiazepines
-takes about a month to work
-blocks reuptake of serotonin in brain

Adverse effects
-GI
-sexual dysfunction

Serotonin syndrome (too much serotonin)


-serious, fatal
-combined MAO/SSRI
Symptoms:
-hypertension
-hyperrexia
-coma
-agitation
-delirium
-death

SNRI (serotonin norepinephrine reuptake inhibitor)


-anxiety/depression
-similar to SSRI, targets 2 neurotransmitters

Venlafaxine (effexor)
Side effects-
Weight gain in older people
Similar to SSRI, but greater effects

Serotonin syndrome
With SNRIs occurs with MAOs

MAO- pheneizine (nardil)

ANS divided into CNS/PNS


CNS= brain/spinal cord
PNS= nerves and ganglia

Sympathetic NS= fight or flight


Parasympathetic NS= rest and digest

NMDA —> class


Memantine (namenda) —> name
-for moderate/severe disease
-NMDA binds to magnesium and slows intracellular calcium accumulation, slows nerve damage

Caution:
Sulfa may cause memantine toxicity
Adverse effects:
-hypertension
-dizziness
-confusion
-anxiety
-fatigue
-hallucinations
-GI

Teaching: fall risk

Dopamine receptor agonist

Levadopa/carbidopa
-increases dopamine in brain

Side effects:
-headache
-hallucinations
-anxiety
-dementia
-drowsiness
-tachycardia
-ectopic HB
-hypotension
-wide QRS

Do not use in children


Given with food or after
Meal to decrease vomiting

Catechol-o-methyl transferases inhibitor

Talcapone (tasmar)
-inhibits metabolism of dopamine in the brain

Side effects
CNS
CV
Integ
GI
Resp
Liver failure
Psychosis
Confusion
Dry mouth
Dizziness
Administered with levodopa- carbidopa

Do not stop abruptly

Dementia (Alzheimer’s disease)

Pathophys:
-amyloid plaque
-neurofibrillary tangles
-neuritic plaques

Med management:
Slow progression, no cure, vitamin E, anti-inflammatory, cholinesterase inhibiters

Parkinson’s disease:
-degenerative disorder of CNS
-death of dopamine producing neurons

Management:
-dopamine receptor agonists
-catehol-o-methlytransforase inhibitors

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