Benzodiazepines and SSRIs Overview

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Questions and Answers

What potential cardiac risk is associated with certain antidepressants?

  • Reduction in heart rate
  • Elevated blood pressure
  • Improved myocardial perfusion
  • Increased risk of dysrhythmias (correct)

Which dietary consideration is essential for patients taking MAO inhibitors?

  • Increased fiber intake
  • Avoidance of fermented foods (correct)
  • Reduction in carbohydrate consumption
  • Increased protein intake

Which mechanism of action characterizes atypical antidepressants like Bupropion?

  • Boosts norepinephrine and dopamine (correct)
  • Blocks NMDA receptors
  • Inhibits serotonin reuptake
  • Inhibits monoamine oxidase

What adverse effect is commonly associated with first-generation antipsychotics?

<p>Tardive dyskinesia (A)</p> Signup and view all the answers

What is a primary reason MAO inhibitors are not commonly prescribed as a first-line treatment for depression?

<p>Increased risk of side effects and dietary restrictions (C)</p> Signup and view all the answers

Which of the following statements about Ketamine is correct?

<p>It can decrease glutamate binding (C)</p> Signup and view all the answers

What is a significant consideration when prescribing Bupropion?

<p>It may increase seizure frequency in predisposed individuals (A)</p> Signup and view all the answers

What is a primary concern when using stimulants like methylphenidate?

<p>Insomnia and restlessness (A)</p> Signup and view all the answers

What is a common desired effect of Trazodone when used in mildly depressed clients?

<p>Sedation to aid sleep (A)</p> Signup and view all the answers

Which of the following is a contraindication for levodopa/carbidopa use?

<p>High protein meals (A)</p> Signup and view all the answers

What is a significant risk associated with chronic use of methylphenidate?

<p>Marked tolerance and psychological dependence (C)</p> Signup and view all the answers

Which medication is recognized for its potential to increase norepinephrine in treating ADHD?

<p>Atomoxetine (C)</p> Signup and view all the answers

What adverse effect is commonly associated with non-stimulant treatments for ADHD?

<p>Nausea and vomiting (D)</p> Signup and view all the answers

Which of the following conditions does levodopa/carbidopa primarily treat?

<p>Parkinson's disease (B)</p> Signup and view all the answers

What is a known side effect of stimulant medications that can impact overall health?

<p>Restlessness (D)</p> Signup and view all the answers

Which medication class has a small risk of severe liver injury?

<p>Non-stimulants for ADHD (C)</p> Signup and view all the answers

What significant risk is associated with Clozapine that necessitates careful monitoring?

<p>Life-threatening agranulocytosis (C)</p> Signup and view all the answers

Which of the following atypical antipsychotics is associated with the lowest risk of cardiometabolic side effects?

<p>Aripiprazole (A), Ziprasidone (B)</p> Signup and view all the answers

What is a major contraindication for using certain antipsychotics in patients?

<p>Severe depression or comatose state (B)</p> Signup and view all the answers

Which mechanism of action is shared by Clozapine and other second-generation antipsychotics?

<p>Dopamine D2 antagonist (D)</p> Signup and view all the answers

In prescribing carbamazepine, screening for which genetic variant is essential to avoid severe skin reactions?

<p>HLA-B1502 (C)</p> Signup and view all the answers

What is a common adverse effect associated with many second-generation antipsychotics?

<p>Weight gain (B)</p> Signup and view all the answers

What condition does Phenytoin primarily treat?

<p>Tonic-clonic seizures (A)</p> Signup and view all the answers

Which of the following is NOT a common side effect of second-generation antipsychotics?

<p>Increased alertness (A)</p> Signup and view all the answers

Flashcards

Depression Treatment-Norepinephrine/Serotonin Reuptake Inhibitors (SNRIs)

SNRIs work by preventing the body from reabsorbing norepinephrine and serotonin, increasing their availability in the brain.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs increase the amount of norepinephrine and serotonin by preventing their breakdown in the brain.

Atypical Antidepressant - Bupropion

Bupropion boosts norepinephrine and dopamine, known for their stimulating effects, potentially improving focus and concentration.

Ketamine - Depression Treatment

Ketamine, often administered intravenously, affects glutamate, a key neurotransmitter. Its effects on depression are relatively quick.

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Brexanolone (Zulresso) Use

Brexanolone is an expensive, IV-administered treatment specifically for postpartum depression.

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First-Generation Antipsychotics

These antipsychotics affect dopamine brain receptors but have significant side effects (e.g., tardive dyskinesia).

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Anticholinergic side effects

Side effects of certain drugs that include dry mouth, blurred vision, and constipation.

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Tyramine-rich food restriction

Patients on MAOIs must avoid tyramine-rich foods to prevent dangerous blood pressure increases.

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Methylphenidate (Ritalin, Concerta) use in ADHD

First-line treatment for ADHD, amplifying low dopamine and norepinephrine signals.

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Dextroamphetamine use in ADHD

First-line treatment for ADHD, amplifying low dopamine and norepinephrine signals; high potential for abuse.

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Atomoxetine (Strattera) mechanism

Second-line ADHD treatment; inhibits norepinephrine reuptake, increasing its levels.

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Levodopa/Carbidopa use in PD

First-line treatment for Parkinson's Disease, converting to dopamine in the brain and activating dopamine receptors.

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Side effects of Levodopa/Carbidopa

Nausea, vomiting, tremor, hypotension, palpitations, dizziness, potential psychosis.

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Second Generation Antipsychotics

Drugs used to treat schizophrenia, working by antagonizing dopamine and serotonin receptors.

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Clozapine's Risk

Clozapine carries a significant risk of life-threatening agranulocytosis (low white blood cells) and myocarditis (heart inflammation).

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Contraindications for Levodopa/Carbidopa

Avoid high-protein meals, avoid first-generation antipsychotics, MAOIs, anticholinergics, and pyridoxine.

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ADHD stimulant side effects

Insomnia, restlessness, appetite suppression (weight loss), slight increase in heart rate and blood pressure.

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Antipsychotic Side Effects

Weight gain, obesity, dyslipidemia (lipid abnormalities), diabetes, and cardiovascular disease are common side effects of second-generation antipsychotics.

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ADHD Non-stimulant side effects

Dyspepsia, nausea, vomiting, decreased appetite, dizziness, somnolence, mood swings, risk of suicidal thinking in children and adolescents.

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Carbamazepine Use

Used for partial and generalized seizures, bipolar disorder, and trigeminal neuralgia.

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Carbamazepine Warnings

May cause Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN); a severe skin reaction. Also associated with blood disorders like aplastic anemia and agranulocytosis.

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Phenytoin Indications

Used to treat tonic-clonic or partial seizures, epilepsy, and seizures related to head trauma, surgery, or stroke.

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D2D Interactions

Interactions with other medications may occur, particularly with anticholinergic drugs, central nervous system depressants, and Levodopa.

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Blood Monitoring

Regular blood tests are necessary (Complete Blood Count, electrolytes, liver, and heart function tests) for patients taking anti-psychotics, in particular clozapine.

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Study Notes

Benzodiazepines

  • Alprazolam (Xanax) works quickly with a moderate half-life. It's often the most addictive.
  • Lorazepam (Ativan) is commonly used for anxiety, but has a slower onset and shorter half-life.
  • Diazepam (Valium) has a longer half-life and is used to help reduce spasms and decrease seizure activity.
  • Indications include anxiety, seizures, and PD. Used for immediate relief from acute anxiety attacks.
  • MOA: Boosts the effect of the neurotransmitter GABA.
  • Safety/Contraindications/D2D: Contraindicated in pregnancy. Caution in those with sleep apnea or a history of alcohol or substance abuse. Combining benzos with opioids or alcohol can cause severe respiratory depression and death.
  • Special: Schedule IV drugs. Routine daily use leads to physical dependence & is discouraged. Discontinuing use should be tapered over many weeks, as abrupt discontinuation can lead to seizures.

SSRIs

  • Escitalopram (Lexapro), paroxetine (Paxil), citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft) are used to treat anxiety and depression.
  • Indications: GAD, SAD, PTSD, PD, OCD
  • MOA: Block serotonin reuptake, increasing serotonin concentration in the synapse and increasing activation of postsynaptic serotonin receptors.
  • Safety/Contraindications/D2D: Abrupt discontinuation may cause withdrawal symptoms. Serotonin syndrome (rare but serious) can occur. Increased suicidal ideation in first 2-3 weeks.
  • Special: Zoloft, Paxil, Fluvoxamine are safe during breastfeeding. Avoid Paxil during pregnancy; Prozac is the most studied for use in children.

SNRIs

  • Venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine SR (Pristiq) are all treatments for depression and anxiety.
  • Indications: AD, PD, PTSD
  • MOA: Increase serotonin and norepinephrine levels.
  • Safety/Contraindications/D2D: Venlafaxine should be avoided with MAOIs.
  • Special: Venlafaxine can be used for post-menopausal hot flashes.

Anxiolytic

  • Buspirone (BuSpar) is used to treat anxiety.
  • MOA: Not a CNS depressant; unknown mechanism of action.
  • Safety/Contraindications/D2D: Takes several weeks to work. Not for PRN (as needed) use. No abuse potential. Interactions with other medications include Erythromycin, Ketoconazole, and grapefruit juice.
  • Side effects: Dizziness, nausea, headache, drowsiness.

Antihistamine

  • Hydroxyzine (Atarax, Vistaril) is an antihistamine used to treat anxiety and insomnia.
  • MOA: Antihistamine
  • Safety/Contraindications/D2D: Anticholinergic side effects. Use with caution in the elderly. It does not have abuse or addiction concerns.

Beta Blocker

  • Propranolol (Inderal) is used to treat performance anxiety.
  • MOA: Decreases symptoms caused by autonomic hyperactivity, such as tremors, sweating, tachycardia, and palpitations.
  • Safety/Contraindications/D2D: Should not be used in patients already taking beta-blockers or other cardiac medications.

St. John's Wort

  • Used to treat sleep, anxiety, and improve mood.
  • Safety/Contraindications/D2D: Many drug interactions, including triptans, benzos, contraceptives, digoxin, SSRIs, and antibiotics.
  • There is a risk of severe phototoxic skin reactions.

Sedative Benzodiazepines

  • Estaizolam (ProSom), flurazepam (Dalmane), temazepam (Restoril).
  • Indications: Sleep
  • Safety/Contraindications/D2D: Short-term use only (10 days maximum). Risk for dependence. Contraindicated in elderly due to increased risk of cognitive impairments, falls and fractures. Rapid dose decreases can cause withdrawal symptoms.

Non-benzodiazepines

  • Eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).
  • Indication: Sleep.
  • Special Use: Lunesta is the only one recommended for long-term use.

Melatonin Agonist

  • Ramelteon (Rozerem).
  • Indications: Sleep
  • MOA: Activates melatonin receptors
  • Safety/Contraindications/D2D: May increase prolactin levels and decrease testosterone. Interactions with fluvoxamine and hepatic impairment. Contraindicated in pregnancy and lactation.

Other considerations

  • TCAs (Tricyclic antidepressants): Amitriptyline, Clomipramine, Doxepin, Imipramine.
  • MAO Inhibitors: Isocarboxazid, Phenelzine.
  • Atypical antidepressants: Bupropion (Wellbutrin), Trazodone.
  • Ketamine.
  • Brexanolone (Zulresso).
  • First-generation/Conventional Antipsychotics: Haloperidol (Haldol), Chlorpromazine.
  • Second-generation/Atypical Antipsychotics: Clozapine, Olanzapine, Ziprasidone, and Aripiprazole.
  • Iminostilbenes: Carbamazepine (Tegretol).
  • Hydantoins: Phenytoin (Dilantin).
  • Succinimides: Ethosuximide (Zarontin), Valproic acid (Depakote), lamotrigine (Lamictal)
  • Cholinesterase Inhibitors: Donepezil (Aricept)
  • NMDA receptor antagonists: Memantine (Namenda)
  • Stimulants: Methylphenidate (Ritalin, Concerta), Dextroamphetamine, (Dexedrine).
  • Non Stimulants: Atomoxetine (Strattera), Clonidine (Kapvay).
  • Dopamine replacement: Levodopa/Carbidopa.
  • Dopamine agonists: Nonergot Derivatives and Egot Derivatives.

Anticholinergic Drug

  • Benztropine (Cogentin).

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