Module 7 CNS Study Guide

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Questions and Answers

What is the primary mechanism of action (MOA) of SSRIs?

Inhibit monoamine oxidase activity

Increase the release of dopamine

Block the reuptake of serotonin (correct)

Block the reuptake of norepinephrine

What is a potential risk associated with taking long half-life drugs like eszopiclone?

Higher risk of next-day impairment (correct)

Increased risk of dependence

Withdrawal symptoms

Development of tolerance

Which class of antidepressants involves blocking the reuptake of both serotonin and norepinephrine?

MAO Inhibitors

SSRIs

Atypical antidepressants

TCAs (correct)

Which medications are considered safe for use during pregnancy?

Benadryl and H1 antihistamines Signup and view all the answers

How long does it generally take to see the full effect of antidepressants?

4-8 weeks Signup and view all the answers

Which of the following is NOT a classification of anxiolytics?

MAOIs Signup and view all the answers

What is the primary reason benzodiazepines should not be prescribed for daily use for anxiety?

They can cause severe withdrawal symptoms. Signup and view all the answers

What is the effect of rapid onset of benzodiazepines on their potential for abuse?

Higher risk of abuse. Signup and view all the answers

Which drug class should be avoided while using benzodiazepines?

Opioids Signup and view all the answers

Which benzodiazepine is known for having the fastest onset of action?

Alprazolam (Xanax) Signup and view all the answers

Why are SSRIs considered a good long-term choice for anxiety management?

They are non-addictive. Signup and view all the answers

What effect do CYP450 and 3A4 inhibitors have on Buspirone (BuSpar)?

Reduce clearance, increasing AUC. Signup and view all the answers

What is a potential issue when using hydroxyzine (Vistaril) in anxiety treatment?

CNS sedation risk. Signup and view all the answers

Which patients should avoid using hydroxyzine?

Elderly patients with glaucoma Signup and view all the answers

How do Beta-Blockers like Propranolol help alleviate anxiety during public speaking?

They block adrenergic stimulation in the heart Signup and view all the answers

Who should avoid taking Beta-Blockers?

Those with cardiac issues Signup and view all the answers

What major drug interaction is associated with St. John’s Wort?

Induces CYP3A4 and reduces the AUC of some medications Signup and view all the answers

What is a unique side effect of Lunesta in chronic insomnia treatment?

Sleep driving Signup and view all the answers

What is the primary action of Rozerem in treating insomnia?

Activates melatonin receptors Signup and view all the answers

What side effect is associated with Rozerem treatment for insomnia?

Increased fatigue Signup and view all the answers

Which of the following is a recommended treatment for chronic insomnia lasting over 2 months?

Lunesta (eszopiclone) Signup and view all the answers

Which medication is indicated for treating depression with concomitant pain?

Duloxetine (Cymbalta) Signup and view all the answers

What is a primary concern when prescribing serotonergic agents?

Serotonin Syndrome Signup and view all the answers

How often should patients be monitored after starting antidepressant treatment?

1-4 weeks, then less frequently Signup and view all the answers

Which antidepressant is associated with a lower risk of sexual side effects?

Wellbutrin Signup and view all the answers

What is the black box warning (BBW) for antidepressants?

Suicide risk, especially in children and adolescents Signup and view all the answers

What should be ruled out before prescribing any antidepressants?

Bipolar disorder and hypothyroidism Signup and view all the answers

Which of the following symptoms is NOT associated with serotonin syndrome?

Bradycardia Signup and view all the answers

What is the recommended follow-up schedule for adolescents starting SSRIs or SNRIs?

Weekly for the first month, then bi-weekly Signup and view all the answers

Study Notes

Module 7 Study Guide - CNS

Anxiolytics and Sedatives/Hypnotic Drugs
- Six classifications of anxiolytics: SSRIs, SNRIs, Azapirones (Buspar), Benzodiazepines, Antihistamines, and β-blockers
- Benzodiazepines should not be prescribed for long-term anxiety management, but are useful for acute events or bridging therapy
- Benzodiazepines are highly addictive and abrupt discontinuation can cause severe withdrawal, seizures and anxiety
- ETOH and opioids should be avoided when using benzodiazepines, due to increased abuse potential
- The faster the onset of action, the higher the likelihood of abuse and dependence (e.g., Alprazolam, Xanax has the fastest onset)
- SSRIs are a good choice for long-term anxiety management but take weeks to take effect, while benzodiazepines are used for acute anxiety
Insomnia
- Lunesta (eszopiclone) and Rozerem (ramelteon) are recommended treatments for chronic insomnia (>2 months).
- Sleep medications should not be taken unless there are 7-8 hours available for sleep.
- Avoid taking sleep medications with other CNS depressants or alcohol.
Antidepressants
- Five classifications: SSRIs, SNRIs, TCAs, MAOIs, and atypical antidepressants
- MOA varies, with SSRIs and SNRIs blocking serotonin and norepinephrine reuptake, respectively. TCAs block both. MAOIs inhibit the breakdown of neurotransmitters. Atypical antidepressants, such as bupropion, have varied mechanisms.
- Initial response time is 2-3 weeks, with full effect seen in 4-8 weeks.
- Main determinants for use are concurrent conditions and attributes of depression
- Serotonin syndrome is a potentially serious complication linked to serotonergic agents
- Patients should be seen 1-4 weeks after initial treatment and frequently thereafter
ADHD Drugs
- Stimulants are first-line treatment, with non-stimulants (e.g., Strattera, Clonidine, Guanfacine) used for cases where stimulants are not tolerated or side effects are severe
- Stimulants are controlled substances, with a high risk for abuse and dependence.
- Non-stimulants are not controlled substances, with lower abuse and dependence risk.
Mood Stabilizers and Antipsychotic Drugs
- Lithium is the gold standard for bipolar disorder treatment, with black box warnings for toxicity.
- Antipsychotic drugs, including first and second-generation classes, have multiple mechanisms of action.
- First-generation antipsychotics primarily target dopamine receptors (e.g., haloperidol, chlorpromazine).
- Second-generation antipsychotics have broader effects on multiple neurotransmitters (e.g., clozapine, risperidone)
Antiepileptic Drugs (AEDs)
- Goal of treatment is to decrease seizures to a manageable level.
- Monitoring of blood plasma levels helps adjust dosing.
- Traditional AEDs include phenytoin, phenobarbital, and ethosuximide. Newer AEDs include gabapentin and lamotrigine.
- Important patient education regarding AED use, food interactions and drug interactions is important for safety and efficacy.
- Concern with contraception and pregnancy with AEDs, and the importance of planning ahead.
Alzheimer's and Parkinson's Disease Drugs
- Cholinesterase inhibitors (mild to moderate AD) and NMDA (moderate to severe AD) receptor antagonists are used to treat Alzheimers.
- Cholinesterase inhibitors prevent the breakdown of acetylcholine , a crucial neurotransmitter in memory and learning.
- Memantine (Namenda) is an NMDA receptor antagonist that modulates glutamate effects.
- Levodopa and dopamine agonists may improve motor symptoms

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Description

This study guide focuses on anxiolytics, sedatives, hypnotic drugs, and insomnia management. Learn about the classifications of anxiolytics, their uses, effects, and the important considerations regarding their prescription. It provides insights into the implications of using benzodiazepines and alternative treatments for sleep disorders.