Module 7 CNS Study Guide

Patients with concerns for anticholinergic side effects (e.g., elderly, BPH, glaucoma) should avoid hydroxyzine.

Beta-blockers like propranolol reduce anxiety symptoms by blocking beta-1 and beta-2 adrenergic receptors, preventing catecholamine effects, without sedation.

Beta-blockers should be avoided by patients with cardiac issues or those already taking them and use EpiPens, as they may hinder effectiveness or cause issues with anaphylaxis.

Induces CYP3A4, affecting the metabolism of many drugs potentially leading to interactions: including triptans, benzodiazepines, warfarin, and contraception; also affects neurotransmitter function and sometimes p-glycoprotein (and therefore other factors).

Eszopiclone (Lunesta) and ramelteon (Rozerem) are recommended for chronic insomnia.

Lunesta (eszopiclone) is a non-benzodiazepine agonist acting on GABA-B receptors.

Ramelteon (Rozerem) acts as a melatonin agonist, promoting sleep onset.

Patient education on sleep medication side effects is critical, including possible complex sleep behaviors like sleepwalking and driving while not fully awake, potentially leading to serious injury.

Benzodiazepines should not be prescribed for ongoing anxiety management due to high addiction risk and severe withdrawal symptoms when discontinued. They are best used as short-term support or to bridge to longer-term therapies.

Abruptly stopping chronic benzodiazepine use can trigger severe withdrawal symptoms, including seizures and intense anxiety.

Benzodiazepines should not be used with alcohol or opioids due to heightened CNS sedation, abuse potential and risk for addiction.

Benzodiazepines with faster onset of action have a higher risk of abuse and dependence, due to their quick impact on the central nervous system.

SSRIs are better for long-term anxiety management, but take several weeks to become effective. Benzodiazepines are often a better choice for immediate anxiety relief.

BuSpar has interactions with MAOIs and certain CYP450/3A4 inhibitors or inducers. These can impact its metabolism and should be considered.

Hydroxyzine is sometimes used for anxiety but has a relatively low risk of abuse compared to benzos. Use caution, and monitor for any signs of misuse.

SSRIs and SNRIs are the recommended drugs for treating anxiety disorders for extended periods. They usually take 2-3 weeks to become effective.

H1 antihistamines (like Benadryl) are generally considered safe; Ambien (a non-benzodiazepine) may be used as a last resort for short-term treatment but is a Category C drug, meaning potential risks to the fetus are possible.

Antidepressants are categorized into SSRIs (e.g., Paxil, Celexa), SNRIs (e.g., Effexor), TCAs (e.g., Elavil), MAO Inhibitors (e.g., Marplan), and atypical antidepressants (e.g., Bupropion).

SSRIs block the reuptake of serotonin, increasing serotonin levels in the brain to enhance activation at post-synaptic receptors.

Initial antidepressant response typically takes 2-3 weeks, but full effects often take 4-8 weeks.

The primary factors in choosing an antidepressant are concurrent medical conditions and the unique characteristics of the patient's depression.

A rare but serious complication from using serotonergic drugs (overdose or drug interactions).

Confusion, agitation, muscle spasms (clonus), fever, tremors, or overly responsive reflexes (hyperreflexia).

Initial follow-up visits frequently (1-4 weeks), then monitoring for suicidal ideation, and effectiveness.

Adjusting dosage or switching medications when antidepressant treatment isn't completely effective (somewhat working).

Sexual dysfunction is a common reason patients stop taking antidepressants. Bupropion (Wellbutrin) has fewer sexual side effects but isn't suitable for patients with seizures.

Increased suicide risk in adolescents taking antidepressants; need for more frequent follow-up visits initially.

SNRIs, such as duloxetine (Cymbalta), can help with stress urinary incontinence and diabetic neuropathy.

Increased risk of suicidal thoughts, especially in adolescents and children, in early treatment stages.