Quiz 3 Notes
Anxiety is most common psychiatric illness. Generalized anxiety disorder- benzodiazepines=
buspirone(Buspar)- Provide immediate relief of anxiety and can be used as needed for intense
anxiety not a CNS depressant, has no abuse potential, does not intensify the effects of CNS
depressants, anxiolytic effects develop slowly well absorbed after oral Administration, adverse
effects include dizziness nausea headache nervousness sedation lightheadedness and excitement.
drug and food interactions- erythromycin, ketoconazole, grapefruit juice. no withdrawal
symptoms.
SSRIs and SNRIs- Venlafaxine(Effexor)- first antidepressant approved for Gad, approved for
short-term and long-term use, most common side effect is nausea, other effects include headache
and anorexia nervousness sweating daytime somnolence insomnia and hypertension. Used to
treat anxiety and depression
SSRIs- initial effects take for weeks to develop and optimal effects are seen in 8 to 12 weeks.
others: Duloxetine(Cymbalta), paroxetine(Paxil)- short and long term use,
escitalopram(Lexapro).
Panic disorder- symptoms include: palpitations pounding heart, racing heartbeat chest pain or
discomfort sensation of shortness of breath feeling of choking dizziness and lightheadedness
nausea or abdominal discomfort derealization or depersonalization fear of losing control fear of
dying tingling or numbness in the hands flushes or chills. tx: cognitive behavioral therapy,
antidepressants(SSRIs, tricyclics antidepressants, MAOIs), benzodiazepines are first-line drugs.
Obsessive compulsive disorder- potentially disabling condition, persistent obsessions and
compulsions. tx- behavioral therapy, drug therapy= SSRIs- first line drugs for OCD: citalopran,
escitalopram, Fluoxetine, paroxetine, sertraline, clomipramine(anafranil)- Less tolerated
second-line drug.
Social anxiety disorder(social phobia)- intense and irrational fear that one will be scrutinized by
others, generalized or non generalized, very debilitating one of the most common disorders. tx-
psychotherapy, SSRIs, paroxetine and sertraline.
PTSD- develops after a traumatic event- re-experiencing the event, avoiding reminders of the
event, persistent state of arousal. tx- Psychotherapy with drugs, 3 ssris And1 serotonin-
norepinephrine reuptake inhibitor(Venlafaxine), Psychotherapy alone.
sertraline- beneficial effects develop slowly over several months to become maximum. Side
effects include nausea headache insomnia and sexual dysfunction, weight gain can occur.
Treatment last for at least one year.
Headaches are triggered by a variety of stimuli- stress fatigue acute illness and sensitivity to
alcohol. Mild headaches are relieved by over the counter drugs like aspirin or Tylenol. Severe
headaches are categorized as migraines cluster and tension type. Identifiable underlying causes
include severe hypertension hyperthyroidism tumor infection disorders of the eye nose sinuses
and throat. Migraines have no identifiable cause.
, Creamy is done in two ways to abort an ongoing attack like aspirin opioid analgesic and
migraine specific drugs and drugs to prevent attacks from occurring like beta-blockers tricyclic
antidepressants and antiepileptic drugs.
Migraine headache- throbbing head pain of moderate-to-severe intensity, nausea vomiting
sensitivity to light and sound highly debilitating. Hormonal component, family history is
typical. Migraine can be with an aura or without.
Serotonin 1B/1D receptor Agonist- sumatriptan(Imitrex)- binds to receptors on intracranial
blood vessels and causes vasoconstriction, diminishes perivascular inflammation, used to abort
an ongoing migraine attack or to relieve headache and Associated symptoms, given orally or
intranasally. Adverse effects include transient heavy arms or chest pressure, coronary
vasospasm, Tetratogenesis, vertigo malaise fatigue tingling Sensations very bad taste when
given intranasally. Interact with ergot alkaloids, sumatriptan and other triptans. Others include:
naratriptan(amerge), rizatriptan(Maxalt), zolmitriptan(zomig), almotriptan(axert),
frovatriptan(frova), Eletriptan(relpax).
Ergot alkaloids- ergotamine- Agonist activity at subtypes of Serotonin receptors 5-HT1B and
5HT1D receptors, suppresses release of cgrp to block inflammation associated with trigeminal
vascular system, second line for stopping an ongoing migraine in patients who have not
responded to triptan, risk for dependence. Toxicity:ergotism.
other abortive agents- sumatriptan and Naproxen.
Preventative therapy for migraines- beta blockers: propranolol, timolol, Atenolol, metoprolol,
nadolol. Antiepileptic drugs: divalproex(Depakote), Topiramate(Topamax),
Gabapentin(Neurontin), tiagabine(gabitril). Tricyclics antidepressants- amitriptyline(elavil).
Estrogens and triptans for menstrual Associated migraine- estrogen gel and patches(climara,
estraderm), frovatriptan, naratriptan, zolmitriptan and naproxen sodium. Calcium channel
blockers- Verapamil and nimodipine. Botulinum toxin a. Angiotensin-converting enzyme
Inhibitors and Angiotensin II receptor blockers. Riboflavin and coenzyme Q10.
Butterbur(herbal preparation).
Cluster headaches- occurring a series of clusters, each attack lasting 15 minutes to 2 hours,
severe throbbing unilateral pain near the eye, lacrimation conjunctival redness nasal congestion
rhinorrhea ptosis and miosis on the same side of the headache. Attacks occur every day for two
to three months. An attack free interval of months to years separates clusters. tx- Primary
Therapy is directed at prophylaxis, glucocorticoids(prednisone and dexamethasone), Verapamil
and lithium.
Tension-type headaches- most common Form of headache moderate nonthrobbing pain, usually
located in a headband distribution may be episodic or chronic. tx- non-opioid analgesics like
acetaminophen. Aspirin ibuprofen and Naproxen. Analgesic sedative combination: aspirin and
butalbital. Patient teaching on how to manage stress.
CNS stimulants and ADHD disorder= amphetamines are used for ADHD and narcolepsy.
Dextroamphetamine sulfate- immediate and extended release. Amphetamine/
dextroamphetamine mixture- immediate and extended release. lisdexamfetamine(vyvanse).
, Methylphenidate and dexmethylphenidate- nearly identical in structure and pharmacologic
actions to that of amphetamines.
Methylphenidate(Ritalin, medidate, methylin, Concerta, daytrana)- ADHD and narcolepsy.
50/50 mixture of dextro and levo isomers. Immediate release= Ritalin and methylin. Sustained
release= Ritalin Sr, Metadate ER, quillivant XR. Once-daily dosing= Concerta, Metadate CD,
Ritalin la, daytrana.
Miscellaneous CNS stimulants- modafinil(Provigil)- promote wakefulness, used for narcolepsy
and shift work sleep disorder, obstructive sleep apnea. Rapidly absorbed in the GI tract
eliminated by hepatic metabolism half life is 15 hours, adverse effects include headache nausea
nervousness diarrhea rhinitis, drug interactions include oral contraceptives and cyclosporines.
ADHD in children- non-stimulant therapy= atomoxetine= non-stimulant no potential for abuse
and daily dose, selective inhibitor of norepinephrine reuptake, Peaks within 1 to 3 hours
metabolized in the liver. Adverse effects include GI reactions reduced appetite dizziness
somnolence mood swings and trouble sleeping. Drug interactions include
MAOIs( isocarboxazid, phenelzine), CYP2D6(Fluoxetine, paroxetine, quinidine), play their
role in ADHD therapy, dose by weight. Alpha 2 adrenergic Agonist: guanfacine= activate
presynaptic Alpha 2 adrenergic receptors in the brain, side effects include somnolence fatigue
and reduce blood pressure. Clonidine= alpha-2 Agonist, side effects include somnolence fatigue
and hypotension.
Antidepressants for children with ADHD- desipramine, imipramine, bupropion. Tricyclics
antidepressants= increase hyperactivity, little effect on impulsitivity and inattention second line
drugs. Burpropion- can reduce Behavioral symptoms, less effective than stimulants poses a risk
of seizure second-line drug.
ADHD in adults- poor concentration stress intolerance antisocial Behavior Outburst of anger
inability to maintain a routine. tx- Methylphenidate.
Give long-acting drugs in the morning after breakfast. Adverse effects of Adderall Sr include
insomnia restlessness Extreme loquaciousness Weight Loss and appetite suppression
dysrhythmias and anginal pain hypertension shortness of breath fainting and psychosis.
Daytrana is a transdermal methylphenidate patch- levels rise slowly and Pete within 9 hours
after which time the patch should be removed. Pad should be applied to the hip in the morning
and Alternate hips each day. Showering and swimming will not dislodge the patch, can cause
erythema and Pruritis and application site.
Patient should be advised to restrict dietary caffeine to prevent excessive CNS stimulation.
Avoid chocolate soft drinks and other caffeine beverages.
Treatment for depression: Primary Therapy is pharmacotherapy. Depression specific
psychotherapy. Electroconvulsive therapy- when drugs in Psychotherapy have not worked,
when rapid response is needed, for suicidal and severely depressed patients, an elderly patients
at risk of starvation. Transcranial magnetic stimulation.
Anxiety is most common psychiatric illness. Generalized anxiety disorder- benzodiazepines=
buspirone(Buspar)- Provide immediate relief of anxiety and can be used as needed for intense
anxiety not a CNS depressant, has no abuse potential, does not intensify the effects of CNS
depressants, anxiolytic effects develop slowly well absorbed after oral Administration, adverse
effects include dizziness nausea headache nervousness sedation lightheadedness and excitement.
drug and food interactions- erythromycin, ketoconazole, grapefruit juice. no withdrawal
symptoms.
SSRIs and SNRIs- Venlafaxine(Effexor)- first antidepressant approved for Gad, approved for
short-term and long-term use, most common side effect is nausea, other effects include headache
and anorexia nervousness sweating daytime somnolence insomnia and hypertension. Used to
treat anxiety and depression
SSRIs- initial effects take for weeks to develop and optimal effects are seen in 8 to 12 weeks.
others: Duloxetine(Cymbalta), paroxetine(Paxil)- short and long term use,
escitalopram(Lexapro).
Panic disorder- symptoms include: palpitations pounding heart, racing heartbeat chest pain or
discomfort sensation of shortness of breath feeling of choking dizziness and lightheadedness
nausea or abdominal discomfort derealization or depersonalization fear of losing control fear of
dying tingling or numbness in the hands flushes or chills. tx: cognitive behavioral therapy,
antidepressants(SSRIs, tricyclics antidepressants, MAOIs), benzodiazepines are first-line drugs.
Obsessive compulsive disorder- potentially disabling condition, persistent obsessions and
compulsions. tx- behavioral therapy, drug therapy= SSRIs- first line drugs for OCD: citalopran,
escitalopram, Fluoxetine, paroxetine, sertraline, clomipramine(anafranil)- Less tolerated
second-line drug.
Social anxiety disorder(social phobia)- intense and irrational fear that one will be scrutinized by
others, generalized or non generalized, very debilitating one of the most common disorders. tx-
psychotherapy, SSRIs, paroxetine and sertraline.
PTSD- develops after a traumatic event- re-experiencing the event, avoiding reminders of the
event, persistent state of arousal. tx- Psychotherapy with drugs, 3 ssris And1 serotonin-
norepinephrine reuptake inhibitor(Venlafaxine), Psychotherapy alone.
sertraline- beneficial effects develop slowly over several months to become maximum. Side
effects include nausea headache insomnia and sexual dysfunction, weight gain can occur.
Treatment last for at least one year.
Headaches are triggered by a variety of stimuli- stress fatigue acute illness and sensitivity to
alcohol. Mild headaches are relieved by over the counter drugs like aspirin or Tylenol. Severe
headaches are categorized as migraines cluster and tension type. Identifiable underlying causes
include severe hypertension hyperthyroidism tumor infection disorders of the eye nose sinuses
and throat. Migraines have no identifiable cause.
, Creamy is done in two ways to abort an ongoing attack like aspirin opioid analgesic and
migraine specific drugs and drugs to prevent attacks from occurring like beta-blockers tricyclic
antidepressants and antiepileptic drugs.
Migraine headache- throbbing head pain of moderate-to-severe intensity, nausea vomiting
sensitivity to light and sound highly debilitating. Hormonal component, family history is
typical. Migraine can be with an aura or without.
Serotonin 1B/1D receptor Agonist- sumatriptan(Imitrex)- binds to receptors on intracranial
blood vessels and causes vasoconstriction, diminishes perivascular inflammation, used to abort
an ongoing migraine attack or to relieve headache and Associated symptoms, given orally or
intranasally. Adverse effects include transient heavy arms or chest pressure, coronary
vasospasm, Tetratogenesis, vertigo malaise fatigue tingling Sensations very bad taste when
given intranasally. Interact with ergot alkaloids, sumatriptan and other triptans. Others include:
naratriptan(amerge), rizatriptan(Maxalt), zolmitriptan(zomig), almotriptan(axert),
frovatriptan(frova), Eletriptan(relpax).
Ergot alkaloids- ergotamine- Agonist activity at subtypes of Serotonin receptors 5-HT1B and
5HT1D receptors, suppresses release of cgrp to block inflammation associated with trigeminal
vascular system, second line for stopping an ongoing migraine in patients who have not
responded to triptan, risk for dependence. Toxicity:ergotism.
other abortive agents- sumatriptan and Naproxen.
Preventative therapy for migraines- beta blockers: propranolol, timolol, Atenolol, metoprolol,
nadolol. Antiepileptic drugs: divalproex(Depakote), Topiramate(Topamax),
Gabapentin(Neurontin), tiagabine(gabitril). Tricyclics antidepressants- amitriptyline(elavil).
Estrogens and triptans for menstrual Associated migraine- estrogen gel and patches(climara,
estraderm), frovatriptan, naratriptan, zolmitriptan and naproxen sodium. Calcium channel
blockers- Verapamil and nimodipine. Botulinum toxin a. Angiotensin-converting enzyme
Inhibitors and Angiotensin II receptor blockers. Riboflavin and coenzyme Q10.
Butterbur(herbal preparation).
Cluster headaches- occurring a series of clusters, each attack lasting 15 minutes to 2 hours,
severe throbbing unilateral pain near the eye, lacrimation conjunctival redness nasal congestion
rhinorrhea ptosis and miosis on the same side of the headache. Attacks occur every day for two
to three months. An attack free interval of months to years separates clusters. tx- Primary
Therapy is directed at prophylaxis, glucocorticoids(prednisone and dexamethasone), Verapamil
and lithium.
Tension-type headaches- most common Form of headache moderate nonthrobbing pain, usually
located in a headband distribution may be episodic or chronic. tx- non-opioid analgesics like
acetaminophen. Aspirin ibuprofen and Naproxen. Analgesic sedative combination: aspirin and
butalbital. Patient teaching on how to manage stress.
CNS stimulants and ADHD disorder= amphetamines are used for ADHD and narcolepsy.
Dextroamphetamine sulfate- immediate and extended release. Amphetamine/
dextroamphetamine mixture- immediate and extended release. lisdexamfetamine(vyvanse).
, Methylphenidate and dexmethylphenidate- nearly identical in structure and pharmacologic
actions to that of amphetamines.
Methylphenidate(Ritalin, medidate, methylin, Concerta, daytrana)- ADHD and narcolepsy.
50/50 mixture of dextro and levo isomers. Immediate release= Ritalin and methylin. Sustained
release= Ritalin Sr, Metadate ER, quillivant XR. Once-daily dosing= Concerta, Metadate CD,
Ritalin la, daytrana.
Miscellaneous CNS stimulants- modafinil(Provigil)- promote wakefulness, used for narcolepsy
and shift work sleep disorder, obstructive sleep apnea. Rapidly absorbed in the GI tract
eliminated by hepatic metabolism half life is 15 hours, adverse effects include headache nausea
nervousness diarrhea rhinitis, drug interactions include oral contraceptives and cyclosporines.
ADHD in children- non-stimulant therapy= atomoxetine= non-stimulant no potential for abuse
and daily dose, selective inhibitor of norepinephrine reuptake, Peaks within 1 to 3 hours
metabolized in the liver. Adverse effects include GI reactions reduced appetite dizziness
somnolence mood swings and trouble sleeping. Drug interactions include
MAOIs( isocarboxazid, phenelzine), CYP2D6(Fluoxetine, paroxetine, quinidine), play their
role in ADHD therapy, dose by weight. Alpha 2 adrenergic Agonist: guanfacine= activate
presynaptic Alpha 2 adrenergic receptors in the brain, side effects include somnolence fatigue
and reduce blood pressure. Clonidine= alpha-2 Agonist, side effects include somnolence fatigue
and hypotension.
Antidepressants for children with ADHD- desipramine, imipramine, bupropion. Tricyclics
antidepressants= increase hyperactivity, little effect on impulsitivity and inattention second line
drugs. Burpropion- can reduce Behavioral symptoms, less effective than stimulants poses a risk
of seizure second-line drug.
ADHD in adults- poor concentration stress intolerance antisocial Behavior Outburst of anger
inability to maintain a routine. tx- Methylphenidate.
Give long-acting drugs in the morning after breakfast. Adverse effects of Adderall Sr include
insomnia restlessness Extreme loquaciousness Weight Loss and appetite suppression
dysrhythmias and anginal pain hypertension shortness of breath fainting and psychosis.
Daytrana is a transdermal methylphenidate patch- levels rise slowly and Pete within 9 hours
after which time the patch should be removed. Pad should be applied to the hip in the morning
and Alternate hips each day. Showering and swimming will not dislodge the patch, can cause
erythema and Pruritis and application site.
Patient should be advised to restrict dietary caffeine to prevent excessive CNS stimulation.
Avoid chocolate soft drinks and other caffeine beverages.
Treatment for depression: Primary Therapy is pharmacotherapy. Depression specific
psychotherapy. Electroconvulsive therapy- when drugs in Psychotherapy have not worked,
when rapid response is needed, for suicidal and severely depressed patients, an elderly patients
at risk of starvation. Transcranial magnetic stimulation.
