Question

What are specific names of benzodiazepines?

Which medication has the safest side effect profile as a sleeping pill for the elderly?

What is important patient teaching for a patient receiving Dilantin?

What are toxic effects of Dilantin?

Therapeutic range for Dilantin?

Anxiolytics...who are they? how do they act in the body? special implications?

How do SSRI antidepressants work?

Important assessments re. tricyclic antidepressants?

Characteristics of atypical antipsychotics?

What effects do antipsychotic medications exert on vital signs?

Anticholinergic side effects? What drugs cause these?

Extrapyramidal symptoms...what are they? who causes them? treatment?

Answer 1

What are specific names of benzodiazepines?

• Alprazolam,Chlordiazepoxide ,Clorazepate, Clonazepam ,Diazepam ,Flurazepam, Lorazepam Midazolam.

Which medication has the safest side effect profile as a sleeping pill for the elderly?

• zolpidem, eszopiclone, zaleplon.

What is important patient teaching for a patient receiving Dilantin?

• Dilantin itself induces hepatic drug metabolism, decreasing the effects of other antiepileptic drugs including carbamazepine, clonazepam, and lamotrigine.

What are toxic effects of Dilantin?

• Ataxia, diplopia, gingival hyperplasia, hirsutism, neuropathy.

Therapeutic range for Dilantin?

• Dilantin has a narrow therapeutic window, between 10-20 mg/L for Adults

Anxiolytics...who are they? how do they act in the body? special implications?

• Antianxiety agents or anxiolytics, used for the treatment of anxiety disorders include benzodiazepines, azapirones, β-blockers, and antidepressants.

MECHANISM OF ACTION

• Benzodiazepine -Bind GABAA receptor subunits to facilitate chloride channel opening and increase frequency • membrane hyperpolarization.
• Barbiturates- Bind to GABA_A receptors → ↑ duration of the GABA-gated chloride channel opening → ↑ intracellular Cl^- flow → hyperpolarization of postsynaptic neurons → ↓ neuronal excitability in the brain

CLINICAL INDICATION- Acute anxiety states, panic attacks, generalized anxiety disorder, insomnia; skeletal muscle relaxation • seizure disorders. Anesthesia (thiopental) • insomnia and sedation (secobarbital）

How do SSRI antidepressants work?

It's thought that SSRIs work by increasing serotonin levels in the brain.

• Inhibits 5-HTreuptake by neurons
• Leads to ↑ 5-HT levels in synaptic cleft
• Take 4-8 weeks to haveeffects
• Used in manypsychiatric disorders

Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It's thought to have a good influence on mood, emotion and sleep.

Important assessments re. tricyclic antidepressants?

• Old antidepressants (1970s)
• Blockedre-uptake of 5-HTand norepinephrine
• “Broad spectrum”
• Anti-histamine
• Anti-muscarinic
• Block alpha-1 receptors
• Many side effects

Characteristics of atypical antipsychotics?

• Second Generation or Atypical antipsychotics
• Clozapine • Olanzapine • Quetiapine • Asenapine • Iloperidone • Paliperidone • Risperidone • Lurasidone • Ziprasidone • Aripiprazole
• Atypical antipsychotics have fewer motor side effects (EPS) due to reduced D₂ receptor antagonism; greater affinity for 5HT_2A receptors and interaction with other receptors
• Smaller increase in prolactin levels compared to typical antipsychotics.
• less common anticholenergic effect

What effects do antipsychotic medications exert on vital signs?

• These effects include tachycardia, postural hypotension, Metabolic effect

Anticholinergic side effects? What drugs cause these?

• Side effect-These include dry mouth, blurred vision (due to mydriasis and cycloplegia), urinary retention, constipation, hyperthermia, confusion, delirium and restlessness etc. Anticholinergic drugs are contra-indicated in glaucoma and BHP
• atropine
• Hexamethonium
• benztropine mesylate
• clidinium.
• cyclopentolate
• darifenacin
• dicylomine.
• fesoterodine

Extrapyramidal symptoms...what are they? who causes them? treatment?

• A collection of movement disorders that are typically due to disruption of dopaminergic pathways in the basal ganglia, resulting in bradykinesia, rigidity, dystonia, athetosis, chorea, ballismus, akathisia, tics, and tremors

CAUSE - Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors

  Inhibition of the nigrostriatal dopaminergic pathways results in EPS

Treatment- If the EPS are induced by an antipsychotic, EPS may be reduced by decreasing the dose of the antipsychotic or by switching from a typical antipsychotic to an atypical antipsychotic.

Acute dystonia- benztropine ,anticholinergic and antihistamine

  Akathisia- propanolol

  Tardive dyskinesia- valbenazine and tetrabenazine