PC707 Module 7 Central Nervous System Exam with 100% Verified and Updated Solutions

PC707 Module 7 Central Nervous System Exam with 100% Verified and Updated Solutions What classification of medications are first-line treatment for anxiety? SSRIs & SNRIs are used for long-term, maintenance. These take about 4-6 weeks to really work (Evidence-based treatment recommendations demonstrate that the most effective treatment for anxiety disorders is a combination of psychotherapy and pharmacotherapy.) ********** Benzodiazepines are for acute situational anxiety. Use with caution is concomitant usage of opioids. These both have a risk for abuse. Don't prescribe more than 30 tablets at a time. No refills. Beta-Blockers are nice for preventing performance anxiety; they affect norepinephrine Define Generalized anxiety disorder a chronic condition characterized by excessive worry and patients suffer from somatic and psychological anxiety symptoms such as palpitations, nausea, muscle tension, trouble concentrating, insomnia, and uncontrollable worry Treatment: Benzodiazepines, SSRI, SNRI, Buspirone, psychotherapy Medication Examples: paroxetine (Paxil - SSRI) duloxetine (Cymbalta - SNRI) escitalopram (Lexapro - SSRI) venlafaxine (Effexor - SNRI) Buspirone (BuSpar) Define Panic disorder Anxiety attacks with sudden onset resulting in physical manifestations of anxiety such as palpitations, sweating, tremor, chest pain, abdominal pain, and more. Panic attacks can be caused by a trigger or appear for no obvious reason Treatments: Benzodiazepines, SSRI, SNRI Example Medications: fluoxetine (Prozac) - SSRI paroxetine (Paxil) - SSRI sertraline (Zoloft) - SSRI venlafaxine (Effexor) - SNRI Define Acute anxiety This type of anxiety is usually situational and can occur with a specific experience or stressor such as giving a presentation or flying on an airplane Treatments: Benzodiazepines, antihistamines, Beta-Blocker Medication Examples: hydroxyzine (Atarax, Vistaril) - Antihistamine propranolol (Inderal®) - Beta Blocker atenolol (Tenormin®) - Beta Blocker What are the five classifications of anxiolytics? Benzodiazepines (Diazepam [Valium]) Azapirones (Buspirone [BuSpar]) SSRI (escitalopram [Lexapro], paroxetine [Paxil]) Beta-blockers (Propranolol [Inderal], atenolol [Tenormin]) Sedative antihistamines (hydroxyzine [Atarax, Vistaril]) Benzodiazapines & Half-Life The primary differences amongst the benzodiazepines are their onset of action. If the choice is made to start benzodiazepines, consider the half-life of the drug and the indication for its use. Patients may come to expect almost immediate relief of their anxiety and be reluctant to switch to another agent. To reinforce one of the most important "take-home" messages for this class of medication, prescribe benzodiazepines cautiously and for as short a time as possible. Diazepam (Valium) has a fairly long half-life. It is used effectively to help reduce spasm and decrease seizure activity. Alprazolam (Xanax) works quickly and has a moderate half-life. Alprazolam's quick onset leads to rapid relief of symptoms. Lorazepam (Ativan) is commonly used for anxiety--it has a slower onset and a shorter half-life. Off-label drugs for insomnia Antidepressants: Mirtazapine (Remeron), trazodone (Desyrel) are frequently used in treating insomnia in the elderly due to reassuring safety profiles. Although tricyclic antidepressants (TCAs) cause sedation, due to significant side effects, particularly in the elderly, TCAs are used infrequently. Antihistamines: Diphenhydramine (Benadryl) and hydroxyzine (Vistaril). However, if the patient has depression, antihistamines can worsen depression and if they are elderly they can cause anticholinergic side effects (so avoid those patient populations). Antipsychotic: Quetiapine (Seroquel), a second-generation antipsychotic causes sedation but it has multiple side effects and is costly. Avoid off-label use for insomnia. If a patient suffers from mild depression and has difficulty with sleeping, trazodone is often given before bed due to its sedative effects. This medication produces a moderate blockade of 5HT reuptake. Overdose is less of a risk with this drug than with TCAs. Drugs for Chronic Insomnia Lunesta (eszopiclone) - Schedule IV Rozerem (ramelteon) - Not a controlled substance Patient teaching regarding Sleep Medications - Do not take unless you have 7-8 hours to sleep - Take on an empty stomach at least 30 minutes before bedtime - Drugs with long half-lives (eszopiclone [Lunesta]) are associated with a higher risk of next-day impairment - Sleepwalking, sleep driving, sleep eating, sleep sex have been reported with zolpidem and other "Z-drugs" (Z-drugs are drugs for sleep) - Do not use with other CNS depressants or alcohol Anxiolytics and Sleep Medication use in Pregnancy Benzodiazepines and pregnancy. The vast majority of benzodiazepines are pregnancy category D. They are contraindicated except for rare exceptions when their benefits outweigh fetal and neonatal risks. Study results have been conflicting; some indicate an increased risk of oral cleft, preterm labor, and fetal growth restriction. “Floppy baby syndrome” (lack of tone, sluggishness, and difficulty with the sucking reflex) immediately after birth and newborn withdrawal up to three months are concerns as well. The long-term effects of benzodiazepine exposure on child and adult development are unknown and should be avoided. - Those SSRIs with an anti-anxiety profile are a common and safer alternative; however, when all alternatives are ineffective, and a benzodiazepine is indicated, short-term use of clonazepam (Klonopin) may be the best choice. Consultation and/or referral are highly recommended at this stage. Non-benzodiazepines and pregnancy. Buspirone (BuSpar) is a non-benzodiazepine that is used as an anxiolytic. While it is labeled as pregnancy category B, use during pregnancy should be avoided due to limited data (remember the data is most important in determining safety and acceptability during pregnancy, not the letter categories). Hydroxyzine (Vistaril) is classified as a non-benzodiazepine/ 1st generation antihistamine and is pregnancy category C. Vistaril is considered safe for short-term treatment of anxiety, insomnia, and exhaustion from prodromal labor. Zolpidem (Ambien) is also a category C and non-benzodiazepine and may be used as a last resort, for short-term treatment as well. Benzodiazepines and Breastfeeding. Those benzodiazepines with a long half-life such as diazepam (Valium) and clonazepam (Klonopin) should be avoided since the mother will not be able to time breastfeeding to minimize infant exposure. Short-term use of those with a shorter half-life such as midazolam (Versed) and lorazepam (Ativan) is likely safe with breastfeeding. As a general rule, recommend that the mother time feedings to reduce exposure and observe the infant for drowsiness, sedation, inadequate weight gain, and developmental issues. If excessive sedation occurs, monitoring serum levels is indicated. Some women may opt to "pump and dump" and temporarily formula feed. A thorough discussion of the risks, benefits, and unknowns as well as consultation is advised before prescribing--especially if the infant is premature. Non-benzodiazepines and Breastfeeding. Buspirone (BuSpar) is also contraindicated with breastfeeding due to limited data. On the other hand, the short-term use of hydroxyzine (Vistaril) in small doses is likely safe with breastfeeding. However, if the woman is not suffering from insomnia, the newer, non-sedating antihistamines are recommended as the first line. Due to low levels in the breastmilk and a short-half life, zolpidem (Ambien) is considered safe with breastfeeding. Serotonin It plays a role in mood, appetite, sleep, memory and learning, and intestinal movements Dopamine It's essential to basal ganglia moto