PC707 Module 7 CNS Meds Exam with 100% Verified and Updated Solutions

PC707 Module 7 CNS Meds Exam with 100% Verified and Updated Solutions 6 Classifications of Anxiolytics - answer1. SSRIs (Lexapro, Paxil, Celexa, Prozac, Luvox, Zoloft) 2. SNRIs (Effexor, Cymbalta, Khedezla/Pristiq, Fetzima) 3. Azapirones (BuSpar/buspirone) 4. Benzos ("pams" - Xanax, Ativan, Valium) 5. Sedative Antihistamines (Atarax, Vistaril) 6. Beta-Blockers (Propanolol/Inderal) Should Benzos be Rx daily for Anxiety? Why or Why not? - answerNo, they are addictive and efficacy lessens with long-term use. Use sparingly and short-term. High risk for addiction, abuse, and misuse, especially when also using opioids (BBW) What could happen if Benzos are abruptly stopped after chronic daily use? - answerSeizures! Must taper them over many weeks. What other drugs must be avoided while using Benzos? - answerETOH, illicit drug use, CYP450 drugs (look up interactions) Rate the onset of action of Benzos with the likelihood of abuse or dependence. - answer1. Diazepam/Valium = long half-life, reduces spasms and sz activity. 2. Alprazolam/Xanax = works quickly, moderate half-life. The most addictive of all 3. 3. Lorazepam/Ativan = slower onset, shorter half-life. Why are SSRIs a good choice for anxiety? - answeranxiety results from decreased serotonin and SSRIs work by blocking the reuptake of serotonin into the neurons, making MORE serotonin available for improving transmission of messages bt the neurons. They also indirectly work on the GABA system. List at least 2 D2D interactions with BuSpar (azapirone) - answer-Fluoxetine, Fluvoxamine, Nefazodone (reduces clearance of BuSpar). -Carbamazepine (increases clearance of BuSpar). What is the abuse potential of using Vistaril (hydroxyzine) for anxiety treatment? - answerNone! No abuse or addiction concerns with this medication. Which patients should avoid taking Vistaril/Hydroxyzine (antihistamine)? - answerElderly and neurocognitive d/o (risk of anticholinergic toxicity and/or delirium) How do beta-blockers work in treating anxiety related to public speaking? - answerIf taken an hour before the event, it competitively blocks B-1 and B-2 adrenergic stimulation in the heart, which is typically induced by epinephrine and NE. So, this helps relieve the catecholamine-mediated autonomic symptoms without sedation. Who should avoid beta-blockers? - answerPeople who have bradycardia, asthma, diabetes, schizo? List D2D interactions for St. John's Wort: - answer1. SSRIs 2. Triptans 3. Benzos 4. Contraceptives 5. Some ABXs 6. Digoxin List 2 agents used to treat chronic insomnia: - answer1. Lunesta/Eszopiclone = the only drug recommended for long-term use. Edu s/e bitter taste. 2. Rozerem/Ramelteon = selective melatonin agonist What is the required education when prescribing sleep medications? - answer-Meds should be used for a short duration -any underlying problems causing insomnia should be evaluated and treated -counsel/edu on sleep hygiene and ID/treat contributing comorbidities *do not take unless you have 7-8 hrs to sleep *Take on an empty stomach @ least 30mins before bed *drugs with long half-lives (eszopiclone) are associated with a higher risk of next-day impairment *sleepwalking, sleep driving, sleep eating, sleep sexing have been reported with Zolpidem and other "Z" drugs. *do NOT use with other CNS depressants or alcohol. Which anxiolytics are safe during pregnancy? - answer-SSRIs (Sertraline/Zoloft & Fluoxetine/Prozac) -Buspirone/BuSpar (azapirone) Cat B??? *See ACOG Practice Bulletin #92 -Antidepressants: Maprotiline/Ludiomil, Bupropion/Wellbutrin (Cat B) Which sleep medications are safe during pregnancy? - answerNOT benzos (last resort would be Klonopin) SSRIs NonBenzos = BuSpar/Buspirone (Cat B)??? Hydroxyzine/Vistaril = nonbenzo/antihistamine, Cat C, safe for short-term tx of insomnia, anxiety, and exhaustion from prodromal labor. Zolpidem/Ambien = Cat C, nonbenzo, last resort for short-term treatment. SSRIs BBW - answerSuicide Risk, especially early on, may increase, esp in children-25yo SNRIs BBW - answerSuicide Risk, especially early on, may increase, esp in children-25yo TCAs BBW - answerSuici