Drugs for Chapter 22

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Barbiturates

butabarbital (Butisol)
Pentobarbital
Penobarbitual (Luminal)
secobarbitual (seconal)

Anxiety and Insomnia (Barbiturates) ADR or Side Effects

somnolence, hanger, confussion, nausea, vomiting, rebound insomnia, CNS depression, coma, death, bradycardia, liver damage, hypocalcemia, Steven-Johnson Syndrome, severe respiratory depression, birth defects
* When barbiturate are used as sedative-hypnotics, their use should be limited to a 14 day max. The risk of psychological and physical dependence is high--several are Schedule II drugs. Withdrawal symptom can occur adn be fatal. Overdose results in profound respiratory depression, hypotension, and shock. **after 2 weeks tolerence begins to develop and cross-tolerence to CNS depressants such as opioids. Higher and higher doses taken and, while tolerence does not develop for the respiratory depressant effects leading to approaching lethal doses.

Benzo's for insomnia

estazolam (Prosom)
flurazepam (Dalmane)
quazepam (Doral)
temazepam (Restoril)
triazolam (Halcion)

Benzo's for insomnia ADR or Side Effects

drowsiness, sedation, lethargy, ataxia, dizziness, headache, tachycardia, confusion, dyspnea, blurred vision, birth defects, respiratory depression

Benzo's for Anxiety

alprazolam (Xanax)
chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
diazepam (Valium)
lorazepam (Ativan)
oxazepam (Servax)

Benzo's for Anxiety ADR or Side Effects

drowsiness, sedation, lethargy, ataxia, dizziness, confusion, paradoxical excitation, tachycardia, vivid dreams, hypotension, dyspnea, blurred vision, birth defects, respiratory depression.

Anti-depressants Approved for Anxiety & Insomnia

duloxetine (Cymbalta)
escitalopram (Lexapro)
fluoxetine (Prozac)
fluvoamine (Luvox)
paroxetine (Paxil)
sertraline HCl (Effector)

Anti-depressants ADR or Side Effects

Insomnia, nausea, vomiting, somnolence, agitation, dry mouth, GI disturbance, nervousness, dizziness, fatigue, anorexia, hot flashes, rash, pruitus, possible anoxeria, orthostatic, hypotension, tremor, decreased libido, viral infections, serotonin syndrome

Nonbenzo's Anxiolytic Anxiety & Insomnia

buspirone (Buspar)
eszopiclone (Lunesta)
ramelton (Rozerem)
zaleplon (Sonata)
zolpidem (Ambien, Tovalt)

Nonbenzo's Anxiolytic Anxiety & Insomnia

Insomnia, nausea, vomiting, somnolence, agitation, dry mouth, GI disturbance, nervousness, dizziness, fatigue, anorexia, hot flashes, rash, pruitus, possible anoxeria, orthostatic, hypotension, tremor, decreased libido, viral infections

A=

Avoid abrupt discontinuation after prolonged use

N=

Not give if increased BP, renal or kidney dysfunction or Hx drug abuse

X=

Xanax, Ativan, Valium, Versed, Serax- benzodiazepines

I=

Increased in 3 D's: drowsiness, dizziness, decreased BP

E=

Enhanced action of GABA (Inhibitory transmitter)

T=

Teach to rise slowly from supine position

Y=

Yes, alcohol should be avoided, CS-IV drugs

FLUMAZENIL

USED IN OVERDOSE

Narcolepsy Treatment

Amphetamines
Methylphenidate
Modafinil ** Not affective against cataplexy

Affective against cataplexy

TCA's
GHB (Xyrem)

CNS depressants

anxiolytics
sedatives
hypnotic sediative

4 General classes for anxiety or insomnia

Benzo's
Nonbenzo
Antidepressants
Barbiturates **can cause life threatening neurologic reactions

Atypical Antidepressants, including SNRI's

duloxetine (Cymbalta)
trazodone HCl (Desyrel)
venlafaxine HCI (Effexor)

MAOI's

isocarboxazid (Marplan)
phenelzine sulfate (Nardil)
tranylcypromine sulfate (Parnate)

Selective Serotonin Reuptake Inhibitors

citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac)
fluvoxamine (Luvox)
paroxetine (Paxil)
setraline (Zoloft)

TCAs

amitriptyline (Elavil)
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin (Sinequan)
imipramine (Tofranil)
nortriptyline (Aventyl)

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