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Weekly study notes form advanced pharmacology, Study notes of Pharmacology

International Institute of Social Studies Pharmacology

Study notes that go into details about medications. Advanced pharmacology (grad school)

Typology: Study notes

2024/2025

Uploaded on 04/30/2026

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NGR6172 WEEK 13
Drugs that Affect the Central
Nervous System: Part 1
Antidepressants,
Anxiolytics, &
Antipsychotics
**REVIEW POWER POINTS**
Review Black Box Warnings / Practice Pearls / Clinical Reasoning /
Teaching Points
Tables with Medication Class categories/Indication/Comments and Monitoring from
your Edmunds' textbook, and review Chapter Summaries and Study Questions found at
the of the chapters in the Lippincott textbook.
Antianxiety and Antiinsomnia Agents Ch. 33
• Review TABLE 33.2 MEDS/INDICATION/COMMENTS
• Review TABLE 33.3 MEDS/INDICATION/COMMENTS
• Review Treatment with antianxiety drugs
•
o Know drug classes recommended for the different disease
disorders.
▪ IMPORTANT: Keep in mind that some antidepressant
medications such as SSRIs, SNRIs, NDRIs are also
approved for management of anxiety.
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NGR6172 WEEK 1 3

Drugs that Affect the Central

Nervous System: Part 1

Antidepressants,

Anxiolytics, &

Antipsychotics

REVIEW POWER POINTS

Review Black Box Warnings / Practice Pearls / Clinical Reasoning /

Teaching Points

Tables with Medication Class categories/Indication/Comments and Monitoring from your Edmunds' textbook, and review Chapter Summaries and Study Questions found at the of the chapters in the Lippincott textbook. Antianxiety and Antiinsomnia Agents Ch. 33

  • Review TABLE 33.2 MEDS/INDICATION/COMMENTS
  • Review TABLE 33.3 MEDS/INDICATION/COMMENTS

  • Review Treatment with antianxiety drugs

    o Know drug classes recommended for the different disease disorders. ▪ IMPORTANT: Keep in mind that some antidepressant medications such as SSRIs, SNRIs, NDRIs are also approved for management of anxiety.

▪ For example, a patient with PTSD that is experiencing anxiety can be treated with sertraline. o Use benzodiazepines for ACUTE anxiety. Reserve SSRIs for long- term treatments. o Review Practice Pearls pg. 529 o Buspirone is used for GAD. This drug is beneficial in patients with GAD that have resulted in GI distress and insomnia. It is well tolerated, relatively safe, and low risk of dependence.

  • Review Treatment for insomnia o Box 33.2 Quick Sleep Tips pg. 528 ▪ Treatment begins with developing good sleep hygiene. If this does not work after a couple of weeks, then medications may be considered. o Temazepam is a benzo used as a hypnotic for management of insomnia. o Zolpidem is a nonbenzodiazepine used to treat insomnia. It should be restricted to 7 to 10 days; however, in practice there are patients on zolpidem for months. o Zaleplon has a short half-life and duration of action. Less daytime sedation or hangover effect with this medication. o Flurazepam and quazepam have longer duration of action. Greater risk of daytime sedation or hangover effect with these meds.
  • Patient Variables o Geriatrics ▪ Increase risk of falls in the elderly with the use of CNS agents o Pediatrics ▪ Review benzodiazepine drugs used in children. ANTIDEPRESSANTS Ch. 34
  • Review TABLE 34.1, 34.3, 34. CATEGORY/INDICATION/CONSIDERATIONS AND MONITORING
  • Risk factors associated with depression: trauma, substance abuse including alcohol, major life changes, family history, recent loss, and history of domestic abuse or violence.
  • Assess patient with symptoms of major depression and rule out any contributing factors to the diagnosis including alcohol, substance abuse, and suicidal ideation.
  • Most 2nd^ generation antipsychotics increase the risk of metabolic syndrome in patients except for ziprasidone. o When choosing a treatment keep in mind your patient specifics, for example, if your patient is overweight then you want a drug that will not increase weight.
  • Review Quality and Safety boxes found on page 577
  • Evidence-based recommendations o Keep in mind that providers gradually increase dosage to achieve therapeutic effect while minimizing side effects.
  • Monitoring o Many of these medications required special lab monitoring before, during, and post treatment.

ADDITIONAL REVIEW NOTES

  • Treatment of patients with insomnia begins with sleep hygiene. When these measures prove ineffective after a couple of weeks, medications may be considered.
  • Before treating insomnia with drug therapy, first it is important to rule out any physiologic causes of a sleep disorder through a thorough history and physical examination. Educating the patient on good sleep hygiene practices would be the next appropriate intervention, followed by other interventions (such as medications) if prior attempts were unsuccessful and no physiologic cause was found.
  • For acute anxiety, a benzodiazepine should be prescribed.
  • SSRIs or buspirone should be used for long-term treatment.
  • For patients awakening in the middle of the night to use the restroom, ensuring that fluids are minimized prior to bedtime should be the first intervention. If problems persist despite fluid restriction, the provider should evaluate the patient for bladder dysfunction.
  • Buspirone is indicated for the treatment of GAD and is considered to be relatively safe, with a low risk of dependence.
  • Lorazepam and alprazolam are better suited for short-term management of anxiety and have a higher risk of abuse.
  • Zolpidem is indicated for insomnia related to issues with sleep initiation or maintenance.
  • Before starting drugs for insomnia, patients should be warned about the potential interactions different herbal remedies and drugs can have.
  • Alcohol can worsen the sedative effect of anti-insomnia medications and should be avoided while taking.
  • Chamomile may increase the effect of insomnia drugs and result in daytime drowsiness/sleep hangover.
  • Patients should take their anti-insomnia right before bed as they tend to work quickly and ensure that they have at least 6-8 hours prior to their wake-up time before taking.
  • The first-line treatment for generalized anxiety disorder is aimed at helping the patient to understand their condition and learn coping skills to address both cognition and behavior. Psychotherapy and/or psychosocial therapy in combination with antidepressant therapy are considered to be more successful long term than pharmacologic treatment alone.
  • Benzodiazepines are at a higher risk of tolerance and physiologic dependence, even without abuse or misuse.
  • Serotonin syndrome is a potentially lethal set of symptoms resulting from an overabundance of serotonin. Providers should evaluate whether a patient is taking other SSRIs, monoamine oxidase inhibitors, bupropion, serotonin-norepinephrine reuptake inhibitors, or other medications that can precipitate this.
  • Patients should never abruptly discontinue an SSRI.
  • When starting patients on medication treatment for depression, it is important to discuss with them beforehand about realistic expectations regarding therapy. o This includes the time frame in which they can expect to see a notable change in symptoms (typically 4-8 weeks), possible side effects, and dose titration timelines.
  • Mirtazapine may be added to the drug regimen for partial responders who continue to have depressive symptoms; due to its common side effects of drowsiness and increased appetite, it is useful in those with insomnia and unintended weight loss.
  • Use of antidepressants in patients with underlying bipolar disorder can precipitate mania or hypomania. Symptoms of mania include inflated self-esteem, grandiosity, pressured speech, excessive talking, increase in goal-directed energy, distractibility, and decreased need for sleep, among other symptoms.

irreversible. This condition can occur with all antipsychotics, especially the first- generation antipsychotics. Increasing the dose may increase the symptoms.

  • Neuroleptic malignant syndrome (NMS) is a potentially fatal symptom complex that is associated with the initiation or increase in the dose of antipsychotic medications. It can occur in both first- and second-generation antipsychotics but is more likely in high-potency first-generation antipsychotics such as fluphenazine and haloperidol. Sudden discontinuation of antipsychotics can also increase the risk of NMS, as well as the risk of other dyskinesias. o Neuroleptic malignant syndrome occurs weeks after initiation and is characterized by fever, catatonia, muscle rigidity, and autonomic instability.
  • Providers should gradually increase the dose of antipsychotic medication to achieve therapeutic effects, while minimizing side effects. It may take weeks to achieve full therapeutic effects.
  • The highest rates of suicide among patients with schizophrenia occur in young males, typically in the beginning stages of the disorder. It is important for providers to conduct suicide risk screenings at check-ups for all at-risk individuals and to inquire further about statements that indicate possible thoughts of self-harm.
  • Many antipsychotics, particularly second-generation antipsychotics, increase the risk of metabolic syndrome in patients. o Which antipsychotic drug has little to no metabolic effect?
  • First-generation antipsychotics treat positive but not negative symptoms associated with schizophrenia.