Week 2 : Why are SSRIs preferred to benzodiazepines for the treatment of anxiety?
SSRIS are non-addictive, however benzodiazepines for anxiety treatment are highly
addictive, and patients can develop a habit of using them anytime they are anxious rather than
learning to regulate their anxiety. (Hommel, 2019).
2. How does Zolpidem work to induce sleep? Should this medication be used long term?
Zolpidem works by slowing down brain activity and relaxing muscles and nerves in the body to
help you fall asleep. The instant release form melts quickly, allowing you to fall asleep quickly.
The extended-release formulation comprises two layers: the first aids in falling asleep, while the
second gradually dissolves to aid in staying asleep.
Long-term usage of zolpidem is not normally recommended because it can make users
dizzy. According to Drugs.com, roughly 5% of people who used the sleep medication for 28 to
35 nights reported feeling disoriented when they stopped taking it. It’s quite tough to stop taking
zolpidem as a sleep aid once you’ve been taking it for a long time. When people stop using
Zolpidem after a lengthy period of use, they experience a variety of withdrawal symptoms.
Amnesia (loss of memory) and hallucinations (seeing or hearing something that isn’t there) are
3. Is melatonin safe to use long term for sleep? How does it induce sleep? How long does it
take to take effect?
Melatonin is SAFE when taken orally appropriately, long-term. Melatonin has been
used safely for up to 3 years in some individuals, it can cause side effects like headache,
short feelings of depression, sleepiness during the day, dizziness, stomach aches, and irritability.
The pineal gland produces melatonin, which is a natural hormone (located in your brain).
It aids in the regulation of your sleep cycle. Melatonin is produced by the body shortly after it
becomes dark, increasing in the early hours of the morning and decreasing during daytime hours.
Melatonin is a hormone that induces sleep by binding to receptors in the body. Melatonin
supplementation increases the body’s natural supply of the hormone. This can assist you in
falling asleep and improving the quality of your sleep.
It takes 30 minutes to start working. Melatonin can stay in the body for about 5 hours,
and depends on some factors like age and health condition
4. What is the mechanism of action of the two major groups of antipsychotic drugs?
Antipsychotic Agents’ Mechanisms of Action Conventional antipsychotics attach to
dopamine receptors more “tightly” than dopamine itself. Clozapine and other secondgeneration medicines bind to D2 receptors more “loosely,” therefore they tend to come off
the receptor more easily in the presence of dopamine.
5. What are extrapyramidal symptoms (EPS)? How are these treated?
Extrapyramidal Side Effects Signs include uncontrolled or uncontrollable movements,
which are also known as drug-induced movement disorders. tremors. contractions of the
If a patient develops acute extrapyramidal adverse effects, such as dystonia, the
causative medicine must be given as a conventional first-generation antipsychotic;
however, switching to an atypical antipsychotic may be tried. The antimuscarinic drug
benztropine, trihexyphenidyl, can treat dystonia in as little as 45 minutes. Additional
therapy options for tardive dystonia include benzodiazepine administration.
Treatment for akathisia includes discontinuing the offending medicine, switching
to an atypical antipsychotic if a typical first-generation antipsychotic was the offending
drug, and providing anti-muscarinic drugs, which are similar to those used to treat
dystonia. A beta-blocker (most often propranolol), amantadine, clonidine,
benzodiazepines, mirtazapine, mianserin (tetracyclic antidepressant), cyproheptadine, and
propoxyphene 50 are some of the more specific treatments for akathisia.
Discontinuation or dose decrease of the causative medication is used to treat druginduced parkinsonism.(Castle, 2018).
6. What is neuroleptic malignant syndrome? How is this treated?
The most common cause of neuroleptic malignant syndrome is an adverse reaction to
neuroleptic or antipsychotic medicines. High fever, sweating, unsteady blood pressure,
stupor, muscle rigidity, and autonomic dysfunction are all symptoms. When certain
neuroleptic medicines are administered, it causes altered mental status, muscle rigidity,
hyperthermia, and autonomic hyperactivity.
Withdrawing the drug is part of the treatment for the disease. Dopamine agonists,
such as bromocriptine mesylate, and muscle relaxants, such as dantrolene sodium, are
two more treatment options.
7. Name three teaching points for the patient starting fluoxetine.
Fluoxetine (SSRI) is a drug that is used to treat serious depression. The following are
Fluoxetine’s three teaching points:
Swallow the delayed-release capsules whole; do not cut, crush, or chew them.
Follow the directions on your prescription label carefully, and if there is
anything you don’t understand, ask your doctor or pharmacist to explain it to
you. Take fluoxetine precisely as prescribed by your doctor. Do not take more or
less of it, or take it more frequently than your doctor has suggested.
You may have withdrawal symptoms such as mood swings, irritability,
agitation, disorientation, numbness or tingling in the hands or feet, anxiety,
perspiration, confusion, headache, exhaustion, and difficulty falling or staying
asleep if you suddenly stop using fluoxetine. Your doctor will most likely
progressively reduce your dose.
8. What are the clinical manifestations of tricyclic antidepressant overdose (toxicity)? How
is this managed?
Hyperthermia, or overheating, is a condition where an individual’s body
temperature rises beyond normal due to failed thermoregulation. one’s body produces or
absorbs more heat than it loses. When extreme temperature elevation occurs, it becomes
a medical emergency requiring immediate treatment to prevent disability or death.
Cardiac arrest is a sudden loss of blood flow resulting from the failure of
the heart to pump effectively. Signs include loss of consciousness and abnormal or absent
Some individuals may experience chest pain, shortness of breath, or nausea before
cardiac arrest. If not treated fast it leads to death. Blurred vision, dilated
pupils, sleepiness, confusion and a high heart rate,
People with symptoms are often monitored in an intensive care unit for at least 12
hours, with particular attention paid to blood pressure, arterial pH, and supportive
therapy, such as breathing assistance and body temperature control, if necessary. A
person’s medical status is generally satisfactory once they have had a normal ECG for
more than 24 hours.
Gastric decontamination is part of the treatment for an acute overdose. It is
accomplished by administering activated charcoal, which adsorbs the medication in the
gastrointestinal tract and is administered either orally or via a nasogastric tube. When
taken within 1 to 2 hours following intake, activated charcoal is most effective. Within an
hour of intake, other decontamination treatments such as stomach pumps can be used.
Treatment with intravenous sodium bicarbonate as an antidote has been demonstrated
to be successful in treating metabolic acidosis and cardiovascular problems caused by TCA
poisoning. If sodium bicarbonate therapy fails to relieve cardiac symptoms, antidysrhythmic
medications or magnesium might be used to correct any heart irregularities
9. Are the dietary and medication interactions with MAOIs? Why are these restricted?
Monoamine oxidase inhibitors (MAOIs) are effective antidepressants for depression
with unusual symptoms or that has not responded to other antidepressants. MAOIs, on the
other hand, are underutilized by doctors due to concerns regarding food and drug
combinations. Interactions between MAOIs and meals containing tyramine, as well as
interactions with serotonergic and sympathomimetic drugs, can cause hypertensive crises and
serotonin syndrome in rare circumstances. A better understanding of the foods and drugs that
can cause adverse reactions, as well as knowledge of newer MAOIs with mechanisms of
action and delivery methods that reduce these risks, may encourage clinicians to consider
using these medications in their patients with depression, when appropriate.
10. What are the adverse effects of lithium used to treat bipolar disorder at normal and
Lithium can damage both the thyroid and the parathyroid glands, causing long-term
thyroid issues. These glands are mostly in charge of controlling calcium levels in the body.
Hyperparathyroidism can impair the body’s ability to detect calcium, resulting in
hypercalcemia, a condition in which a person’s calcium levels are abnormally high.
Increased frequency of urination; increased thirst; nausea; trembling of hands vomiting,
diarrhea, constipation, drowsiness, dry mouth are also side effects of lithium use
Another potential side effect is cognitive dulling, which is when a person does not feel as
“sharp” or alert as they once did. Sometimes, a doctor may have difficulty telling whether a
person is depressed or experiencing cognitive dulling due to lithium treatment.
Other short term side effects that a person may experience when first taking lithium include:
Diarrhea, hand tremors, sexual dysfunction, such as lowered libido or erectile dysfunction
weight gain. (Gitlin, 2016)
11. What teaching points would you use to help the patient stay within normal lithium levels?
Take this medication exactly as prescribed; do not change the dosage or medication for
The extended-release capsule should never be broken, crushed, or chewed.
When using Lithium, always consult your doctor if you feel fainting, an irregular
heartbeat, or difficulty breathing.
12. Name the three classes of drugs used to treat bipolar. What aspect of the disease do these
drugs each treat? (pg 370)
Mood stabilizers, antipsychotics, and antidepressants are the three primary types of
medications used to treat bipolar disorder.
Treatment usually consists of a mixture of mood-stabilizing drugs and/or atypical
antipsychotics, as well as psychotherapy. Lithium carbonate and valproic acid are two of the
most commonly prescribed medications for bipolar illness. Lithium carbonate can help with
mania and depression recurrence, but it appears to be more effective against mania than
depression. As a result, it is frequently used in conjunction with other medications that are
more beneficial for depression symptoms, such as antidepressants.
Valproic acid (Depakote) is a mood stabilizer used in conjunction with
carbamazepine, an antiepileptic medication, to treat the manic or mixed periods of bipolar
disorder. To treat symptoms, these medications can be administered alone or in combination
In addition, newer drugs are coming into the picture when
traditional medications are insufficient. Lamotrigine (Lamictal), another antiepileptic drug, has
been shown to have value for preventing depression and, to a lesser degree, manias or
hypomania. (Melinda, 2019)
Hommel, H. (2019, March 9). Benzodiazepines vs. SSRIs for Anxiety: PharmaNerd.
Benzodiazepines vs. SSRIs for Anxiety:
Melatonin and Zolpidem: Do Sleeping Aids Actually Work? – Penn Medicine. (n.d.).
Melatonin for Sleep: Does It Work? (2012). https://www.hopkinsmedicine.org/health/wellnessand-prevention/melatonin-for-sleep-does-it-work
Castle, D. (2018, May 25). Extrapyramidal movement disorders with antipsychotics- EPSE.
Psych Scene Hub. https://psychscenehub.com/psychinsights/extrapyramidal-movementdisorders-antipsychotics-epse/
Neuroleptic Malignant Syndrome Information Page | National Institute of Neurological
Disorders and Stroke. (n.d.). Www.ninds.nih.gov.
Fluoxetine: MedlinePlus Drug Information. (2019, October). Medlineplus.gov.
Tricyclic Antidepressant Overdose: Manifestations and Management. (n.d.). Pharmacy Times.
Retrieved August 15, 2021, from https://www.pharmacytimes.com/view/tricyclicantidepressant-overdose-manifestations-and-management
Hall-Flavin, D. K. (2018, December 18). Avoid the combination of high-tyramine foods and
MAOIs. Mayo Clinic. https://www.mayoclinic.org/diseasesconditions/depression/expert-answers/maois/faq-20058035
Gitlin, M. (2016). Lithium side effects and toxicity: prevalence and management
strategies. International Journal of Bipolar Disorders, 4(1).
Melinda. (2019, June 17). HelpGuide.org. HelpGuide.org.