Anxiolytics Flashcards
(105 cards)
1
Q
what do benzodiazepine receptors modulate
A
GABA activity
2
Q
nonbenzodiazepine agonists
A
zolpidem
zaleplon
eszopiclone
3
Q
benzodiazepine receptor antagonist
A
flumazenil
4
Q
5 benzodiazepines A-D
A
alprazolam
clonazepam
chlordiazepoxide
clorazepate
diazepam
5
Q
8 benzodiazepines E-T
A
lorazepam
oxazepam
midazolam
flurazepam
temazepam
triazolam
estazolam
quazepam
6
Q
brand name of diazepam
A
valium
7
Q
brand name clonazepam
A
klonopin
8
Q
brand name alprazolam
A
xanax
9
Q
brand name lorazepam
A
ativan
10
Q
brand name oxazepam
A
serax
11
Q
brand name chlordiazepoxide
A
librium
12
Q
brand name clorazepate
A
tranxene
13
Q
brand name midazolam
A
versed
14
Q
brand name flurazepam
A
dalmane
15
Q
brand name temazepam
A
restoril
16
Q
brand name triazolam
A
halcion
17
Q
brand name estazolam
A
prosom
18
Q
brand name quazepam
A
doral
19
Q
brand name zolpidem
A
ambien
20
Q
brand name zaleplon
A
sonata
21
Q
brand name eszopiclone
A
lunesta
22
Q
brand name flumazenil
A
romazicon
23
Q
brand name buspirone
A
buspar
24
Q
brand name propranolol
A
inderal
25
which receptors do benzodiazepines work on in general
GABA
26
other uses for benzodiazepines
anesthetics
anticonvulsants
muscle relaxants
catatonia treatment
27
what is first line treatment for anxiety disorders and why
SSRI/SNRI d/t risk for sedation/dependence with benzodiazepines
28
absorption of all benzodiazepines except clorazepate
completely absorbed from GI after PO administration
29
absorption of clorazepate
converted in stomach to desmethyldiazepam which is then completely absorbed
30
benzodiazepines with fastest absorption, peak, and onset of action
diazepam
lorazepam
alprazolam
triazolam
estazolam
31
6 "long-acting" benzodiazepines
diazepam
chlordiazepoxide
clonazepam
clorazepate
flurazepam
quazepam
32
steady state of long-acting benzodiazepines
may take up to two weeks
33
half-life of long-acting benzodiazepines
30-100 hours
34
4 benzodiazepines with half-life 8-30 hours
lorazepam
oxazepam
temazepam
estazolam
35
half-life of alprazolam
10-15 hours
36
which benzodiazepine has the shortest half-life and what is it
triazolam
2-3 hours
37
how does high lipid solubility affect the onset and duration of action of benzodiazepines
causes rapid action in brain d/t diffusion across concentration gradient. when there is more drug in the brain than the blood the gradient reverses and effects rapidly leave the brain
38
therapeutic indications for benzodiazepines other than anxiety
insomnia
bipolar
catatonia
agitation
alcohol withdrawal
39
anxiety disorders treated with benzodiazepines
GAD
panic disorder
social anxiety
anxiety associated with depression
40
duration of benzodiazepine use for insomnia
7-10 days
41
3 benzodiazepines approved for insomnia
temazepam
flurazepam
triazolam
42
5 benzodiazepines approved for use as hypnotics
flurazepam
temazepam
quazepam
estazolam
triazolam
43
benzodiazepine treatment of GAD
predetermine duration of therapy at initiation
-some patients do require long term maintenance therapy
44
commonly used benzodiazepines for panic disorder
alprazolam
clonazepam
45
benzodiazepines v. SSRIs for panic disorder
-benzodiazepines have rapid onset w/ less sexual side effects and weight gain
-SSRIs are still preferred d/t less abuse potential and tolerance
46
initiating benzodiazepines and SSRIs together
can initiate together and taper benzo in 3-4 weeks when SSRI effects are evident
47
benzodiazepine typically used for social anxiety
clonazepam
48
what role do benzodiazepines have in the treatment of bipolar disorder
treat acute mania and can be an adjunct to antidepressants instead of antipsychotics
49
3 benzodiazepines typically used in bipolar disorder
clonazepam
lorazepam
alprazolam
50
which med can decrease depressive episodes and time between cycles when used as an adjunct to lithium or lamotrigine
clonazepam
51
what type of catatonia can be treated with benzodiazepines
acute
chronic does not respond well
52
benzodiazepine used to treat acute catatonia
lorazepam
53
what treats chronic catatonia
ECT
54
first line treatment for akathisia
B-adrenergic antagonists
55
which benzodiazepines are used for alcohol withdrawal
chlordiazepoxide
clorazepate
56
what is administered for benzodiazepine OD
flumazenil
57
administration of flumazenil in benzodiazepine OD
-0.2mg IV over 30 seconds
-if no response in 30 seconds give 0.3mg over 30 seconds
-then can give 0.5mg every 30 seconds - 1 minute to a total dose of 3mg
58
what if sedation in benzodiazepine OD reoccurs after initially responsive to flumazenil
administer additional doses at 20 minute intervals with no 1 dose exceeding 1mg and total dose NTE 3mg in 1 hour
59
when are seizures more likely with flumazenil administration
preexisting seizure disorders
benzodiazepine dependence
ingestion of large quantity
60
administration of flumazenil in a multi-drug OD involving benzodiazepines
adverse effects of other meds that benzos may have been treating can emerge
61
what needs to be in place prior to administration of flumazenil
IV access
reliable airway
62
benzodiazepine most associated with anterograde amnesia
triazolam
63
benzodiazepines in patients with preexisting brain damage
paradoxical agitation
64
benzodiazepine administration with asthma or COPD
increased respiratory depression
65
benzodiazepines during pregnancy and lactaton
contraindicated
66
abrupt dc of benzodiazepines
can cause severe withdrawal
67
symptoms of severe withdrawal from benzodiazepines
depression
paranoia
delirium
seizures
*may be delayed 1-2 weeks if using long acting meds
68
which benzodiazepine is significantly associated with acute severe withdrawal
alprazolam
69
benzodiazepine taper
25% weekly
70
other strategies for discontinuing benzodiazepines
concurrent use of carbamazepine
switch from alprazolam to clonazepam then taper
71
common CNS depressants that can interact with benzodiazepines
TCAs
DRAs
antihistamines
alcohol
72
which meds cause ataxia and dysarthria when administered with benzodiazepines
lithium
antipsychotics
73
benzodiazepines and clozaril
delirium
74
benzodiazepines and antacids
reduced absorption
75
which meds increase triazolam and alprazolam to toxic levels
nefazodone
fluvoxamine
76
dosages for coadministration of triazolam or alprazolam with nefazodone or fluvoxamine
reduce alprazolam dose by 50%
reduce triazolam dose by 75%
77
carbamazepine and alprazolam
decreased concentration of alprazolam
78
benzodiazepines and smoking
increases metabolism
79
which medications can have increased concentrations when administered with benzodiazepines
phenytoin
digoxin
80
which benzodiazepine is available in a wafer
clonazepam
81
classification of buspirone
azapirone
82
actions of buspirone at serotonin and dopamine receptors
agonist/partial agonist at 5HT1A
agonists/antagonist at D2
83
approved indication for buspirone
only GAD
84
what effects does buspirone NOT produce
anticonvulsant
muscle relaxant
euphoria
85
buspirone and food
reduced absorption
86
half-life and peak plasma concentrations of buspirone
half-life 2-11 hours
peak plasma in 40-90 minutes
87
what anxiety sx are buspirone more effective for
anger
hostility
88
which anxiety symptoms are buspirone less effective for
somatic symptoms
89
dosage at which full benefit is seen for buspirone
>30mg
90
what SSRI-induced adverse reactions can be treated with buspirone
bruxism
sexual dysfunction
91
initiation of buspirone
5mg TID or 7.5mg BID then raise by 5mg q2-4 days until desired effect is reached
(15-60mg)
92
2 strategies for switching from benzodiazepines to buspirone
-can taper down benzo while tapering up buspirone
-can give both until buspirone is effective then taper benzo
93
most commonly used b-adrenergic receptor antagonist in psychiatry
propranolol
94
therapeutic indications for b-adrenergic antagonists
anxiety
lithium-induced postural tremor
neuroleptic induced akathisia
aggression
alcohol withdrawal
antidepressant augmentation
95
propranolol in anxiety; indication and dosage
social anxiety
10-40mh 20-30 minutes before performing
96
propranolol dose for medication-induced postural tremor
20-60mg in 2-3 divided doses
97
contraindications to b-adrenergic antagonists
-asthma
-insulin dependent DM
-CHF
-vascualr disease
-angina
-hyperthyroidism
98
b-adrenergic antagonists in pregnancy
contraindicated
99
which medications increase concentrations of propranolol
antipsychotics
anticonvulsants
theophylline
levothyroxine
100
which meds contraindicate b-adrenergic antagonists
calcium channel blockers
101
dc b-adrenergic antagonists
never abruptly
taper by 60mg daily until at 60mg
then reduce by 10-20mg q3-4 days
102
therapeutic indications for barbiturates
ECT
seizures
narcoanalysis
insomnia
103
which barbiturate is used for ECT
methohexital
104
typical barbiturate used for seizures
phenobarbital
105
barbiturate used for narcoanalysis
amobarbital (really been replaced by diazepam)
