Anxiolytics Flashcards
(18 cards)
What are six indications for benzodiazepines?
Anxiety-related disorders
Chemotherapy-caused nausea and vomiting
Irritable bowel syndrome
Need for muscle relaxation
Restless legs syndrome
Status epilepticus
What is the MOA of BZDs?
Affect binding of GABA (increases GABA’s effect at the receptor) causing CNS depression, reduction in anxiety, muscle relaxation, and anticonvulsant activity
Adverse effects of BZDs:
Dizziness and confusion
Hypotension
Paradoxical anxiety, agitation, and acute rage
Psychological and physical dependence
Sedation
Visual blurring
Increased production of saliva with Clonazepam
What are two things the prescriber can do to help the pt avoid physical and psychological dependence?
Only use the BZD as needed and not continuously (if appropriate for clinical situation)
Use BZD with longer half-life
Give two examples of BZDs that are short-acting having a rapid onset and stronger potency, thus causing increased risk of dependence.
Alprazolam (Xanax)
Lorazepam (Ativan)
It is important for the pt taking BZDs to avoid what kind of activities during the initiation of treatment? This is important to maintain safety.
activities requiring mental alertness
Gradual tapering of the BZD must occur to avoid a CNS ___________ syndrome.
withdrawal
What are contraindications for BZDs?
Pregnancy and lactation
Children younger than 6
Hepatic and renal disease
Elderly
Hypersensitivity to the medication
What med is used to treat Generalized Anxiety Disorder (GAD)?
Buspirone (BuSpar)
Which medication is a full agonist at the presynaptic serotonin 1A receptor allowing serotonin to bind after this med binds? It is also a partial agonist at the serotonin 1A postsynaptic receptor, has minor dopaminergic actions, and no effect on GABA receptors.
Buspirone (BuSpar)
What are adverse effects of BuSpar?
Potential drowsiness (monitor for this)
Most common: lightheadedness, headache, insomnia, nausea, nervousness, dry mouth (usually mild and resolve with ongoing therapy)
Rare: akathisia (restlessness) and involuntary movements
Does BuSpar have a high or low risk of dependence?
low
What should a person do to decrease the liver first-pass effect of buspirone?
take with food
Because buspirone is metabolized by oxidation in the liver and excreted in the urine, for what patients should you avoid prescribing buspirone?
Patients with severe hepatic or renal dysfunction
Why does buspirone take weeks to show effects? What should the patient do in the meantime and throughout therapy to mitigate this?
It has a short half-life and slow onset of action.
The patient should use non pharmacologic anxiety measures throughout therapy.
What are the contraindications of BuSpar? Should it be given during pregnancy?
Hypersensitivity
Panic disorder (noradrenergic effects of one metabolite)
Lactating patients
Pregnancy- only use if benefit to risk ratio is favorable
What is the patient at risk for if they take buspirone with other serotonergic drugs such as an SSRI?
Serotonin syndrome
