Anxiolytics Flashcards Preview

Pharm main > Anxiolytics > Flashcards

Flashcards in Anxiolytics Deck (60)
1

What is anxiety

Normal response to threatening or harmful stimul

2

What is pathological anxiety

Anxiety that is exhibited at inappropriate times that interferes with normal functioning

3

Systems involved in anxiety

Noradrenergic
Seratonergic
GABA
CCK

4

Way is the role of the noradrenergic system in anxiety

Locus ceruleus is the alarm center,becomes pathological when it is over active

5

Role of seratonergic system in anxiety
What drugs target this system?
Were is it located?

This is an inhibitory NT, concentrated in the raphe nuclei,
SSRI's help with anxiety

6

Role of GABA in anxiety?
What drugs target this system

This is the major inhibitory nt in the brain.
Inhibits both serotonin and NE
Benzodiazepines act indirectly on this system

7

What is the role of CCK in anxiety?
Where does it act?

Acts in locus ceruleus to enhance noradrenergic activity

8

What drugs can induce anxiety?

Antidepressants such as SSRI's, SNRI's, and bupropion can cause transient anxiety.
Amantidine, dopa and its analogs
Sympathmimetics and stimulants

9

Way drugs cause anxiety when going through withdrawal?

Barbiturates
Benzodiazepines- especially short acting ones
Ethanol
Narcotics

10

Types of Anxiety disorders

General Anxiety Disorder
Panic Disorders
OCD
PTSD
Social Anxiety Disorder
Specific Phobias
Stage fright

11

Describe General anxiety disorder

This is a fear of the future.
Experience fatigue, muscle tension, or this fear on mored days than not for more than 6 months

12

Tx for General Anxiety Disorder

SSRI's- venlafaxine, duloxetine, paroxetine, escitalopram
TCA
BZD- short term
Buspirone- esp if patients have- sleep apnea- h/o substance abuse, or falls

13

What is a Panic Attack

Sudden onset fear of death with somatic symptoms including at least 4 of the following- fear of dying, chest pain/ discomfort, chills or hot flashes, choking, shaking, and tachycardia

14

What is a Panic Disorder

A History of attack with 1 or more of the following after the attack- fear of another attack, concern of what will happen if another attack occurs, and agoraphobia b/c think that there are places that trigger the attack

15

How to Tx Panic Disorder

SSRI- DOC
BZD- clonazepam on a scheduled basis, alprazolam has withdrawal symptoms and may cause seizures (SR formula may be better)
MAO, TCA, CBT- do not mi

16

Describe OCD

Obsessive thoughts that are relieved by compulsive behaviors

17

Treating OCD

SSRI- DOC- fluoxetine, fluvoxamine, sertaline, paroxetine- could req higher dose than for depression.
TCA with a significant serotonergic component- clomipramine
CBT- Meds require accompanying CBT. more effective than meds. Dont use BZD with CBT

18

Describe Post Traumatic Stress Disorder

Occurs after a traumatic event
After the event the patient gets flashbacks, avoids certain beh, and is hyperarousable

19

What is the role of pain medication in PTSD

Treating the acute trauma and pain that occurs at the time of the event lessens the PTSD

20

what is the role of betablockers in preventing PTSD

Block the formation of the memories thus minimizing the rexeperience

21

How do you treat PTSD

SSRI,- sertaline and paroxetine
TCA, MAOI
adjunct- antipsychotics, anticonvulsants, beta blockers
BZD- similar to alcohol only make things worse

22

Social Anxiety Disorder

fear of embarrassment

23

how do you treat social anxiety disorder

SSRI, MAOI

24

How do you treat specific phobias

desensitization

25

How do you treat stage fright

small amount of beta blocker

26

What is the role of CBT

normally CBT and pharmacologic agents work best together.
DO NOT GIVE BZD WHILE GIVING CBT.
It is important to educate the patient

27

What is the role of SSRI's in treating anxiety disorder

They work for all types of anxiety disorders

28

what is the role of TCA in treating anxiety disorders

TCA's work well in panic disorders

29

What is the role of venlafaxine in treating anxiety disorders

Work well in GAD and panic disorders

30

What is the role of Bupropion in treating anxiety disorders

NONE, can inc anxiety

31

How and why do you use antidepressants to tx anxiety disorders

start at a low dose to avoid anxiety that comes with initial therapy.
it is Good fr patients with a history of substance abuse or concurrent depression

32

Benzodiazepines- MOA

increase the frequency of GABA channel opening to enhance the ability of GABA to inhibit NE and 5HT

33

DO benzodiazepines have a ceiling effect?

No

34

Benzodiazepines- AE

sedation, ataxia, anterograde amnesia, respiratory depression, paradoxical excitement, and aggression

35

How to differentiate between Benzodiazepine OD and an alcohol/ barbiturate OD

BZD are not assoc with a nystagmus, but alcohol and barbiturates are.

36

Benzodiazepine Uses

1) Short term use while waiting for SSRI to kick in
2) Long term use if there are somatic symptos

37

What other conditions are BZS's used in

insomnia, akathesia, acute mania, RLS, seizures, and alcohol detox

38

What are the two aspects of BZD dependence

Psychological and physiological

39

what are the physiologic symptoms of BZD withdrawal

fatal seizures, insomnia, ataxia, tremors, anxiety, hallucinations. N/V

40

How are the symptoms of BZD withdrawal avoided

Make sure that you taper down the dosage

41

BZD- CI

concurrent alcohol or narcotic use- can be deadly
dont use during CBT

42

BZD- tolerance

tolerance develops to the euphoria that BZD's can cause but not the anxilolytic effect- so be careful to examine why you are raising dose

43

What may happen besides withdrawal symptoms when you stop taking BZD

pt may experience a relapse or rebound which will be worse than before

44

What determines the absorption rate and distribution

liphollicity- the more fat soluble--> the faster it is absorbed into the CNS --> faster onset.

45

BZD metabolism

Generally metabolized by the liver into active products

46

Long Acting BZD's- names

Diazepam
Clorazepate
Chlordizaepoxide

47

What are the advantages of long acting BZD's

Less frequent dosing, less rebound between doses, less severe withdrawal

48

what is the metabolism of long acting BZD's

metabolized in the liver

49

Short acting BZD's-names

Lorazepam
Oxazepam

50

Short acting BZD's- pros and cons

More frequent dosing, more rebound between doses, and more severe withdrawal
BUT there is less accumulation of drug in the system

51

Short acting BZD's- metabolism

metabolized by glucoronidation

52

Short acting BZD's preferred population

elderly and those with liver dz

53

Most lipohillic BZD
Least lipohillic BZD

diazepam is the most lipophillic
temazepam- least lipophillic

54

Flumenazil MOA

Competitive antagonist with BZD @ GABA-A receptors

55

Flumenazil- AE

can precipitate withdrawal in pts that are BZD dependent

56

Buspirone- MOA

partial presynaptic 5HT1A agonist which causes an increase in NE and 5HT activity

57

Buspirone- Indications

Scheduled med in GAD
good in Sleep Apnea, for pts with a h/o substance abuse, and have no prior BZD tx

58

Buspirone- AE

HA/N/dizziness and nervousness
overall mide SE- no rebound anxiety, no sedative effect, not associated with dependence

59

Busiprone- how long does it take take effect

Very slow acting

60

Does Busiprone interact with alcohol

NO