Anxiolytics

Question 1

What are anxiolytics?

Answer 1

Anti-anxiety drugs

Question 2

What are the three anxiolytic classes?

Answer 2

Antidepressants
Benzodiazepines
Buspirone

Question 3

Any antidepressant that increases ______ an be given for anxiety.

Answer 3

Seratonic

Question 4

Out of the three classes, which is the most addictive?

Answer 4

Benzodiazepines

Question 5

With all anxiety disorders, _____ is frequently comorbid.

Answer 5

Depression

Question 6

What are benzodiazepines prescribed most commonly for?

Answer 6

Generalized anxiety disorder (GAD)

Question 7

What are SSRIs (antidepressant) used for?

Answer 7

All anxiety disorders

Question 8

What is GAD?

Answer 8

A chronic condition characterized by uncontrollable worrying

-Of all anxiety disorders, GAD is the least likely to remit

Question 9

Antidepressants: Rapid onset of relief or delayed onset of relief?

Answer 9

Delayed

Question 10

Benzodiazepines: Rapid onset of relief or delayed onset of relief?

Answer 10

Rapid

Question 11

Buspirone: Rapid onset of relief or delayed onset of relief?

Answer 11

Delayed

Question 12

When are benzodiazepines preferred?

Answer 12

For immediate stabilization, especially when anxiety is severe

Question 13

When are antidepressants and buspirone drugs preferred?

Answer 13

For long term management

Question 14

Where do the benefits of benzodiazepines derive from, aka the MOA?

Answer 14

Enhancing responses to GABA (an inhibitory neurotransmitter)

Review: GABA is an amino acid neurotransmitter- it is a relaxer and slows the process in the brain down. This is why benzodiazepine is a good drug for anxiety.

Question 15

The side effects of benzodiazepines are similar to what other drug?

Answer 15

ETOH (alcohol)

Question 16

What are the side effects of benzodiazepines?

Answer 16

Sedation
Slurred speech
Ataxia

Question 17

Because of the abuse potential of the benzodiazepines, what patients should benzodiazepines be used with caution?

Answer 17

In patients known to abuse alcohol or other psychoactive substances

Question 18

Of the 13 benzodiazepines, there are 6 that are approved for anxiety. Which one is the best for generalized anxiety?
Which one is the most commonly abused?

Answer 18

Best for generalized anxiety= Clonazepam

Most commonly abused=alprazolam

Question 19

What are the 3 safety issues with benzodiazepines?

Answer 19

• Synergistic effect when combined with ETOH
• Habit forming
• Seizure risk when withdrawing

Question 20

Do benzodiazepines treat the cause of anxiety?

Answer 20

No

Question 21

What is the MOA of buspirone?

Answer 21

Unclear

Question 22

Does buspirone work on GABA?

Answer 22

No

Question 23

What does buspirone exert its effect on?

Answer 23

The serotonin system

Question 24

Are there any addiction risks with buspirone?

Answer 24

No

Question 25

What are the 3 advantages of buspirone?

Answer 25

- No sedation - No tolerance/dependence - No interaction with ETOH

Question 26

What are the 2 disadvantages of buspirone?

Answer 26

- Slow onset of action (weeks) | - Low efficacy (has been called an expensive placebo)

Question 27

Is buspirone a CNS depressant?

Answer 27

No

Question 28

Is benzodiazepine a CNS depressant?

Answer 28

Yes

Question 29

Which anti-anxiety drug is more suitable to give PRN or for patients who need immediate relief?

Answer 29

Benzodiazepine

Question 30

How many antidepressants have been approved to be given for anti anxiety?

Answer 30

4; 2 SNRI and 2 SSRI

Question 31

What anxiety disorder is this: chronic condition characterized by uncontrollable worrying?

Answer 31

Generalized anxiety disorder

Question 32

What anxiety disorder is this: patients experience recurrent panic attacks, characterized by palpations, pounding heart, chest pain, derealization or depersonalization, and fear of dying or going crazy.

Answer 32

Panic disorder

Question 33

Many patients with _____ experience agoraphobia, a condition characterized by anxiety of being in places or situations from which escape might be embarrassing or difficult, or in which help might be unavailable if a panic attach should occur.

Answer 33

Panic disorder

Question 34

What are the first line drugs for panic disorders?

Answer 34

SSRIs

Question 35

What anxiety disorder is this: persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day and significantly interfere with daily living?

Answer 35

Obsessive-compulsive disorder *Side note review: the limbic nuclei associated with OCD is cingulate gyrus; with severe OCD, the anterior cingulate gyrus may be cut out--sometimes this completely cures a patient with severe OCD

Question 36

What are the first line of drugs for OCD?

Answer 36

SSRI

Question 37

What anxiety disorder is this: characterized by an intense, irrational fear of being scrutinized by others, or of doing something that could be embarrassing or humiliating.

Answer 37

Social anxiety disorder

Question 38

What are the first-line drugs for most patients with social anxiety disorder?

Answer 38

SSRI

Question 39

When is treatment with a benzodiazepine preferred to an SSRI for a patient with social anxiety disorder?

Answer 39

When the disorder is limited to fear of speaking or performing in public. These situations arise infrequently, so PRN treatment of a benzodiazepine may be preferred to long-term treatment of an SSRI

Question 40

What anxiety disorder is this: develops following a traumatic event that elicited an immediate reaction of fear, helplessness, or horror

Answer 40

Post-traumatic stress disorder (PTSD)

Question 41

What are the 3 core symptoms of PTSD?

Answer 41

Reexperiencing Avoidance/emotional numbing Hyperarousal

Question 42

What are treatments for PTSD?

Answer 42

SSRIs for first line treatment of PTSD | Additional drugs used: SNRI (venlafaxine), TCAs, and MAOIs