What do benzo’s do?
They bind to GABA receptors, thereby increasing activity and increasing inhibition
What is the most prevalent inhibitory neurotransmitter in CNS?
GABA (gamma-aminobutyric acid)
What other substances also bind to GABA receptors?
Alcohol & barbiturates, although they have their own binding sites and slightly different ways of affecting the receptors
Why shouldn’t alcohol, barbiturates, and BZD’s be combined?
Because together they have an additive/synergistic effects that can be fatal.
What are the therapeutic effects of BZD’s?
Decrease anxiety temporarily
Induce anterograde amnesia for medical procedures
Induce sedation for agitation, sleep for insomnia
Relax muscles for spasms
Raise seizure threshold (e.g. alcohol withdrawal)
What are the SE’s of BZDs?
- Paradoxical agitation (anxiety, aggression, behavioral disinhibition)
- Sedation, drowsiness, lethargy, depression (especially in elderly)
- Confusion, cognitive impairments, impaired learning, amnesia (even dementia)
Ataxia, resulting in falls in elderly
-Slurred speech
-Dependence
-Interactions with alcohol/other sedatives
Possible fetal abnormalities
Paradoxical agitation
One of the SE of BZD’s in which the pt experiences increases in anxiety, agression and behavioral disinhibition
T or F: With few exceptions, BZD’s should only be used for a few weeks for temporary relief until other therapy techniques can take effect.
T
T or F: BZD’s may interfere with CBT
T
T or F: BZD’s are never prescribed for long periods
F; BZD’s are very commonly and inappropriately prescribed for long periods.
What are the 1st-line Rx for anxiety disorders due to efficacy and to the SE’s of sedative-hypnotics?
SSRI’s
What is considered responsible for effectiveness of SSRI’s for anxiety?
5-HT usually decreases anxiety and frequently inhibits behaviors; however, 5HT2 receptors may cause anxiety until they downregulate/desensatize
What are the two biggest problems with prescribing mirtazapine (Remeron) (which is NOT a BZD)?
Weight gain
Hypersomnia
Which antidepressants are commonly prescribed for anxiety?
See slides
What is the first line treatment for OCD?
SSRI’s
What is the second line treatment for OCD?
Best option are high doses of SSRI’s or augmentation with an atypical antipsychotic
Also used are clomipramine (Anafranil), MAOI, and SNRI.
What is the 1st line treatment for PTSD?
- SSRI’s
- SNRI’s
- For patients who are left with residual sxs, an alpha1 antagonist at night may prevent nightmares.
What is the second line treatment for PTSD?
alpha2sigma ligands, TCA’s, MAOI’s, BZD’s (w/ caution because many abuse substances)
