Drugs for Anxiety Flashcards
what kind of drugs are sertraline, escitalopram, fluoxetine, and paroxetine?
SSRIs: selective serotonin re-uptake inhibitors
first-line [along with SNRIs] for generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder
what kind of drugs are venlafaxine and duloxetine?
SNRIs: serotonin-NE re-uptake inhibitors
first-line [along with SSRIs] for generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder
categorize the following drugs as SSRIs or SNRIs:
a. sertraline
b. escitalopram
c. venlafaxine
d. fluoxetine
e duloxetine
SSRIs: sertraline, escitalopram, fluoxetine
SNRIs: venlafaxine, duloxetine
all first-line for anxiety disorders!
what is the first-line pharmacological treatment for anxiety disorders? name 2 examples of each
SSRIs: sertraline, escitalopram, fluoxetine
AND
SNRIs: venlafaxine, duloxetine
how long do SSRIs/SNRIs need to be taken to see a full anxiolytic response?
first line for anxiety, require 2-4 weeks for full anxiolytic response and 4-6 weeks for assessment of initial therapy
in cases of adequate response, tx should be continued for at least 1 year
SSRIs: sertraline, escitalopram, fluoxetine
SNRIs: venlafaxine, duloxetine
what are 3 side effects of SSRIs and SNRIs (first line for anxiety)?
- GI effects
- sleep disturbances
- sexual dysfunction (decreased libido, ED)
NOT associated with risk of dependence !
SSRIs: sertraline, escitalopram, fluoxetine
SNRIs: venlafaxine, duloxetine
describe the clinical use of benzodiazepines (BZDs) for the treatment of anxiety disorders
best for rapid/ short-term (2-4 weeks) management of acute anxiety symptoms; second-line for long-term use (after SSRI/SNRI)
ex: alprazolam, clonazepam, diazepam, lorazepam, oxazepam, chloridiazepoxide
what is the MOA of alprazolam, clonazepam, diazepam, lorazepam, oxazepam, chloridiazepoxide? what are the adverse effects (6)?
benzodiazepines (BZDs): bind/activate GABA(A) receptors
AE: somnolence, cognitive deficits, psychomotor discoordination, respiratory depression, anterograde amnesia, dependence risk (schedule IV)
what kind of drug is flumazenil? what precaution should be taken when it is administered?
competitive antagonist at the benzodiazepine binding site on GABA(A) receptors
used to reverse CNS depression following BZD overdose - may precipitate withdrawal symptoms
which drug should be given to reverse the CNS effects of benzodiazepine overdose?
flumazenil: competitive antagonist at the benzodiazepine binding site on GABA(A) receptors
may precipitate withdrawal symptoms
what is the MOA and clinical use of buspirone?
non-BZD anxiolytic (anxiety drug): agonist at presynaptic 5-HT(1A) auto-receptors —> inhibits serotonin release
adjunct for anxiety therapy {with SSRI/SNRI}, more safe than BZDs
side effects: CYP3A4 modulation, N/V, dizziness, drowsiness
what is the MOA and clinical use of pregabalin?
anticonvulsant that is also used as adjunct therapy for anxiety (with SSRI/SNRI)
increases biosynthesis and release of GABA
AE: dizziness, somnolence, edema, dry mouth, blurry vision, weight gain, difficulty concentrating, schedule V
what is the MOA and clinical use of imipramine?
tricyclic antidepressant also used as adjunct therapy for anxiety (with SSRI/SNRI)
side effects related to blockade of histamine, muscarinic/cholinergic, and alpha receptors
describe the adverse effects of imipramine
TCA used as adjunct therapy for anxiety
- antihistamine - sedation, somnolence
- anticholinergic - dry mouth, constipation, blurry vision, tachycardia
- anti-adrenergic - orthostatic hypotension
high doses can cause seizures, tachycardia, cardiac arrest
which of the following is a first-line option for anxiety?
a. alprazolam
b. buspirone
c. fluoxetine
d. chlordiazepoxide
e. pregabalin
f. imipramine
c. fluoxetine = SSRI
a. alprazolam = BZD
b. buspirone = non-BZD anxiolytic
d. chlordiazepoxide = BZD
e. pregabalin = anticonvulsant
f. imipramine = TCA
