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Psychiatry > Pharmacology of Anxiolytic Drugs > Flashcards

Pharmacology of Anxiolytic Drugs Flashcards

(47 cards)

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1
Q

What are some drugs used to treat anxiety?

A

Benzodiazepines, antidepressants, beta blockers, pregabalin, bispirone

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2
Q

What are some comorbid disorders of anxiety?

A

Substance abuse, ADHD, bipolar disorder, panic disorder, sleep disorder

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3
Q

What are the core symptoms of anxiety?

A

Significant symptom overlap with depression
Amygdala centred circuit = panic and phobia
Cortico-striatal-thalamic-cortical (CSTC) circuit = anxiety, apprehension, obsessions

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4
Q

What is the function of the amygdala in anxiety?

A

Integrates sensory and cognitive symptoms

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5
Q

Where in the brain is the affect of fear seen?

A

Anterior cingulate cortex and orbitofrontal cortex

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6
Q

What is the periaqueductal gray responsible for?

A

Fight or flight response

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7
Q

What part of the brain is ultimately responsible for increasing cortisol levels?

A

Hypothalamus

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8
Q

How does the locus coeruleus increase blood pressure and heart rate in fear?

A

Via autonomic output

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9
Q

What kind of memories is the hippocampus responsible for?

A

Traumatic memories

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10
Q

What neurotransmitters are involved in the amygdala centred circuit?

A

5-HT, GABA, glutamate, CRF, NE and voltage gated ion channels

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11
Q

What is GABA?

A

Main inhibitory transmitter in brain = reduces activity of neurons in the amygdala and CSTC circuit

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12
Q

What effect do benzodiazepines have on GABA?

A

Enhance GABA activity

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13
Q

What are the main GABA receptors?

A

GABA-A, GABA-B and GABA-C

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14
Q

What is GABA-A a target for?

A

Benzodiazepines, alcohol and barbiturates

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15
Q

What are some examples of benzodiazepines?

A

Lorazepam, diazepam and chlordiazepoxide

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16
Q

What effects do benzodiazepines have?

A

Reduce anxiety and depression, hypnosis and sedation, muscle relaxation, anticonvulsant, anterograde amnesia

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17
Q

What are the clinical uses of benzodiazepines?

A

Acute treatment of extreme anxiety, hypnosis, alcohol withdrawl, mania, delirium, rapid tranquillisation, status epilepticus

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18
Q

What are some side effects of benzodiazepines?

A

Paradoxical aggression, anterograde amnesia and impaired co-ordination, tolerance and dependence

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19
Q

What are some symptoms of benzodiazepine withdrawl?

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A

Abdominal cramps, panic attacks, sweating, shaking, palpitations, blurred vision, depression, insomnia, dizziness, headaches, nausea/vomiting, tingling in hands/feet, restlessness, sensory sensitivity

20
Q

What causes the symptoms of benzodiazepine withdrawl?

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A

Chronic treatment reduces response to GABA = withdrawl results in anxiety or convulsions due to reduced density of benzodiazepine receptors

21
Q

What is the first step when withdrawing a patient from benzoddiazepines?

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A

Transfer patient to equivalent daily dose of diazepam or chlordiazepoxide preferably taken at night

22
Q

How often do you reduce dose of benzodiazepines when withdrawing a patient from this drug?

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A

Reduce dose every 2-3 weeks in steps of 2-2.5mg = if withdrawl symptoms occur then maintain dose until they clear, reduce dose further after this

23
Q

How long can it take to withdraw a patient from benzodiazepines?

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A

Can take anything from 4 weeks up to 1 year or more

24
Q

Where does 5-HT innervate?

25
How do SSRIs and SNRIs increase 5-HT levels?
Block the 5-HT transporter
26
How do SSRIs increase 5-HT levels?
Inhibit reuptake of 5-HT = leads to increased levels in the synaptic cleft
27
What antidepressants can be used acutely to treat anxiety?
SSRIs = increase extracellular 5-HT
28
What does chronic use of antidepressants to treat anxiety cause?
Anxiolytic properties begin to appear
29
By which mechanisms do antidepressants treat anxiety?
Expression of receptors for 5-HT and glucocorticoids that depend upon sustained exposure to high extracellular concentrations of 5-HT Enhanced neurosteroid synthesis
30
What anxiety disorders can SSRIs be used to treat?
Panic disorder, OCD, PTSD and phobias | Paroxetine and escitalopram used for GAD
31
What anxiety disorders are tricyclics used to treat?
Used for OCD | 2nd line for panic disorder
32
What is venlafaxine (SNRI) used to treat?
GAD
33
What is moclobemide (MAOI) used to treat?
Social anxiety disorder
34
What are some features of pregabalin?
Ca2+ channel blocker and GABA enhancer = only considered if patient not responsive to other treatments
35
What are some features of propanolol?
Beta blocker = best used for somatic symptoms (e.g palpitations or tremor)
36
What are the steps for treating GAD?
``` 1 = psychoeducation and self help/psychoeducation groups 2 = CBT or SSRIs ( consider <2 weeks benzodiazepines) 3 = SNRI 4 = Pregabalin 5 = combination of CBT and drug treatment ```
37
How often should you wait before reviewing treatment of GAD?
Up to 12 weeks to asses efficacy = unlikely to respond if no effect in 4 weeks
38
How long should you stay with the treatment for GAD?
Continue for 18 months | When stopping, reduce dose gradually to avoid discontinuation
39
What are the steps for treating panic disorder?
``` 1 = self help 2 = CBT or SSRI (if no benefit from longstanding CBT) 3 = tricyclics (e.g clomipramine) ```
40
What drugs should be avoided when treating panic disorder?
benzodiazepines, sedating antihistamines, propanolol, bispirone, bupropion
41
How long do you stick with treatment for panic disorder?
6 months
42
What are the steps for treating OCD?
``` 1 = low intensity psychological intervention 2 = more intensive psychological intervention or SSRI, continue for 1 year if effective 3 = consider dose increase after 4-6 weeks 4 = SSRIs plus CBT and ERP 5 = clomipramine 6 = augmentation with antipsychotic/clomipramine plus citalopram ```
43
What is the treatment of PTSD within 4 weeks of the traumatic event?
Watchful waiting
44
What is the treatment of PTSD within 3 months of the traumatic event?
Trauma focused CBT | Hypnotic medication for sleep disturbance
45
What is the treatment for PTSD over 3 months since the traumatic event?
Trauma focused CBT or EMDR
46
Are drugs used to treat PTSD?
Limited evidence for their use = paroxetine, mirtazepine, amitriptyline
47
What are the steps for treating social anxiety disorder?
``` 1 = individual CBT 2 = SSRI (escitalopram, sertraline), review in 12 weeks 3 = SSRI plus CBT 4 = SNRI or alternative SSRI 5 = MAO inhibitor (moclobemide) ```

Psychiatry (36 decks)

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