week4 anxiety disorder managment

Question 1

What is the mechanism of action of Clonazepam (Klonopin®)?

Answer 1

: GABA-A receptor agonist; increases frequency of Cl⁻ channel

Question 2

What are the short-term indications for benzodiazepines like Clonazepam and Flurazepam?

Answer 2

A: Acute management of anxiety, seizures, and sedative-hypnotic withdrawal.

Question 3

What are common side effects of benzodiazepines?

Answer 3

A: Sedation, memory impairment (especially short-acting agents), risk of abuse/addiction/withdrawal.

Question 4

Q: What medication reverses benzodiazepine effects?

Answer 4

A: Flumazenil – a benzodiazepine antagonist.

Question 5

Q: Hydroxyzine and Diphenhydramine MOA and use?

Answer 5

A: Histamine receptor antagonists; used PRN for anxiety; side effects include sedation and deliriogenic potential.

Question 6

What is Propranolol’s use in anxiety?

Answer 6

A: Performance anxiety (β-antagonist); side effects: bradycardia, hypotension.

Question 7

What is Buspirone’s mechanism and indication? and SE?

Answer 7

A: Partial 5-HT₁A agonist and dopamine antagonist; used for GAD. Delayed onset (2–4 weeks); SE: dizziness, GI upset, confusion.

Question 8

What is the mechanism of action of “Z-drugs” (e.g., Zolpidem, Zaleplon, Eszopiclone)?

Answer 8

A: GABA-A receptor agonists; used for insomnia; rapid onset.

1. 3 Zs: Zolpidem, Zaleplon, esZopiclone (nonbenzodiazepine hypnotics) 2. Cab-A: nonbenzodiazepine hypnotics (e.g. zolpidem) bind to an allosteric site on the GABAA receptor 3. "Chlo-Rider": the GABAA receptor is a chloride channel 4. CNS light: benzodiazepines potentiate GABAA transmission in the CNS 5. "Take it easy": GABA (with glycine) is a major inhibitory neurotransmitter in the CNS 6. Grabbing same cab handle: nonbenzodiazepine hypnotics and benzos bind to the same allosteric site on GABA-A 7. Alcoholic on Cab-A: alcohol binds the GABAA receptor at a separate allosteric site 8. Barbershop next to Cab-A: barbiturates bind the GABAA receptor at a separate allosteric site 9. "fast": zaleplon and zolpidem have a rapid onset of action 10. Quick jump and fall: nonbenzodiazepine hypnotics have a short duration of action 11. Liver spot: zaleplon and zolpidem are rapidly metabolized by the liver 12. Sleeping: nonbenzodiazepine hypnotics treat insomnia 13. "Fall asleep": zaleplon and zolpidem treat sleep onset insomnia (eszopiclone has the longest half life and is effective for both sleep onset and sleep maintenance insomnia) 14. Disoriented old man: elderly patients are more sensitive to the side effects of nonbenzodiazepine hypnotics (e.g. cognitive impairment and delirium) 15. Unbalanced stack: nonbenzodiazepine hypnotics can cause central ataxia (causing falls in the elderly) 16. "Cannot combine with other CoupoNS": avoid use with other CNS depressants 17. Bee swatter smacking head: avoid use with other CNS depressants (e.g. 1st generation antihistamines, alcohol, benzos, barbs) 18. "Not tolerated": nonbenzodiazepine hypnotics are less likely to cause tolerance 19. "break bad habits": nonbenzodiazepine hypnotics are less likely to cause withdrawal symptoms and dependence

Question 9

What black box warning is associated with Z-drugs?

Answer 9

A: Sleep-related behaviors (e.g., sleepwalking) can lead to injury or death.

Question 10

What is the only FDA-approved indication for Ramelteon?

Answer 10

A: Insomnia (melatonin receptor agonist; acts at the SCN).

21. "melt away": melatonin and ramelteon (a melatonin receptor agonist) treat insomnia 22. Dark and light: melatonin receptors maintain circadian rhythm 23. Nucleus above "X": MT1 and MT2 melatonin receptors are located in the suprachiasmatic nucleus of the hypothalamus (activated by ramelteon) 24. Peacefully sleeping elderly:

Question 11

What are the key properties of Trazodone and Doxepin in sleep management?

Answer 11

A: Trazodone: 5-HT, H₁, α₁ antagonist.
Doxepin: TCA with strong antihistaminergic/anticholinergic side effects.

Question 12

Q: What are the general considerations for anxiety medication use?

Answer 12

A: Short-term meds (e.g., benzos) can bridge to long-term antidepressants; avoid benzos in substance use disorder.