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Behavioral Medicine > Anti-anxiety Meds > Flashcards

Anti-anxiety Meds Flashcards

1
Q

During GAD, ______ panic attacks will be seen.

A

breakthrough

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2
Q

Which anxiety medication has minimal unwanted sedative side effects?

A

Buspirone

(Takes about two weeks for effect)

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3
Q

Anxiety is an emotional state where the patient preceives danger. They have an unpleasant state of ______ (3)

A
  1. Tension
  2. Apprehension
  3. Uneasiness
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4
Q

Severe anxiety symptoms (4)

A
  1. Tachycardia
  2. Sweating
  3. Trembling
  4. Palpitations

(sympathetic activation)

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5
Q

Why are anti-anxiety drugs considered both anxiolytic and hypnotic?

A

They caused some sedation

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6
Q

Pathophysiology of anxiety (3)

A
  1. Overactivity of circuits mediated by norepinephrine
  2. Deficiency of GABA & serotonin systems
  3. Alterations in autonomic functions
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7
Q

Hypnotics cause _______ (2) effects

A
  1. Drowsiness
  2. Increased tendency to sleep
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8
Q

Sedation causes ______ (3) effects.

A
  1. Decrease anxiety
  2. Decrease motor activity
  3. Decrease mental activity
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9
Q

Sedative hypnotics are indicated for GAD, Anxiety from diz, _______(3).

A
  1. Psychiatric disease → anxiety
  2. Drug induced anxiety (illicit & prescription)
  3. Social anxiety disorder
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10
Q

Anticonvulsant such as ______ may cause anxiety

A

Carbamazepine

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11
Q

GABAA receptors mediate fast inhibitory synaptic transmissions and regulate neuronal excitability. They’re responsible for _______ .

A

Rapid mood changes (e.g.anxiety, panic and stress response)

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12
Q

GABAB receptors mediate slow inhibitory potentials and have effects on ______ (3).

A
  1. Memory
  2. Mood
  3. Pain response
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13
Q

List tthe 5 Rx classes that treat anxiety disorder

A
  1. Antidepressants (long-term)
  2. Benzodiazepines
  3. Buspirone
  4. Beta blockers
  5. CBT
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14
Q

______ is the first line therapy for long-term management of GAD.

A

Antidepressants

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15
Q

Which antidepressant (class) takes effect the fastest?

A

SSRIs

(1-2 weeks, although full effect may take up to 3 months)

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16
Q

FDA-approved antidepressants for GAD

A
  1. Venlafaxine
  2. Paroxetine
  3. Citalopram

(full therapeutic response may take up to three months)

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17
Q

SSRIs advantages when treating anxiety (w/or w/o MDD): alleviates anxiety and major depression, minimizes _______ risk.

A
  • Minimum cardiovascular risk

(Also approved for panic disorder, OCD, PTSD and social anxiety disorder)

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18
Q

SSRIs disadvantages when treating anxiety (w/or w/o MDD): (4)

A
  1. Slow onset
  2. Cost
  3. Sexually adverse effects
  4. Potential for serotonin syndrome

(compared to MOAIs and TCAs, the effects happen faster BUT max therapeutic effect can take up to 3 months)

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19
Q

SNRIs used to treat anxiety: (2)

A
  1. Venlafaxine (Effexor)
  2. Duloxetine (Cymbalta)
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20
Q

SSRIs & SNRIs: start slow to minimize exaceraation of anxiety and consider _____ (3) adjuncts

A
  1. BZD
  2. beta-blocker
  3. anticonvulsant
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21
Q

What happens if you abruptly withdrawal an SSRI?

A

Discontinuation syndrome

(presentation: flu-like symptoms; mn: FLUSH Flu, Light-headedness, Uneasiness, Sleep Disorders, HA)

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22
Q

SSRI & SNRI potential side effects: weight gain, sexual disturbance, GI distress ____ (6).

A
  1. Jitteriness
  2. Headache
  3. Sleep disturbance
  4. Sedation
  5. Increase blood pressure
  6. Urinary retention
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23
Q

Which 2 medications will rapidly end a panic attack?

A

Alprazolam (Xanax)

Clonazepam

24
Q

In addition to reducing anxiety and aggression, BZD also has _______ (3) properties/uses.

A
  1. Anticonvulsant
  2. Muscle relaxant
  3. Alcohol detoxification
25
Q

______ is specifically used for treating alcohol withdrawal (Delirium Tremens).

A

Diazepam

26
Q

GABA receptor in the CNS has which two receptor sites?

A
  1. Barbituate
  2. BZD

(these are adjacent to the chloride channel)

27
Q

Benzodiazepine mechanism of action

A

Opens chloride Channel→ hyperpolarization→ inhibits action potential

28
Q

Which drug in high doses is GABAmimetic?

A

Barbiturates

29
Q

Sedative hypnotic benzodiazepines are highly _____.

A

Lipophilic

(Short, intermediate and long acting groups)

30
Q

Sedative hypnotics are extensively metabolized by which enzymes?

A

CYP 3A4 & CYP2C19

* Clorazepate decarboxylated in gastric juice to desmethyldiazepam

31
Q

Potential benefits of benzodiazepine

A
  1. Effective
  2. Well tolerated
  3. Rapid onset
  4. Maybe use for situational anxiety PRN
  5. Reduced antidepressant induced activation
32
Q

Drawbacks of benzodiazepines: ________ (4).

A
  1. Sedative, cognitive, psychomotor impairment
  2. Potential for abuse
  3. Not effective for comorbid depression
  4. Interaction w/alcohol
33
Q

Which to benzodiazepines not produce active metabolites, do not accumulate and are conjugated extrahepaticly? (It will not cause CNS depression)

A
  1. Oxazepam
  2. Lorazepam
34
Q

Triazolam pharmacokinetics

A
  1. Rapid onset
  2. Sustained action
  3. No residual action
35
Q

Oxazepam/Lorazepam: not likely to accumulate with repeated dosing. They are indicated for which patient population?

A

elderly patients

36
Q

CNS Side effects of benzodiazepines

A
  1. CNS depression: Lightheadedness, drowsiness, incoordination, difficulty concentrating
  2. Anterograde amnesia
37
Q

Respiratory side effects of benzodiazepine

A

Respiratory depression

(Severe if given IV or combined with other CNS depressants)

38
Q

Sedative effects of BZD can be reversed with ______ a competitive antagonist of benzodiazpine receptor

A

Flumazenil (Romazicon)

(For BZD OD & reversal of sedative effects; Administered IV)

39
Q

Caution and contraindication for BZD

A
  • Pregnancy (Birth defects may occur if used in 1st trimester, neonatal CNS depression & withdrawal)
  • Contraindicated during nursing

(fluoxetine is preferred for pregnant women)

40
Q

Monitor patients for _____ (how lonng) after BZD treatment is discontinued

A

three weeks

(differentiate return of original disease symptoms from withdrawal symptoms)

41
Q

Benzodiazepines are extremely hazardous when combined with _______

A

other CNS depressants → profound respiratory depression, coma, death

(WARN PATIENTS ABOUT USING ALCOHOL AND ALL OTHER CNS DEPRESSANTS : antipsychotic agents, TCA’s, opioids)

42
Q

Erythromycin, clarithromycin, ritonavir, itraconozole, ketoconazole, nefadozone & grapefruit juice inhibit CYP3A4 → _______

A

Effect on benzodiazepine metabolism and possibility of potential drug interactions.

43
Q

Potential benefits of combining antidepressants with benzodiazepines: better prevention & treatment of depression, ______(3).

A
  1. Rapid anxiolysis
  2. Decrease early anxiety association
  3. Treat residual anxiety
44
Q

Which sedative-hypnotic is best for pregnant and nursing patients?

A

Buspirone

(Does not cause sedation, no abuse potential)

45
Q

Which sedative hypnotic is not chemically or pharmacologically related to benzodiazepines?

A

Buspirone

46
Q

Buspirone mechanism of action

A

Partial Agonist at brain 5HT1A receptors

47
Q

Buspirone is metabolized by which enzyme?

A

CYP3A4

48
Q

Buspirone is metabolized by CYP3A4. Rifampin decreases plasma levels of Buspirone and _____ (2) increases plasma levels.

A
  • Erythromycin
  • Ketoconazole
49
Q

Overdose on diazepam will lead to which major physical symptom?

A

Respiratory distress

50
Q

What are two benzodiazepine receptor agonist that have a fast onset of action and terminate within 4 to 6 hours?

A
  • Zolpidem (Ambien)
  • Zaleplon (Sonata)

(indicator for short-term treatment of insomnia)

51
Q

Zolpidem (Ambien) & Zaleplon (Sonata) are used for short-term treatment of insomnia and do NOT have _______(3) properties.

A
  1. anxiolytic
  2. muscle relaxant
  3. anticonvulsant
52
Q

If a patient with panic disorder has debilitating symptoms you would consider SSRI, SNRI and/or CBT and also adding a short course of______.

A

BZD

53
Q

When would you assess the effectiveness of panic disorder treatment?

A

Six to eight weeks after treatment with SSRI/SNRI +/- BZD +/- CBT

(then continue for a year, reassessing periodically)

54
Q

After a six to eight week trial of panic disorder treatment (with SSRI/SNRI +/- BZD +/- CBT), if the patient only has a partial response, what is the next step?

A

add other componenets until :

  • CBT + SNRI or SSRI
  • SSRI + CBT/BZD
  • SNRI + CBT/BZD
55
Q

After a six to eight week trial of panic disorder treatment (with SSRI/SNRI +/- BZD +/- CBT), if the patient only has no response, what is the next step?

A
  • If CBT → switch to SSRI or SNRI
  • If SSRI → switch to SNRI/CBT
  • If SNRI → switch to SSRI/CBT
56
Q

Suffix - endings for barbiturates

A

-tal

Behavioral Medicine (35 decks)

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