Anti-anxiety Meds Flashcards
During GAD, ______ panic attacks will be seen.
breakthrough
Which anxiety medication has minimal unwanted sedative side effects?
Buspirone
(Takes about two weeks for effect)
Anxiety is an emotional state where the patient preceives danger. They have an unpleasant state of ______ (3)
- Tension
- Apprehension
- Uneasiness
Severe anxiety symptoms (4)
- Tachycardia
- Sweating
- Trembling
- Palpitations
(sympathetic activation)
Why are anti-anxiety drugs considered both anxiolytic and hypnotic?
They caused some sedation
Pathophysiology of anxiety (3)
- Overactivity of circuits mediated by norepinephrine
- Deficiency of GABA & serotonin systems
- Alterations in autonomic functions
Hypnotics cause _______ (2) effects
- Drowsiness
- Increased tendency to sleep
Sedation causes ______ (3) effects.
- Decrease anxiety
- Decrease motor activity
- Decrease mental activity
Sedative hypnotics are indicated for GAD, Anxiety from diz, _______(3).
- Psychiatric disease → anxiety
- Drug induced anxiety (illicit & prescription)
- Social anxiety disorder
Anticonvulsant such as ______ may cause anxiety
Carbamazepine
GABAA receptors mediate fast inhibitory synaptic transmissions and regulate neuronal excitability. They’re responsible for _______ .
Rapid mood changes (e.g.anxiety, panic and stress response)
GABAB receptors mediate slow inhibitory potentials and have effects on ______ (3).
- Memory
- Mood
- Pain response
List tthe 5 Rx classes that treat anxiety disorder
- Antidepressants (long-term)
- Benzodiazepines
- Buspirone
- Beta blockers
- CBT
______ is the first line therapy for long-term management of GAD.
Antidepressants
Which antidepressant (class) takes effect the fastest?
SSRIs
(1-2 weeks, although full effect may take up to 3 months)
FDA-approved antidepressants for GAD
- Venlafaxine
- Paroxetine
- Citalopram
(full therapeutic response may take up to three months)
SSRIs advantages when treating anxiety (w/or w/o MDD): alleviates anxiety and major depression, minimizes _______ risk.
- Minimum cardiovascular risk
(Also approved for panic disorder, OCD, PTSD and social anxiety disorder)
SSRIs disadvantages when treating anxiety (w/or w/o MDD): (4)
- Slow onset
- Cost
- Sexually adverse effects
- Potential for serotonin syndrome
(compared to MOAIs and TCAs, the effects happen faster BUT max therapeutic effect can take up to 3 months)
SNRIs used to treat anxiety: (2)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
SSRIs & SNRIs: start slow to minimize exaceraation of anxiety and consider _____ (3) adjuncts
- BZD
- beta-blocker
- anticonvulsant
What happens if you abruptly withdrawal an SSRI?
Discontinuation syndrome
(presentation: flu-like symptoms; mn: FLUSH Flu, Light-headedness, Uneasiness, Sleep Disorders, HA)
SSRI & SNRI potential side effects: weight gain, sexual disturbance, GI distress ____ (6).
- Jitteriness
- Headache
- Sleep disturbance
- Sedation
- Increase blood pressure
- Urinary retention
Which 2 medications will rapidly end a panic attack?
Alprazolam (Xanax)
Clonazepam
In addition to reducing anxiety and aggression, BZD also has _______ (3) properties/uses.
- Anticonvulsant
- Muscle relaxant
- Alcohol detoxification
______ is specifically used for treating alcohol withdrawal (Delirium Tremens).
Diazepam
GABA receptor in the CNS has which two receptor sites?
- Barbituate
- BZD
(these are adjacent to the chloride channel)
Benzodiazepine mechanism of action
Opens chloride Channel→ hyperpolarization→ inhibits action potential
Which drug in high doses is GABAmimetic?
Barbiturates
Sedative hypnotic benzodiazepines are highly _____.
Lipophilic
(Short, intermediate and long acting groups)
Sedative hypnotics are extensively metabolized by which enzymes?
CYP 3A4 & CYP2C19
* Clorazepate decarboxylated in gastric juice to desmethyldiazepam
Potential benefits of benzodiazepine
- Effective
- Well tolerated
- Rapid onset
- Maybe use for situational anxiety PRN
- Reduced antidepressant induced activation
Drawbacks of benzodiazepines: ________ (4).
- Sedative, cognitive, psychomotor impairment
- Potential for abuse
- Not effective for comorbid depression
- Interaction w/alcohol
Which to benzodiazepines not produce active metabolites, do not accumulate and are conjugated extrahepaticly? (It will not cause CNS depression)
- Oxazepam
- Lorazepam
Triazolam pharmacokinetics
- Rapid onset
- Sustained action
- No residual action
Oxazepam/Lorazepam: not likely to accumulate with repeated dosing. They are indicated for which patient population?
elderly patients
CNS Side effects of benzodiazepines
- CNS depression: Lightheadedness, drowsiness, incoordination, difficulty concentrating
- Anterograde amnesia
Respiratory side effects of benzodiazepine
Respiratory depression
(Severe if given IV or combined with other CNS depressants)
Sedative effects of BZD can be reversed with ______ a competitive antagonist of benzodiazpine receptor
Flumazenil (Romazicon)
(For BZD OD & reversal of sedative effects; Administered IV)
Caution and contraindication for BZD
- Pregnancy (Birth defects may occur if used in 1st trimester, neonatal CNS depression & withdrawal)
- Contraindicated during nursing
(fluoxetine is preferred for pregnant women)
Monitor patients for _____ (how lonng) after BZD treatment is discontinued
three weeks
(differentiate return of original disease symptoms from withdrawal symptoms)
Benzodiazepines are extremely hazardous when combined with _______
other CNS depressants → profound respiratory depression, coma, death
(WARN PATIENTS ABOUT USING ALCOHOL AND ALL OTHER CNS DEPRESSANTS : antipsychotic agents, TCA’s, opioids)
Erythromycin, clarithromycin, ritonavir, itraconozole, ketoconazole, nefadozone & grapefruit juice inhibit CYP3A4 → _______
Effect on benzodiazepine metabolism and possibility of potential drug interactions.
Potential benefits of combining antidepressants with benzodiazepines: better prevention & treatment of depression, ______(3).
- Rapid anxiolysis
- Decrease early anxiety association
- Treat residual anxiety
Which sedative-hypnotic is best for pregnant and nursing patients?
Buspirone
(Does not cause sedation, no abuse potential)
Which sedative hypnotic is not chemically or pharmacologically related to benzodiazepines?
Buspirone
Buspirone mechanism of action
Partial Agonist at brain 5HT1A receptors
Buspirone is metabolized by which enzyme?
CYP3A4
Buspirone is metabolized by CYP3A4. Rifampin decreases plasma levels of Buspirone and _____ (2) increases plasma levels.
- Erythromycin
- Ketoconazole
Overdose on diazepam will lead to which major physical symptom?
Respiratory distress
What are two benzodiazepine receptor agonist that have a fast onset of action and terminate within 4 to 6 hours?
- Zolpidem (Ambien)
- Zaleplon (Sonata)
(indicator for short-term treatment of insomnia)
Zolpidem (Ambien) & Zaleplon (Sonata) are used for short-term treatment of insomnia and do NOT have _______(3) properties.
- anxiolytic
- muscle relaxant
- anticonvulsant
If a patient with panic disorder has debilitating symptoms you would consider SSRI, SNRI and/or CBT and also adding a short course of______.
BZD
When would you assess the effectiveness of panic disorder treatment?
Six to eight weeks after treatment with SSRI/SNRI +/- BZD +/- CBT
(then continue for a year, reassessing periodically)
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?
add other componenets until :
- CBT + SNRI or SSRI
- SSRI + CBT/BZD
- SNRI + CBT/BZD
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?
- If CBT → switch to SSRI or SNRI
- If SSRI → switch to SNRI/CBT
- If SNRI → switch to SSRI/CBT
Suffix - endings for barbiturates
-tal
