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Ph 4 > Antianxiety > Flashcards

Antianxiety Flashcards

0
Q

How is anxiety distinct from fear?

A

Anxiety is absent of a incident

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1
Q

What are the symptoms of anxiety?

A

Heighten tension, apprehension, uneasiness

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2
Q

Does simple treatment get rid of anxiety?

A

No

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3
Q

What are the causes of secondary anxiety?

A

Medical
Psychiatric disorder
Due to certain medications

Primary anxiety is Not due to any of the above

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4
Q

What are the type of anxiety disorders?

A
  • PTSD: delayed reaction to stress at a least 6 months after causative episode- acute can be managed with anti anxiety drugs but not chronic
  • Generalized Anxiety Disorder : it is a trait of the patient (most cases are these)
  • Panic Disorder: this is an episodic condition characterized by 3-4 panic reactions a week. They do NOT respond well to anti anxiety drugs with exception to short action benzodiazepines and IMIPRAMINE
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5
Q

What other drug class is similar to anti anxiety drugs?

A

Sedative/hypnotics

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6
Q

What class of drugs they have the least in common with?

A

Antipsychotics

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7
Q

What is the most important group of anti anxiety drugs and why?

A

Benzodiazepines because they are effective, safe, versatile in uses

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8
Q

How does Benzodezepines work?

A

It involves GABA A receptor- chloride ion channel complex. It is ligand gated, the ligand is GABA which allows it to open up.

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9
Q

How does benzodiazepines and zolpidem bind?

A

They bind allostericly from GABA. They enhance or increase GABA mediated chloride conduction.

  • benzodiazepines agonist are positive allosteric modulators and causes increase of chloride in cell. Benzodiazepine do not substitute GABA, they enhance them
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10
Q

What are the 3 types of benzodiazepine receptor ligands?

A
  1. Agonist: DIAZAPAM, ZOLPIDEM ( not a BZ)
  2. ATAGONIST : FLUMAZENIL
  3. Inverse Agonist: Beta carbinoles (not a drug)
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11
Q

How does BZ AGONIST drugs work?

A

DIAZAPAM and ZOLPIDEM (not BZ)
- these facilitate GABA action as POSITIVE allosteric modulators of GABA receptors function .

DIAZAPAM: use-anti anxiety, anti convulsive action. There are 2 receptor types of DIAZAPAM , BZ1 and BZ2.

ZOLPIdem : is a selective agonist to only BZ1.

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12
Q

How does BZ antagonist work?

A

FLUMAZENIL: blocks action of BZ and zolpidem if given before. But does not block the action of barbiturates and alcohol.

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13
Q

How does iNverse agonist work?

A

beta carbinoles are not drugs. These act as NEGaTIVE allosteric modulators of GABA receptor function. There action with BZ receptor causes anxiety and seizures because it prevents GABA from binding and chloride from opening at all.

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14
Q

What are the clinical indications for benzodiazepines ?

A
  1. Anxiety
  2. Dysthymic disorder:mild form of depression
  3. Skeletal muscle relaxation
  4. Seizure states and epilepsy
  5. alcohol withdrawal
  6. Anesthesia
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15
Q

What BZ drug is used for anxiety?

A

LORAZEPAM : short acting
Diazepam and chlordiazepoxide : long acting

They provide symptomatic relief of anxiety, they do relieve the cause.

Do NOT use BZs for depression, psychosis, phobias, obsession, compulsions ONLY symptomatic anxiety
P

16
Q

What BZ drug is used for skeletal muscle relaxation?

A

DIAZAPAM: you need a higher dose than anesthesia dose to relax skeletal muscle. It works by facilitating the action of 2 CNS inhibitory neuro transmitter at spinal cord: 1. GABA and 2. Glycine. At high doses used with analgesics to treat back pain.

17
Q

What drugs are used for seizure and epilepsy?

A

Clonazepam and DIAZAPAM

Used acutely as anticonvulsant in seizure states.
Chronicly for certain epilepsy such as status epilpicus(continuous seizures)- DIAZAPAM is used for this

18
Q

What drug is used for alcohol withdrawal?

A

Chlordiazepoxide is safely used with withdrawal of alcohol

19
Q

What drug is used for anesthesia?

A

DIAZAPAM: when used via IV for anesthesia in tooth extraction but not potent for surgical

20
Q

What are adverse effects of BZ?

A

Day time sedation, muscle relaxation, ataxia, amnesia-anterograde

Anterograde is the inability to remember events during drug action (cause by DIAZAPAM and short acting agents) impair cognitive function. You remember prior to drug but not while on drug. This is cause by sedative doses and you do not develope tolerance

21
Q

Can you develop tolerance for anti anxiety?

A

Yes tolerance can develop within 3 months. You will need to increase dose, use in limited by tolerance, you only for situational anxiety, use flexible dose regiment short acting drugs

22
Q

Can you develop dependence?

A

Long term use of greater than 3 months can lead to physical dependence (if u keep increasing dose). If you develop depence and try to stop “cold turkey” withdrawal seizures can occur and rebound anxiety (like barbiturates withdrawal). So cut back on dose over time

23
Q

What is an additive effect for BZs?

A

When CNS depression occurs with alcohol, antihistamine, antidepressants, narcotics (analgesic)

24
Q

Can overdoses occur with BZs?

A

When BZ is used alone, it suicide proof however with an additive CNS depression it can cause death (even if it is in small doses)

25
Q

What is FLUMAZENIL used for?

A

It is a BZ antagonist, that competes to block actions of BZ and zolpidem but not of sedative/hypnotic. Approved use: is reversing CNS depression effects of BZ overdose or reverse anesthetic effects of BZ

If you FLUMAZENIL to patient that dependent/ tolerance, you can cause full blown withdrawal.

26
Q

What is BUSPIRONE ?

A

It is a drug that acts thru non- GABA mechanisms and has decrease adverse effects
Relieve anxiety without sedative and euphoric effects

It does not have antihypnotic, anticonvulsant , no muscle relaxation

It causes anti anxiety effects by working on brain serotonin receptors
The anti anxiety effect takes more than 1 week to develop, not to be used in situational anxiety or panic disorder . Use: generalized anxiety

27
Q

BZ vs BU

A 
Addiction liability: BZ
Relief of general anxiety: BZ and BU
Rebound anxiety:BZ
Physical dependence: BZ
Delay on onset of anti-anxiety: bu
Potentiates alcohol intoxication:BZ

Ph 4 (7 decks)

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