Antianxiety Flashcards
How is anxiety distinct from fear?
Anxiety is absent of a incident
What are the symptoms of anxiety?
Heighten tension, apprehension, uneasiness
Does simple treatment get rid of anxiety?
No
What are the causes of secondary anxiety?
Medical
Psychiatric disorder
Due to certain medications
Primary anxiety is Not due to any of the above
What are the type of anxiety disorders?
- 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
What other drug class is similar to anti anxiety drugs?
Sedative/hypnotics
What class of drugs they have the least in common with?
Antipsychotics
What is the most important group of anti anxiety drugs and why?
Benzodiazepines because they are effective, safe, versatile in uses
How does Benzodezepines work?
It involves GABA A receptor- chloride ion channel complex. It is ligand gated, the ligand is GABA which allows it to open up.
How does benzodiazepines and zolpidem bind?
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
What are the 3 types of benzodiazepine receptor ligands?
- Agonist: DIAZAPAM, ZOLPIDEM ( not a BZ)
- ATAGONIST : FLUMAZENIL
- Inverse Agonist: Beta carbinoles (not a drug)
How does BZ AGONIST drugs work?
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.
How does BZ antagonist work?
FLUMAZENIL: blocks action of BZ and zolpidem if given before. But does not block the action of barbiturates and alcohol.
How does iNverse agonist work?
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.
What are the clinical indications for benzodiazepines ?
- Anxiety
- Dysthymic disorder:mild form of depression
- Skeletal muscle relaxation
- Seizure states and epilepsy
- alcohol withdrawal
- Anesthesia
What BZ drug is used for anxiety?
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
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What BZ drug is used for skeletal muscle relaxation?
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.
What drugs are used for seizure and epilepsy?
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
What drug is used for alcohol withdrawal?
Chlordiazepoxide is safely used with withdrawal of alcohol
What drug is used for anesthesia?
DIAZAPAM: when used via IV for anesthesia in tooth extraction but not potent for surgical
What are adverse effects of BZ?
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
Can you develop tolerance for anti anxiety?
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
Can you develop dependence?
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
What is an additive effect for BZs?
When CNS depression occurs with alcohol, antihistamine, antidepressants, narcotics (analgesic)
