antianxiety/antiinsomnia

Question 1

pharmacodynamics benzos

Answer 1

• potentiates action of GABA which leads to enhanced neuronal inhibition and CNS depression
• causes muscle relaxation
• can act as anticonvulsant
• causes ataxia
• affects emotional behavior

Question 2

benzos for antiinsomnia

Answer 2

• acts as sedative-hypnotic by acting on limbic system and subcortical CNS
• shortens REM and stage 4 sleep but increases total sleep time
• schedule IV drug-needs DEA to prescribe
• preg. class D

Question 3

buspirone (Buspar)

Answer 3

• antianxiety med
• related to anxiolytic meds
• high affinity for serotonin receptors and less affinity to dopamine receptors
• doesn’t have muscle relaxation or antivconvulsant properties or sedative effect
• does not effect GABA
• can not be used to substitute for benzos during withdrawal
• monitor for dizziness

Question 4

benzodiazepines

Answer 4

-alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan)
used for antianxiety, muscle relaxant, restless leg syndrome, panic attacks, acute agitation, dystonia
-short term management-can gain dependence/tolerance
-monitor liver and renal function

Question 5

phamacokinetics buspirone

Answer 5

• contraindications: severe renal/hepatic disease, panic disorder (exacerbates)
• ADRs: head ache insomnia, nausea, nervousness, dry mouth
• drug interactions: MAOIs and SSRIs may cause seratonin syndrome; haloperidol and trazodone
• avoid ETOH and no grapefruit juice

Question 6

GABA-BZ agonists

Answer 6

• for insomnia
• zolpidem (Ambien), zaleplon (Sonata)
• short acting
• act through the potentiation of GABA on benzodiazepine receptors, esp. omega-1 receptors
• monitor for dizziness, light headedness, headaches
• used mostly for sedation
• little effect on skeletal muscle or seizure threshold
• minimal disruptive action on normal sleep cycle
• ? potential for addiction
• schedule IV drug

Question 7

treatment of anxiety

Answer 7

• CBT then SSRI or SSNI
• second line: buspirone, bupropion (Welbutrin), hydroxyzine, or imipramine
• panic disorder: CBT, SSRI, or venlafaxine XR
  
  • second line: mertazapine, TCAs or benzos
• phobic disorder: CBT; agoraphobia: SSRIs, social phobia: SSRIs, OCD: CBT, SSRIs, venlafaxine; PTSD: CBT, SSRIs

Question 8

treating pediatric patients with anxiety

Answer 8

• SSRI first line for anxiety
• use benzo ONLY for acute episodes
• r/o ADD or ADHD as component of anxiety

Question 9

education for benzos

Answer 9

• safety while driving/operating machinery
• avoidance of CNS depressants and ETOH
• possibility of dependence
• contact provider b/4 taking OTC
• report symptoms to provider: dizziness, tremors, unable to wake up
• orthostatic hypotension

Question 10

diazepam (Valium)

Answer 10

-contraindications-glaucoma (worsening), impaired liver, nephritis, impaired pulmonary function
-adrs: persistent sedation/drowsiness, respiratory depression especially in combo with other CNS depressants or ETOH, memory impairment
-metabolized in liver- CYP substrate interactions
-monitor liver and kidney functions
-

Question 11

zolpidem (Ambien)

Answer 11

• non-benzo hypnotic
• preg. class C
• adrs: transient anterograde amnesia, dizziness, somnolence, nausea
• metabolized in liver-CYP substrate interactions
• lowest dose effective
• need to be able to have 7-8 hours uninterrupted sleep if not, psycho motor issues