Anxiety Flashcards
a drug that has a calming effect, relieving anxiety and tension. Sedatives are hypnotic drugs administered at lower doses than those needed for sleep (drowsiness common side effect)
Sedative
A drug that produces sleep by depressing brain function
Often cause hangover effects in the morning
Hypnotic
A drug that reduces anxiety
Anxiolytic
medical conditions that can cause patients to have anxiety
MI asthma hyperthyroidism migraine pain
where do benzos act?
allosteric site of GABA
MOA of benzos
The binding of benzodiazepines enhances the action of GABA, resulting in a greater entry of chloride ion
Meds that decrease ___ help anxiety
norepinephrine
Meds that increase ____ at receptors help w/ anxiety
5-HT (serotonin)
fear of market place or open spaces
agoraphobia
what are the benzos used for anxiety
alprazolam clonazapam chlordiazepoxide clorazepate diazepam halazepam lorazepam oxazepam
most effective and safe med for acute anxiety symptoms
benzos
long acting benzos (1-3 days)
chlordiazepoxide
diazepam
flurazepam
intermediate acting benzos (10-20 hours)
alprazolam
lorazepam
temazepam
short acting benzos (3-8 hours)
oxaepam
traizolam
MOA of benzos
potentiate inhibitory activity of GABA
which benzos have lower potency
chlordiazepoxide
oxazepam
temazepam
what benzos have medium potency
diazepam estazolam flurazepam prazepam quazepam
what benzos have high potency
alprazolam bromazepam clonazepam lorazepam traizolam
ADRs w/ benzos
sedation, fatigue, weakness
decreased memory and recall
ataxia, mental confusion
who can you see a paradoxical rxn w/ benzos in
extremes of age
brain injury
to D/c benzos what must be done
taper <10-25% every 1-2 weeks
at 50% dose slow-taper further to avoid withdrawal
other CNS depressants to not combine w/ benzos
ETOH
opiates
what drug inhibits metabolism of long acting BZDs
cimetidine
what drug decreases clearance of diazepam
fluoxetine
disadvantages of benzos
psychological dependence/ abuse
withdrawal rxns
withdrawal symptoms of benzos
confusion, anxiety, agitation, restlessness, insomnia, tension
what reverses the affects of benzos
flumazenil (rapidly reverses effects)
problem w/ flumazenil
will precipitate withdrawal symptoms (seizures)
Not used for anxiety or insomnia
Induce tolerance, physical dependency, severe withdrawal symptoms
Potentially Fatal Respiratory Depression
potent liver inducers- many drug interactions
Barbiturates
barbiturates uses
general anesthetic
anticonvulsant
sedative/ hypnotics- risky
MOA of barbiturates
Potentiates GABA action on chloride entry into neuron hyperpolarization
Barb receptor on GABA different than Benzo
Block excitatory glutamate receptors
Anesthetic concentrations block Na+ channels
is there an antagonist for barbiturates?
No
how are beta blockers useful w/ anxiety
helps w/ physical symptoms- tachycardia, palpitations, tremor, sweating
what situations can’t you use beta blockers
asthma
diabetes
CHF
drugs used for performance anxiety (ie- public speaking)
propranolol 10 mg prn
Treat anxiety d/o
Reduce 5-HT transmission by acting as partial agonist at these receptors
Buspirone (Buspar)
advantages of buspirone
dependence unlikely
minimal sedation
disadvanatges w/ buspirone
only works well in GAD
can cause hypothermia, increased prolactin/ GH
P450
onset of effects w/ buspirone
onset in 1 weeks, max effects in 4-6 weeks
drug for anxiety that reduces calcium influx into the neuron and reduces release of glutamate, NE and substance P
pregabalin
antidepressants shown to not be helpful w/ patients who has anxiety
tradazone
bupropion
tx of choice for panic disorders
SSRIs
antidepressant + benzo can result in what?
jitteriness syndrome
tx by giving smaller dose of antidepressant
SSRI may induce what in the first 4 weeks
anxiety, so add a benzo to help
the majority of anxiety and panic disorder need what
long-term treatment
Tx of anxiety & insomnia, non-addicting
antihistamines
