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Psychiatry > Anxiety Disorders - Pharmacology > Flashcards

Anxiety Disorders - Pharmacology Flashcards

1
Q

Name 5 drugs/drug groups that can be used to treat anxiety?

A

Benzodiazepines, anti-depressants, buspirone, pregabalin, beta blockers

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2
Q

How long can benzodiazepines be used for in the treatment of anxiety?

A

Short term only, < 2 weeks

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3
Q

What beta blocker is the most likely to be used for anxiety?

A

Propranolol

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4
Q

What drug class is the mainstay of treatment for anxiety?

A

Anti-depressants

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5
Q

What are the two core features of anxiety?

A

Fear and worry

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6
Q

What are the two main anxiety disorders which are primarily characterised by fear?

A

Phobias and panic disorder

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7
Q

What are the two main anxiety disorders which are primarily characterised by worry?

A

GAD and OCD

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8
Q

The amygdala centred circuit is responsible for which core symptom of anxiety?

A

Fear

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9
Q

The cortico-striatal-thalamic-cortical circuit is responsible for which core symptom of anxiety?

A

Worry

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10
Q

What is GABA?

A

The main inhibitory neurotransmitter in the brain

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11
Q

What is the role of GABA?

A

To reduce the activity of neurones in the amygdala and CSTC tract

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12
Q

What is the role of a benzodiazepine?

A

To enhance the action of GABA (hence causing further inhibition)

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13
Q

Which GABA receptor is the target of benzodiazepines?

A

GABA-A

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14
Q

What are some examples of drugs which act on GABA-A receptors?

A

Benzodiazepines, barbiturates and alcohol

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15
Q

Where do benzodiazepines bind to GABA-A receptors?

A

At a site which is separate from the GABA binding site

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16
Q

Benzodiazepines binding to GABA-A receptors at a site different to GABA itself has what effect?

A

Positive allosteric effect

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17
Q

What happens when GABA/benzodiazepines bind to the GABA-A receptor?

A

An ion channel opens, allowing Cl- ions to pass through causing hyperpolarisation, making it less likely that a neurone will fire an action potential

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18
Q

Give some examples of benzodiazepines?

A

Lorazepam, diazepam, chlordiazepoxide

19
Q

What are the pharmacological effects of benzodiazepines?

A

Reduce anxiety and aggression, muscle relaxant, anti-convulsant, hypnosis/sedation

20
Q

The choice of benzodiazepine drug is usually made based on what?

A

Duration of action

21
Q

Give some examples of uses of benzodiazepines?

A

Acute anxiety, delirium, mania, alcohol withdrawal, status epilepticus

22
Q

Are benzodiazepines safe in overdose?

A

Yes, fairly

23
Q

What is the antagonist which can be used in a benzodiazepine overdose?

A

Flumazenil

24
Q

What are some downsides to the use of benzodiazepines?

A

Paradoxically can cause aggression, anterograde amnesia and impaired co-ordination as well as tolerance and dependence

25
Q

Name some symptoms which may be seen in benzodiazepine withdrawal?

A

Increased anxiety and depression, abdominal cramps, insomnia, dizziness, blurred vision, headaches, N+V

26
Q

Benzodiazepine withdrawal can present similarly to what?

A

Delirium tremens

27
Q

What are the two main causes of benzodiazepine withdrawal?

A

Rapid withdrawal of the drug, neuroadaptation of GABA response

28
Q

What are some symptoms which may occur if a benzodiazepine is stopped suddenly?

A

Hypertension/tachycardia, confusion, psychosis, convulsions, sweating, agitation, tremor

29
Q

What causes neuroadaptation of the GABA response?

A

Chronic treatment with benzodiazepines decreases the response to GABA

30
Q

If you are wanting to withdraw a patient from lorazepam, what is the first step?

A

Change them to the equivalent dose of diazepam or chlordiazepoxide, and take them at night

31
Q

How should you reduce the dosage of benzodiazepines?

A

Reduce dose every 2-3 weeks, by 2-2.5mg

32
Q

What should you do if withdrawal symptoms occur while taking a patient off benzodiazepines?

A

Maintain the dose that you are on until symptoms resolve

33
Q

How long can it take to completely withdraw benzodiazepines?

A

4 weeks - 1 year

34
Q

What are some factors which can speed up the withdrawal of benzodiazepines?

A

If the person is an inpatient or if they haven’t been on it for too long

35
Q

What is the key neurotransmitter that innervates the amygdala?

A

Serotonin

36
Q

Why are anti-depressants useful in anxiety?

A

Many symptoms overlap - acutely, they cause increased extracellular serotonin, and chronically they have anti-anxiolytic properties

37
Q

SSRIs are useful in the treatment of which anxiety disorders?

A

GAD, panic disorders, OCD, PTSD, phobias

38
Q

When are tricyclics used in the treatment of anxiety disorders?

A

2nd line in OCD and panic disorder

39
Q

What SNRI is most likely to be used in anxiety? What anxiety disorder is this most likely to be used for?

A

Venlafaxine, GAD

40
Q

What anxiety disorder may an MAOI be used for?

A

Social anxiety

41
Q

What is pregabalin?

A

A Ca++ blocker, GABA enhancer

42
Q

When is pregabalin used in anxiety?

A

If unresponsive to other treatments

43
Q

When are beta blockers used in anxiety?

A

For somatic symptoms e.g. palpitations, tremor

Psychiatry (20 decks)

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