Anxiety Disorders - Pharmacology

Question 1

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

Answer 1

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

Question 2

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

Answer 2

Short term only, < 2 weeks

Question 3

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

Answer 3

Propranolol

Question 4

What drug class is the mainstay of treatment for anxiety?

Answer 4

Anti-depressants

Question 5

What are the two core features of anxiety?

Answer 5

Fear and worry

Question 6

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

Answer 6

Phobias and panic disorder

Question 7

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

Answer 7

GAD and OCD

Question 8

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

Answer 8

Fear

Question 9

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

Answer 9

Worry

Question 10

What is GABA?

Answer 10

The main inhibitory neurotransmitter in the brain

Question 11

What is the role of GABA?

Answer 11

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

Question 12

What is the role of a benzodiazepine?

Answer 12

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

Question 13

Which GABA receptor is the target of benzodiazepines?

Answer 13

GABA-A

Question 14

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

Answer 14

Benzodiazepines, barbiturates and alcohol

Question 15

Where do benzodiazepines bind to GABA-A receptors?

Answer 15

At a site which is separate from the GABA binding site

Question 16

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

Answer 16

Positive allosteric effect

Question 17

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

Answer 17

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

Question 18

Give some examples of benzodiazepines?

Answer 18

Lorazepam, diazepam, chlordiazepoxide

Question 19

What are the pharmacological effects of benzodiazepines?

Answer 19

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

Question 20

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

Answer 20

Duration of action

Question 21

Give some examples of uses of benzodiazepines?

Answer 21

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

Question 22

Are benzodiazepines safe in overdose?

Answer 22

Yes, fairly

Question 23

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

Answer 23

Flumazenil

Question 24

What are some downsides to the use of benzodiazepines?

Answer 24

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

Question 25

Name some symptoms which may be seen in benzodiazepine withdrawal?

Answer 25

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

Question 26

Benzodiazepine withdrawal can present similarly to what?

Answer 26

Delirium tremens

Question 27

What are the two main causes of benzodiazepine withdrawal?

Answer 27

Rapid withdrawal of the drug, neuroadaptation of GABA response

Question 28

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

Answer 28

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

Question 29

What causes neuroadaptation of the GABA response?

Answer 29

Chronic treatment with benzodiazepines decreases the response to GABA

Question 30

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

Answer 30

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

Question 31

How should you reduce the dosage of benzodiazepines?

Answer 31

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

Question 32

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

Answer 32

Maintain the dose that you are on until symptoms resolve

Question 33

How long can it take to completely withdraw benzodiazepines?

Answer 33

4 weeks - 1 year

Question 34

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

Answer 34

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

Question 35

What is the key neurotransmitter that innervates the amygdala?

Answer 35

Serotonin

Question 36

Why are anti-depressants useful in anxiety?

Answer 36

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

Question 37

SSRIs are useful in the treatment of which anxiety disorders?

Answer 37

GAD, panic disorders, OCD, PTSD, phobias

Question 38

When are tricyclics used in the treatment of anxiety disorders?

Answer 38

2nd line in OCD and panic disorder

Question 39

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

Answer 39

Venlafaxine, GAD

Question 40

What anxiety disorder may an MAOI be used for?

Answer 40

Social anxiety

Question 41

What is pregabalin?

Answer 41

A Ca++ blocker, GABA enhancer

Question 42

When is pregabalin used in anxiety?

Answer 42

If unresponsive to other treatments

Question 43

When are beta blockers used in anxiety?

Answer 43

For somatic symptoms e.g. palpitations, tremor