Anxiety drugs

Question 1

What main types of anxiety drugs are used

Answer 1

Beta blockers, benzos, pregablin and busipirone

Question 2

How do beta blockers work

Answer 2

Block B1 and B2 adrenoreceptors causing vasodilation of the coronary arteries and decreasing HR

Question 3

When are beta blockers used

Answer 3

Somatic symptoms e.g. palpitation and tremor

Question 4

Side effects of beta blockers

Answer 4

Tiredness, clod peripheries, HF, bradycardia, fatigue (CO (B1) and skeletal muscle perfusion (B2) in exercise are regulated by adrenoreceptor

Question 5

Give examples of benzodiazepines

Answer 5

Midazolam, lorazepam, oxazepam, alprazolam (xanax), diazepam (valium)

Question 6

How do benzodiazepines work

Answer 6

Increasing GABA-mediated inhibition

Question 7

Role of GABA in anxiety

Answer 7

Ethanol, neurosteroids and barbiturates all exhibit anxiolytic properties in humans and/or some animal tests of anxiety
Inverse BDZ agonists (beta-carbolines) have anxiogenic properties
Flumazenil (antagonist) can increase anxiety in non-anxious rats

Question 8

What are the pharmacological effects benzodiazepines

Answer 8

Reduce anxiety and aggression, sedation, muscle relaxation, anti-convulsant effect, anterograde amnesia

Question 9

Clinical uses of benzos

Answer 9

Acute treatment of extreme anxiety, hypnosis, alcohol withdrawal, mania, delirium (2nd line), rapid tranquilisation, status epilepticus

Question 10

Side effects of benzos

Answer 10

Paradoxical aggression, anterograde amnesia and impaired coordination, cause tolerance and dependence

Question 11

Withdrawal symptoms of benzos

Answer 11

Confusion, toxic psychosis, convulsions, insomnia, anxiety, loss of appetite and body weight, fine tremor, perspiration, tinnitus and perceptual disturbances

Question 12

How to withdraw from benzos

Answer 12

1) Transfer patient to equivalent daily dose of diazepam/chlordiazepoxide, preferably at night
2) Reduce dose every 2-3 weeks in steps of 2 or 2.5 mg, if withdrawal symptoms occur maintain this dose until symptom improve
3) Reduce dose further, if needed a smaller dose
4) Stop completely

Question 13

How long is the max use of benzos

Answer 13

4 weeks

Question 14

How does pregablin work

Answer 14

Calcium channel blocker and GABA enhancer

Question 15

When is pregablin considered

Answer 15

Only considered if no response to other treatment and also is used for peripheral and central neuropathy

Question 16

Side effects of pregablin

Answer 16

Appetite changes, blurred vision, confusion, constipation, diplopia, muscle control disturbance, loads of side effects

Question 17

How does buspirone work

Answer 17

5-HT1A receptor partial antagonist at the D1, 2 and 4 receptors, partial alpha1 receptor antagonism, overall suppresses serotenergic while noradrenergic and dopaminergic cell firing is enhances

Question 18

When is buspirone used

Answer 18

Sometimes prescribed with SSRIs in order to modify libido effects
Anxiety short term use

Question 19

Side effects of buspirone

Answer 19

Diziness, excitement, headache, nausea, nervousness

Question 20

When is buspirone contraindicated

Answer 20

Epilepsy