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Pharmacology > Anxiety management > Flashcards

Anxiety management Flashcards

1
Q

Generalized Anxiety Management

A
  • SSRIs (DOC) & Venlafaxine
  • Benzos - are used at the start to produce short-term relief while the AD take 2-4 weeks. Tapered over 4-12 weeks.
  • Buspirone (2nd line)
  • Hydroxyzine & Pregabalin ( Alternatives)
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2
Q

Panic Disorder Management

A
  • SSRI (DOC) OR TCA/ MAOI if SSRI is ineffective
  • Benzos- Concomitantly with AD or Monotherapy for acute relief
    NB: Alprazolam is widely used but may cause rebound anxiety, withdrawal syndrome & seizures
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3
Q

Social Anxiety Management

A
  • SSRI (DOC)
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4
Q

Obsessive Compulsive Disorder Management

A
  • Clomipramine
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
    NB: Add a BENZO or AP for highly anxious OCD pts.
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5
Q

Post-traumatic Stress Disorder Management

A
  • SSRI (DOC)
  • Venlafaxine, TCAs & MAOIs - more AE
  • Sertraline & Paroxetine (Acute management)

NB: Sertraline is also approved for long-term management

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6
Q

Performance Anxiety Management

A
  • B-blockers - Propranolol & Nadolol

AE: hypotension

NB: b-blockers w/ higher lipophilicity is used

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7
Q

Benzodiazepine MOA

A

Binds to the GABAa receptors –> Opens Cl channel –> Cl influx

  • +ve allosteric modulator –> Dec EC50
  • Inc. FREQUENCY of channel opening
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8
Q

GABAa receptor & the binding sites

A
  • A2B2y pentameric structure
  • GABA binding site = between adjacent A&B subunits
  • Benzo binding site = between adjacent A&Y subunits
    NB: Benzo receptors in the CNS are BZ1 & BZ2
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9
Q

Actions of Benzos

A
  • Anxiety management - Clonazepam, Lorazepam, Alprazolam & Diazepam
  • Sedative & hypnotic - Temazepam & Triazolam
  • Anticonvulsant - Clonazepam (epilepsy), Midazolam, Lorazepam & Diazepam ( Status epilepticus)
  • Muscle relaxant - Diazepam
  • Alcohol withdrawal
  • Anesthesia
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10
Q

Pharmacokinetics of Benzos

A
  • Onset of action= 30-60 mins (varying half-life)
  • Lipophilic
  • Rapidly & completely absorbed
  • Oral
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11
Q

Benzos (names) based on duration of action

A 
Long acting
- Clonazepam
- Diazepam
- Flurazepam
Intermediate acting
- Alprazolam
- Lorazepam
- Oxazepam
- Temazepam
Short acting
- Midazolam
- Triazolam
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12
Q

Metabolism of Benzos

A
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13
Q

Adverse effects of Benzos

A
  • Drowsiness & confusion
  • Ataxia
  • Cognitive impairment
  • Paradoxical effects (rare)- anxiety, irritability, hostility, rage, paranoia, depression & suicidal ideation
  • Dependence & withdrawal syndrome - Confusion, anxiety, agitation, restlessness, insomnia & tension
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14
Q

Benzo Overdose Management

A

FLUMAZENIL (Only Benzo receptor antagonist)

  • rapid onset & short duration (1hr)
  • reverse CNS depressant effects
  • blocks effects of Benzos & Z-drugs
  • may cause seizures if benzo was used for seizure control
  • may precipitate withdrawal syndrome
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15
Q

Barbiturates MOA

A
  • +ve GABAa receptor allosteric modulators
  • Inc. DURATION of Cl- channel opening
  • High dose - Directly activate Cl channels
  • Block Glutamate receptors
  • Inhibits voltage-activated Na & Ca channels
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16
Q

Actions of Barbituates

A

CNS depression
- Low dose - Sedation
- High dose - Hypnosis, Anesthesia, Coma & Death
RESP. depression
- Suppress the Hypoxic & Chemoreceptor response to CO2
ENZYME induction
- Induce P450 enzymes

17
Q

Uses of Barbituates

A
  • Anesthesia (short-acting barbiturates used IV)
    Anticonvulsants
  • Phenobarbital - Tonic-clonic seizures & Status epilepticus
    Phenobarbital & Thiopental - Status epilepticus
18
Q

Adverse effects of Barbiturates

A
  • Drowsiness & impaired concentration
  • Paradoxical excitement
  • Hypersensitivity
  • Hangover
  • Respiratory depression
  • Pain
  • Dependence & Severe withdrawal syndrome
  • Poisoning- severe Resp. & central CV depression
19
Q

Non-benzodiazepine Benzodiazepine Receptor Agonists (NBBRA)/ Z-Drugs (names)

A
  • Zolpidem
  • Zaleplon
  • Eszopiclone
20
Q

NBBRA/ Z-drugs MOA

A
  • +ve GABAa receptor modulator
  • Acts on BZ1
  • ONLY used as hypnotics
  • Little/ No tolerance & AEs - FLUMAZENIL reverses effects
21
Q

Uses of NBBRA

A 
Only approved for HYPNOTICS
INSOMNIA w/
- problems initiating sleep = Zolpidem
- problems of sleep onset & maintenance = Zolpidem ER
- short term management = Zaleplon
  • Minimal muscle relaxing & anti-convulsant effects
22
Q

Z-drugs properties (onset, DOA, HL & uses)

A
23
Q

Melatonin Receptor Agonists (Name & MOA)

A

RAMELTEON

  • MT1 & MT2 agonist
  • Can be used long term bc of minimal abuse potential
24
Q

Uses of Melatonin Receptor Agonist (Remelteon)

A

Insomnia characterized by difficulty with sleep onset

25
Q

Adverse effects of Melatonin Receptor Agonist

A
  • Dizziness
  • Somnolence
  • Fatigue
  • Endocrine changes
  • Dec in Testosterone
  • Inc in Prolactin
26
Q

Orexin Receptor Antagonist (names & MOA)

A

SUVOREXANT & LEMBOREXANT
- Dual OX1R & OX2R Receptor Antagonist (DORA)

NB: Orexin A & B promote wakefulness by activating OX1 & OX2

27
Q

Uses of Orexin Receptor Antagonist

A

Insomnia characterized by difficulties w/ sleep onset and/or sleep maintenance

28
Q

Adverse effects & Contraindications of Orexin Receptor Antagonist

A
  • Daytime somnolence
  • Worsening of depression/ Suicidal Ideation

Contraindicated in Narcolepsy

29
Q

Beta blockers (names, uses)

A

PROPRANOLOL

  • Dec autonomic symptoms of specific phobias
  • USED to control performance anxiety (stage fright)
30
Q

Anti-histaminic (names, class, uses)

A

Doxepin (TCA)

  • Insomnia w/ difficulty of sleep maintenance
  • H1 antagonism

Hydroxyzine

  • Symptomatic relief of anxiety
  • Antiemetic propertied

Diphenhydramine & Doxylamine (non-prescription)
- Mild types of insomnia

31
Q

5HT1A Partial Agonist (Name, uses, onset, MOA, interactions)

A

BUSPIRONE

  • Anxiety & GAD (2nd line)
  • ONLY anxiolytic properties
  • Onset = 2-3 weeks
  • MOA- same as Antidepressants
  • No interaction w/ alcohol or benzos or other sedative-hypnotics, rebound anxiety, withdrawal signs, dependence & less psychomotor impairment than BZ

Pharmacology (16 decks)

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