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Neuro 4 Mine > Anxiety/PTST/OCD/Sedatives > Flashcards

Anxiety/PTST/OCD/Sedatives Flashcards

1
Q

Pharmacotherapy for Social Anxiety Disorder

A
  1. SSRIs or SNRIs for generalized SAD
  2. beta block or high potency BZDs for nongeneralized SAD
  3. CBT, group therapy
    - also buspirone (5HT1A partial agonist)
    - barbiturates (rarely used)
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2
Q

Pharmacotherapy for Panic Disorder

A
  • acute panic attack: BDZ
  • mild/mod sx: antidepressants (SSRIs, BDZs, TCADs and MAOIs) or CBT
  • sever sx: antidepressants and CBT
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3
Q

Pharmacotherapy for OCD

A
  • CBT most effective
  • SSRIs
  • SNRIs
  • severe sx: antidepressants and CBT
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4
Q

Pharmacotherapy for PTSD

A
  • CBT
  • SSRIs
  • SNRIs
  • severe sx: antidepressants and CBT
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5
Q

Barbiturates for Anxiety

A
  • generally unsatisfactory

- many side effects

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6
Q

Major Targets of Antianxiolytic Agents

A
  • 5HT (SSRIs, SNRIs, buspirone)

- GABA (benzos, barbs)

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7
Q

Antidepressants (for anxiety)

A
  • targets 5HT
  • SSRIs, SNRIs (first line med tx)
  • 1st line agents for most anxiety disorders
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8
Q

Benzodiazapenes: target, uses, MOA, overdose

A

Benzodiazapenes: target, uses, MOA, overdose

  • targets a1 and a2-5 of GABA (presence of GABA required for BDZ effect)
  • used as anxiolytic and anticonvulsant
  • declining use due to abuse potential (lethal with EtOH)
  • used in acute and situational anxiety
  • MOA: enhance Cl channel opening only in presence of GABA
  • administration of flumazenil (romazicon) will reverse toxicities associated with an overdose
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9
Q

Barbiturates: target, MOA, overdose

A
  • targets GABA for inc, also dec. Glu (why you can use as general anesthetic) , higher doses no GABA required + inhibition of excitatory NTs
  • rarely used for anxiety
  • low safety margin- drug interaction, high abuse potential
  • MOA: prolong Cl channel opening in presence of GABA and at higher doses open channel directly
  • in case of overdose, give supportive therapy (vitamin thiamine B1)
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10
Q

Effects of Benzodiazapines

A
  • muscle relaxation
  • hypnosis (sleep)
  • anesthesia
  • tolerance and dependence (physical dependence and withdrawal syndrome)
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11
Q

Benzodiazapine Absorption and Distribution

A
  • absorption: oral, IM,
  • distribution: very lipid soluble and enter rapidly, rapid redistribution out of brain into other tissues can terminate CNS effects of single dose
  • if begin with L or O, use glucuronidation metabolic pathway and are best for pts with liver disease or elderly
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12
Q

Benzodiazapine Adverse Reactions

A
  • very low risk
  • most common ADRs are extension of CNS depression
  • CNS effects more likely as age of pt inc.
  • EtOH is contraindicated
  • can exacerbate breathing problems in pts with COPD and symptomatic sleep apnea
  • anterograde amnesia (rohypnol)
  • psychologic and physiologic dependence
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13
Q

Alprazolam

A
  • benzodiazepine agonist (GABA Cl- channel)
  • xanax
  • sedative
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14
Q

Flurazepam

A
  • benzodiazepine agonist (GABA Cl- channel)
  • sedative
  • long half life + active metabolite
  • can accumulate in elderly
  • daytime sedation (hangover)/overdose is issue
  • impaired hepatic clearance
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15
Q

Diazapam

A
  • benzodiazaepine agonist (GABA Cl- channel)
  • valium
  • sedative
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16
Q

Oxazepam

A
  • benzodiazdpine agonist (GABA Cl- channel)

- sedative

17
Q

Triazolam

A
  • benzodiazepine agonist (GABA Cl- channel)
  • sedative
  • short half life
  • rebound insomnia next day due to rapid elimination, less daytime sedation
  • anterograde amnesia worse than with temazepam
  • dependance
18
Q

Lorazepam

A
  • ativan
  • benzodiazepine agonist (GABA Cl- channel)
  • sedative
19
Q

Midazolam

A
  • versed
  • benzodiazepine agonist (GABA Cl- channel)
  • sedative
20
Q

Zolpidem

A
  • non-benzodiazepine benzodiazepine agonist (GABA Cl- channel)
  • ambien, ambien CR
  • sedative
21
Q

Eszopiclone

A
  • non-benzodiazepine benzodiazepine agonist (GABA Cl- channel)
  • lunesta
  • sedative
22
Q

Zaleplon

A
  • non-benzodiazepine benzodiazepine agonist (GABA Cl- channel)
  • sonata
  • sedative
23
Q

Phenobarbital

A
  • barbiturate (GABA Cl- channel)

- sedative

24
Q

Remelteon

A
  • Melatonin receptor agonist

- sedative

25
Q

Diphenhydramine

A
  • benadryl

- sedative

26
Q

Flumazenil

A
  • benzodiazepine receptor antagonist
  • used in tx of BDZ overdose toxicity
  • not effective for BARB or EtOH toxicity
27
Q

Panic Disorder

A
  • sudden overwhelming episodes of anxiety that include both somatic and psychic elements
  • female:male = 2:1
  • age of onset= typically early adulthood
28
Q

Generalized Anxiety Disorder

A
  • excessive worry and more generalized somatic sxs of anxiety
  • ~75-90% comorbid with other psychiatric disorders (most commonly depression)
  • female:male = 2:1
29
Q

Tx for Generalized Anxiety Disorder

A
  • CBT
  • BDZs
  • buspirone
  • TCAs
  • MAOIs
  • SNRIs
  • SSRIs
30
Q

Social Phobia

A
  • overwhelming anxiety in social situations

- most common anxiety disorder

31
Q

OCD Etiology

A
  • negative feedback loop dysfunction
  • highly comorbid with tourettes
  • basal ganglia
32
Q

Buspirone

A
  • anxyolitic
  • 5HT1A partial agonist- not a BDZ
  • no potentiation of EtOH intoxication
  • no sedating action or drowsiness
  • no appreciable dependence liability
  • requires 2 weeks for onset of anxiolytic effect and 4-6 weeks for maximal efficacy
33
Q

Temazolam

A
  • intermediate half life

- BDZ

Neuro 4 Mine (14 decks)

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