Anxiety/PTST/OCD/Sedatives

Question 1

Pharmacotherapy for Social Anxiety Disorder

Answer 1

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)

Question 2

Pharmacotherapy for Panic Disorder

Answer 2

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

Question 3

Pharmacotherapy for OCD

Answer 3

• CBT most effective
• SSRIs
• SNRIs
• severe sx: antidepressants and CBT

Question 4

Pharmacotherapy for PTSD

Answer 4

• CBT
• SSRIs
• SNRIs
• severe sx: antidepressants and CBT

Question 5

Barbiturates for Anxiety

Answer 5

• generally unsatisfactory

- many side effects

Question 6

Major Targets of Antianxiolytic Agents

Answer 6

• 5HT (SSRIs, SNRIs, buspirone)

- GABA (benzos, barbs)

Question 7

Antidepressants (for anxiety)

Answer 7

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

Question 8

Benzodiazapenes: target, uses, MOA, overdose

Answer 8

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

Question 9

Barbiturates: target, MOA, overdose

Answer 9

• 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)

Question 10

Effects of Benzodiazapines

Answer 10

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

Question 11

Benzodiazapine Absorption and Distribution

Answer 11

• 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

Question 12

Benzodiazapine Adverse Reactions

Answer 12

• 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

Question 13

Alprazolam

Answer 13

• benzodiazepine agonist (GABA Cl- channel)
• xanax
• sedative

Question 14

Flurazepam

Answer 14

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

Question 15

Diazapam

Answer 15

• benzodiazaepine agonist (GABA Cl- channel)
• valium
• sedative

Question 16

Oxazepam

Answer 16

• benzodiazdpine agonist (GABA Cl- channel)

- sedative

Question 17

Triazolam

Answer 17

• 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

Question 18

Lorazepam

Answer 18

• ativan
• benzodiazepine agonist (GABA Cl- channel)
• sedative

Question 19

Midazolam

Answer 19

• versed
• benzodiazepine agonist (GABA Cl- channel)
• sedative

Question 20

Zolpidem

Answer 20

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

Question 21

Eszopiclone

Answer 21

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

Question 22

Zaleplon

Answer 22

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

Question 23

Phenobarbital

Answer 23

• barbiturate (GABA Cl- channel)

- sedative

Question 24

Remelteon

Answer 24

• Melatonin receptor agonist

- sedative

Question 25

Diphenhydramine

Answer 25

• benadryl

- sedative

Question 26

Flumazenil

Answer 26

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

Question 27

Panic Disorder

Answer 27

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

Question 28

Generalized Anxiety Disorder

Answer 28

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

Question 29

Tx for Generalized Anxiety Disorder

Answer 29

• CBT
• BDZs
• buspirone
• TCAs
• MAOIs
• SNRIs
• SSRIs

Question 30

Social Phobia

Answer 30

• overwhelming anxiety in social situations

- most common anxiety disorder

Question 31

OCD Etiology

Answer 31

• negative feedback loop dysfunction
• highly comorbid with tourettes
• basal ganglia

Question 32

Buspirone

Answer 32

• 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

Question 33

Temazolam

Answer 33

• intermediate half life

- BDZ