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Advanced Pharmacology > Anxiolytics > Flashcards

Anxiolytics Flashcards

1
Q

____ is an emotional state caused by the perception of real or potential danger that threatens the security of the individual

A

Anxiety

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2
Q

What are some symptoms of anxiety?

A

-Heart pounds
-Butterflies in stomach
-Shaking
-Trembling
-Sweating

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3
Q

An ___ ___ connotes significant distress and dysfunction due to the anxiety

A

Anxiety disorder

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4
Q

Usually, the anxiety response is usually reasonable with a build-in control mechanism to return to a normal ____ ____

A

Physiological state

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5
Q

What are some examples of anxiety disorders?

A

-General anxiety disorder
-Panic (with or without agoraphobia)
-Phobia (social and/or specific)
-Obsessive-compulsive
-PTSD

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6
Q

____ ____ disorder causes people to worry about numerous events/activities

A

Generalized anxiety

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7
Q

General anxiety disorder is diagnosed if someone has ___ months of persistent symptoms

A

6

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8
Q

____ disorders cause intense feelings or fear of discomfort

A

Panic

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9
Q

Panic disorders cause spontaneous attacks that last ___-___ minutes

A

20-30

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10
Q

____ is anxiety about being in places or situations from which escape might b difficult or embarrassing or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms

A

Agoraphobia

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11
Q

Agoraphobic fears typically involve characteristic clusters of situations that include being…

A

-Outside the home alone
-Being in a crowd or standing in a line
-Being on a bridge
-Traveling on a bus, train, or automobile,

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12
Q

____% of the population has an anxiety disorder

A

25

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13
Q

___ ___ are the most common anxiety disorder, with a 12-month prevalence of 8.7%

A

Specific phobias

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14
Q

The one year prevalence of generalized anxiety disorder is ____%

A

3.1

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15
Q

The one year prevalence of panic disorder is ____%

A

2.7

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16
Q

The one year prevalence of social anxiety disorder is ___%

A

6.8

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17
Q

Anxiety disorders are more common in what gender (2:1)?

A

Females

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18
Q

Anxiety disorders are also more common in those with family history of ____ and ____

A

Anxiety and depression

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19
Q

Anxiety disorders are commonly co-morbid with other disease states like…

A

-Major depression
-Schizophrenia
-Mood disorder
-Alcohol and drug abuse

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20
Q

Anxiety disorders generally develop before age ____

A

30

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21
Q

What medical diseases can cause anxiety?

A

-Anemia
-Hyperthyroidism
-Pain
-Asthma

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22
Q

Knowledge of ones ____ (cancer, diabetes) can also trigger and complicate therapy for anxiety

A

Illness

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23
Q

What psychiatric diseases can present with anxiety?

A

-Mood disorders
-Schizophrenia
-Delirium

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24
Q

Most patients will have ____ or more psychiatric disorders within a lifetime

A

2

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25
Q

What types of drugs can induce anxiety?

A

-Stimulants
-CNS depressant withdrawal (Benzodiazepines)
-Antipsychotics
-SSRIs

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26
Q

Anxiety mimics symptoms of other medical conditions like…

A

-Palpitations
-Tachycardia
-Chest pain
-Short of breath
-Hyperventilation

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27
Q

What are examples of stimulants that might cause anxiety?

A

-Albuterol
-Cocaine
-Amphetamines
-Pseudoephedrine

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28
Q

What are two things in the diet that may cause anxiety?

A

-MSG (Chinese restaurant syndrome)
-Caffeine

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29
Q

Multiple brain structures and multiple _____ are involved in the modulation of anxiety

A

Neurotransmitters

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30
Q

Anxiety may be cause by neurochemical abnormalities with things like…

A

-Norepinephrine
-Serotonin
-GABA
-Corticotrophin-releasing factor
-Cholesystokinin

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31
Q

Genetics can play a role in development of anxiety disorders, as well as environmental factors like…

A

-Abusive environments
-PTSD

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32
Q

The medications we use for anxiety exert their actions on different parts of the brain and effect different ____

A

Neurotransmitters

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33
Q

Too much ____ release in response to stress can dampen the negative feedback over time, leading to symptoms of anxiety

A

Norepinephrine

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34
Q

_____ has no definitive role in anxiety, but it appears to be involved

A

Serotonin

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35
Q

____ is a major inhibitory neurotransmitter that regulates norepinephrine and serotonin systems; it can decrease nerve excitability

A

GABA

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36
Q

What are treatment goals for anxiety disorders?

A

-Decrease anxiety and improve adaptive functioning
-Prevent secondary medical or psychiatric disorder
-Minimize adverse effects of medication
-Prevent relapse/recurrence

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37
Q

Non-pharmacological treatments of anxiety include…

A

-Identifying the source of anxiety
-Assessing factors which may contribute to anxiety (diet, medications, etc)
-Behavioral modication

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38
Q

What are examples of behavioral modifications for treating anxiety?

A

-Cognitive behavioral therapy
-Stress/time management
-Psychotherapy
-Meditative/relaxation techniques
-Exercise

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39
Q

The primary non-pharmacological treatment for anxiety is one-on-one ____

A

Therapy

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40
Q

What are 4 classes of drugs that are commonly prescribed for the treatment of anxiety disorders?

A

-Benzodiazepines
-Buspirone (Buspar)
-Antidepressants
-Beta-blockers

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41
Q

What are two examples of Benzodiazepines?

A

-Ativan
-Valium

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42
Q

What are three antidepressants commonly prescribed for anxiety?

A

-TCAs (amitriptyline)
-SSRI (Lexapro, Paxil)
-Venlafaxine (Effexor XR)

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43
Q

What is an examples of a Beta-blocker prescribed for anxiety?

A

Propranolol (Inderal)

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44
Q

____ is a drug that is not approved for use in anxiety disorders

A

Wellbutrin

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45
Q

_____ are used adjunctively (though not FDA approved) to treat anxiety disorders (this includes Depakote, Topamax, Lamictal, and Neurontin)

A

Anticonvulsants

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46
Q

____ (Atarax, Vistaril) is an antihistamine/anticholinergic that causes sedation and can be used for anxiety disorders

A

Hydroxyzine

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47
Q

Hydroxyzine can also be used as an ____ for itching

A

Antipruitic

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48
Q

What are two examples of non-prescription pharmacological treatments of anxiety?

A

-Diphenhydramine (Benadryl) - sedative/antihistamine
-Ethanol (the oldest anxiety “remedy”)

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49
Q

Benzodiazepines are widely used in the treatment of anxiety, but are also used for…

A

-Insomnia
-Skeletal muscle spasm and spasticity
-Alcohol withdrawal
-Certain convulsive disorders
-Preanesthetic in procedures such as endoscopy, bronchoscopy, and cardioversion

50
Q

What are commonly used benzodiazepines in the United States?

A

-Chlordiazepoxide (Librium)
-Lorazepam (Ativan)
-Diazepam (Valium)
-Oxazepam (Serax)
-Alprazolam (Xanax)
-Clorazepate (Tranxene)
-Triazolam (Halcion)

51
Q

What is the mechanism of action of benzodiazepines?

A

-They bind to GABA-RC and facilitate GABA binding to the receptor
-They intensify GABA-induced chloride conductance (hyperpolarization)
-Cause decreased neuronal firing (CNS depression)

52
Q

What are some clinical considerations with benzodiazepines?

A

-Dose requirements vary widely among patients
-Relatively high therapeutic index
-Issues of tolerance, dependence, and withdrawal
-May want to avoid if alcohol abuse is suspected
-Use Benzodiazepines with caution in the elderly, particularly drugs with long half-lives

53
Q

Benzodiazepines are usually well tolerated and have minimal effects on…

A

-Blood pressure
-Heart rate

54
Q

Some side effects that may be caused by benzodiazepines include…

A

-Sedation
-Psychomotor and memory impairment
-Nightmares (rare)

55
Q

Benzodiazepines may cause a paradoxical reaction where someone has symptoms like…

A

-Excitement
-Agitation
-Confusion

56
Q

With Benzodiazepines, tolerance builds to sedation, muscle relaxant, and anticonvulsant activities but not to ____ and ___ efficacy

A

Anxiolytic and anti-panic

57
Q

The risk of dependence/withdrawal with benzodiazepines is low if there is no history of _____ _____

A

Substance abuse

58
Q

The risk of dependence/withdrawal with benzodiazepines is high if there is a history of ___ ___ and/or a diagnosis of a ___ ___

A

Alcohol abuse; personality disorder

59
Q

Benzodiazepine withdrawal symptoms can be seen within ___-___ days from a short-acting agent or ___-___ days if using a long-acting agent

A

1-2; 5-10

60
Q

What are symptoms of benzodiazepine withdrawal?

A

-Anxiety (rebound)
-Agitation
-Restlessness
-Fatigue
-Headache
-Sweating
-Irritability
-Delusions
-Hallucinations
-Seizures

61
Q

If discontinuing benzodiazepines, ____ the dose down over several weeks

A

Taper

62
Q

Benzodiazepine withdrawal should be minimum if the patient was on the medication for less than ___ months

A

6

63
Q

Usually, a good rule of thumb is decreasing the benzodiazepine dose by ____% each week to discontinue the drug

A

10

64
Q

What are examples of long-acting benzodiazepines?

A

-Clorazepate
-Flurazepam
-Chlordiazepoxide
-Diazepam

65
Q

What are examples of long-acting benzodiazepines?

A

-Clorazopate
-Flurazepam
-Chloridiazepoxide
-Diazepam

66
Q

What are examples of short/intermediate-acting benzodiazepines?

A

-Alprazolam
-Lorazopam
-Oxazepam
-Tempazepam
-Estazolam
-Triazolam

67
Q

Alprazolam has a half-life of ___-___ hours

A

6-20

68
Q

Lorazepam has a half-life of ____-____ hours

A

10-20

69
Q

Oxazepam has a half-life of ___-___ hours

A

5-15

70
Q

Temazepam has a half-life of ___-___ hours

A

10-20

71
Q

Estazolam has a half-life of ___-___ hours

A

10-24

72
Q

Triazolam has the shortest half-life of ___-___ hours

A

1.5-5

73
Q

_____ is the oldest benzodiazepine and is used for alcohol withdrawal

A

Chlodiazepoxide (Librium)

74
Q

_____ is widely used to treat anxiety due to the rapid onset of the effect

A

Diazepam (Valium)

75
Q

Oxazepam (Serax) has a ___ absorption and ____ duration

A

Slow; short

76
Q

Oxazepam (Serax) is used for…

A

-Elderly or patients with hepatic disease
-Alcohol withdrawal

77
Q

____ has the most potent anti-anxiety effects

A

Alprazolam (Xanax)

78
Q

____ is an example of a Benzodiazepine antagonist

A

Flumazenil (Romazicon)

79
Q

Flumazenil (Romazicon) has a high ____ for benzodiazepine receptors, but lacks efficacy

A

Affinity

80
Q

___-___ mg of Flumazenil (Romazicon) can be given intravenously to reverse benzodiazepine effects

A

0.2-0.3

81
Q

Benzodiazepines have no effect on ____

A

Barbiturates

82
Q

Buspirone (Buspar) has been approved by the FDA for use in ___ ___ ___

A

Generalized anxiety disorder

83
Q

The structure and mechanism of Buspirone (Buspar) differs from ____

A

Benzodiazepines

84
Q

Mechanism of action of Buspirone (Buspar):

A

-5-HT1A (serotonin) receptors involved in fear and anxiety
-Partial (weak) agonist of 5-HT1A (serotonin) receptors

85
Q

The anxiolytic effect of Buspirone (Buspar) takes ____, versus days with benzodiazepines

A

Weeks

86
Q

Buspirone also has some _____ effect

A

Antidepressant

87
Q

Buspar does not work, however, for ____ disorder

A

Panic

88
Q

Buspirone (Buspar) is non-____ and also non-addicting

A

Sedating

89
Q

Buspirone (Buspar) is not effective as a _____

A

Hypnotic

90
Q

Buspirone (Buspar) has no _____ activity

A

Anticonvulsant

91
Q

What is the standard initial dose of Buspirone (Buspar)?

A

-5-7.5 mg orally two times per day
-Titrate (increase) 5 mg every 2-3 days

92
Q

What is the average dose range of Buspirone?

A

-20-30 mg/day (usually split into two to three doses per day)
-Max of 60 mg/day

93
Q

Buspirone is effective within ___-___ weeks, with maximum relief at 6 weeks (2-4 weeks for full effect)

A

1-2

94
Q

Buspirone is not for ____ use, but we can supplement benzodiazepines if needed (works very well when benzodiazepines are prescribed on an “as needed basis” for anxiety

A

PRN

95
Q

What are some disadvantages of Buspirone (Buspar)?

A

-No anticonvulsant or muscle relaxant properties
-No immediate effect
-Not useful on an “as needed” basis
-Multiple dosing: two to three times per day

96
Q

What are some advantages of Buspirone (Buspar)?

A

-Low abuse/addiction potential
-Less sedation, motor impairment
-No additive effects with alcohol

97
Q

What is the mechanism of action for Venlafaxine (Effexor XR)?

A

-Potent inhibitor of serotonin and norepinephrine reuptake

98
Q

Only the ____ form of Venlafaxine is approved for generalized anxiety disorder

A

XR

99
Q

What are the doses of Venlafaxine (Effexor XR) capsules?

A

-37.5 mg
-75 mg
-150 mg

100
Q

Venlafaxine (Effexor XR) is dosed ____ per day

A

Once

101
Q

The initial starting dose for Venlafaxine (Effexor XR) is ___ mg XR

A

75

102
Q

We can increase the dose of Venlafaxine (Effexor XR) by ___ mg every 4-5 days

A

75

103
Q

The maximum recommended dose of Venlafaxine (Effexor XR) is ____ mg/day

A

225

104
Q

What are some common side effects of Venlafaxine (Effexor XR)?

A

-Nausea (37%)
-Headache (25%)
-Somnolence (23%)
-Dizziness (19%)
-Insomnia (18%)
-Constipation (15%)
-Nervousness (13%)
-Sweating (12%)
-Abnormal ejaculation (12%)
-Asthenia (12%)

105
Q

Possible drug interactions with Venlafaxine (Effexor XR):

A

Possible serotonin syndrome with an SSRI

106
Q

Symptoms of serotonin syndrome:

A

-Agitation
-Hyperthermia
-Neuromuscular disturbance
-Tachycardia

107
Q

What is an example of a beta-blocker used for anxiety?

A

Propranolol (Inderal)

108
Q

Propranolol (Inderal) is used for ____ anxiety (stage fright)

A

Acute

109
Q

Propranolol (Inderal) relieves _____ symptoms such as rapid heartbeat

A

Autonomic

110
Q

Beta-blockers like Propranolol (Inderal) are used ____ with benzodiazepines

A

Adjunctive

111
Q

Propranolol (Inderal) can be given in a ___-___ mg dose 1-2 hours prior to a stressful event

A

10-60

112
Q

Propranolol (Inderal) can also be given in ___-___ mg doses every day for maintenance

A

80-160

113
Q

What are three types of antidepressants that can be used for anxiety?

A

-TCA (Imipramine)
-SSRI (first-line therapy for OCD, GAD)
-Duloxetine (Cymbalta)

114
Q

TCA should be given at ____

A

Bedtime

115
Q

The anticholinergic side effects of TCA limit its use; these include:

A

-Dry mouth
-Constipation
-Cardiac abnormalities
-Arrhythmias

116
Q

Duloxetine (Cymbalta) has similar effects to ____

A

Venlafaxine (Effexor XR)

117
Q

Vistaril (hydroxyzine pamoate) has been approved for ____/____

A

Anxiety/tension

118
Q

Vistaril (hydroxyzine pamoate) is given as ___-___ mg per dose

A

25-100 mg

119
Q

Vistaril (hydroxyzine pamoate) should be given at a max dose of ___ mg/day

A

600

120
Q

Vistaril has anxiety-relieving properties that are not related to its sedative effects; it may be related to certain ____ effects

A

Histaminergic

Advanced Pharmacology (10 decks)

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