anxiolytics Flashcards
1
Q
Anxiety Disorders Based on DSM-5
A
- Generalized Anxiety Disorder (GAD)
- Panic Disorder (PD)
- Social Anxiety Disorder (SAD)
- Other
2
Q
Disease Overlap mdd and anxiety
A
5HT Common Link
3
Q
Generalized Anxiety Disorder symptoms
A
- Excessive anxiety or worry
- Muscle tension
- Restlessness
- Fatigue
- Impaired Concentration
- Irritability
- Insomnia
4
Q
Panic Disorder symptoms
A
- Recurrent unprovoked panic attacks
– Shortness of breath
– Dizziness or faintness
– Palpitations
– Sweating
– Trembling or shaking
– Nausea
– Dizziness
– Paresthesias
– Hot flashes or chills
– Chest pain
– Feelings of choking
– Discomfort or fear
can lead to agoraphobia
5
Q
Social Anxiety Disorder symptoms
A
Fear or anxiety about social situations
– Concern regarding scrutiny
from others
– Concern regarding
humiliation
embarrassment
– Fear of rejection
– Concern regarding
offending others
earliest onset
6
Q
1st line tx of GAD
A
SSRI, SNRI, pregabalin
BZD short term
7
Q
1st line panic disorder
A
SSRI and SNRI
BZD short term
8
Q
SAD 1st line tx
A
SSRI
9
Q
Side Effects Important in Dentistry
(SSRI)
A
- Increased risk for
bleeding and bruising - Bruxism
10
Q
SSRI Drug Interaction with NSAID
A
Pharmacodynamic interactions
– SSRI – decrease platelet aggregation
* INCREASED RISK FOR BLEEDING
11
Q
SSRI Drug Interactions with Opioid Medications
A
- Pharmacokinetic interaction
- Drugs that INHIBIT CYP450 2D6
PREVENT the metabolism of
codeine, hydrocodone and
oxycodone to an active medication. - OUTCOME: pain relieving effects
are REDUCED - Antidepressants
– Paroxetine (Paxil)
– Fluoxetine (Prozac)
(codeine, hydrocodone and oxycodone)
12
Q
Pregabalin (Lyrica) and Gabapentin
(Neurontin) strucutre
A
affect GABA
13
Q
Pregabalin moa
A
affect GABA receptor, likely increase GABA but unknown
technically unknown
14
Q
Pregabalin
* FDA approved uses
A
- FDA approved uses include postherpetic neuralgia, neuropathic pain due to diabetic peripheral neuropathy and spinal cord injury, seizures, and fibromyalgi
15
Q
pregabalin first line for?
A
GAD
16
Q
pregabalin common side effects
A
Common side effects: dizziness, sedation, ataxia, blurred vision, and weight gain
] No life-threatening side effects
17
Q
pregabalin oral effects?
A
none
18
Q
pregabalin OD
A
safe
19
Q
Pregabalin interactions
A
none
20
Q
Gabapentin
* FDA approved uses?
* Used off-label ?
* Limited evidence ?
A
- FDA approved uses include postherpetic neuralgia and seizures
- Used off-label for anxiety – both scheduled and prn
- Limited evidence for use in anxiety
21
Q
gabapentin moa
A
unknown
22
Q
gabapentin common side effects?
A
- Common Side Effects
– Dizziness, sedation and ataxia - No life-threatening side effects
23
Q
gabapentin oral effects
A
none
24
Q
gabapentin OD
A
safe
25
# gabapentin interactions
none
26
Buspirone (Buspar)
* Mechanism of Action
– 5-HT1A partial agonist
stablize 5ht levels (increase in low areas and decrease where too high)
27
Buspirone (Buspar)
* Uses
– FDA approval for GAD (not recommend as first line therapy)
– Used as adjunctive therapy with an antidepressant for treatment refractory depression
28
Buspirone:
*abuse/withdraw?
* Onset of action ?
* OD
* ddi
* NO abuse or withdrawal potential
* Onset of action 4-6 weeks
* Safe in overdose situations
* Low risk for drug interactions
29
Buspirone Side Effects
* Generally well tolerated
– GI complaints
– Sedation
– Insomnia
– Agitation
– Headache
– Weakness
– Dizziness
– No serious side effects
– No oral side effects
30
Role of Benzodiazepines (BZD) in the Treatment of Anxiety Disorders and Other Conditions
* Common Uses
– Panic attacks (acute treatment only - NOT panic disorder)
– Anxiety (short-term treatment only)
– Seizures
– Insomnia
– Muscle relaxant
– Acute alcohol withdrawal
– Acute mania
– Acute agitation
prn night before procedures
31
BZD moa
binds GABA A= increases Cl
| agonist
32
what substances can affect GABA-A
33
GABA agonists effects
* anxiolytic
* sedative hypnotic
* muscle relaxant
* anticonvulsant
* amnestic
* dependency
| BZDs
34
GABA partial agonists effects
anxiolytic
only
35
GABA antagonists effects
none
36
GABA partial inverse agonist effects
promnestic (memory enhancing)
anxiogenic
37
# GABA inverse agonist effect
promnestic
anxiogenic
pro-convulsant
38
Midazolam (Versed)
* onset
* duration
* use
Rapid
Ultrashort
Anesthetic
39
Triazolam (Halcion)
* onset
* duration
* use
Rapid
Ultrashort
Hypnotic
40
Alprazolam (Xanax)
* onset
* duration
* use
Rapid
Short
Anxiolytic
41
Diazepam (Valium)
* onset
* duration
* use
Rapid
Long
Anxiolytic, Muscle relaxant, ETOH withdrawal, Anticonvulsant
42
Lorazepam (Ativan)
* onset
* duration
* use
Intermediate
Medium
Anxiolytic, Hypnotic, ETOH withdrawal,
Anticonvulsant
43
BZD Side Effects
Common
* Drowsiness
* Sedation
* Psychomotor impairment
* Blurred vision
* Ataxia
* Daytime sedation
* Impairment in memory and recall
| like being drunk
44
BZD Side Effects
Less Common
* Disorientation
* Aggression
* Confusion
* Paradoxical Excitation
45
BZD oral Side Effects
none
46
BZD with CNS depressants
Synergistic effect with other CNS depressants
– Alcohol
– TCA
– Barbiturates
– Pain Medication (Opioids/Opiates)
47
what is depressed in BZD OD
CNS and respiratory depression in overdose
48
BZD ddi
Risk for pharmacokinetic and pharmacodynamic
drug interactions
49
BZD tolerance
Tolerance develops to sedative/hypnotic effect
– Tolerance does NOT develop for other uses
* anticonvulsant, anxiolytic, muscle relaxant
50
BZD Abuse
* All benzodiazepines have the potential for?
* Benzodiazepines with what property are more likely to be abused? likely agents?
* Use with caution in patients with a history of?
* Use with extreme caution in combination with??
* All benzodiazepines have the potential for abuse
* Benzodiazepines with a “quick” onset of action are more likely to be abused
– **alprazolam, diazepam**
* Use with caution in patients with a history of substance abuse, can develop dependence
* Use with extreme caution in combination with pain medications (opioids)
51
Drug Interactions with BZD
* BZD + CNS Depressants (ex. opioid pain medication) = additive CNS depressant effects
52
Propranolol (Inderal)
* FDA approved uses
* FDA approved uses include HTN, angina pectoris, atria; fibrillation, myocardial infarction, migraine prophylaxis, essential tremor, hypertrophic subaortic stenosis, pheochromocytoma
53
Propranolol (Inderal) off label use
Used off-label for
“performance” anxiety
54
Propranolol moa
nonselective beta-
adrenergic receptor
blocking agent
55
Propranolol common side effects
* Dizziness, weakness and
fatigue
* No life-threatening side
effects
56
propranolol oral effects
none
57
propranolol od
Overdose –
hypotension and
bradycardia
58
propranolol ddi
High risk for drug
interactions
59
which BZD has a long duration
diazepam
60
which BZD has an intermediate onset
lorazepam
