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pharm 2 > anxiolytics > Flashcards

anxiolytics Flashcards

1
Q

Anxiety Disorders Based on DSM-5

A
  • Generalized Anxiety Disorder (GAD)
  • Panic Disorder (PD)
  • Social Anxiety Disorder (SAD)
  • Other
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2
Q

Disease Overlap mdd and anxiety

A

5HT Common Link

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3
Q

Generalized Anxiety Disorder symptoms

A
  • Excessive anxiety or worry
  • Muscle tension
  • Restlessness
  • Fatigue
  • Impaired Concentration
  • Irritability
  • Insomnia
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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

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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

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6
Q

1st line tx of GAD

A

SSRI, SNRI, pregabalin

BZD short term

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7
Q

1st line panic disorder

A

SSRI and SNRI

BZD short term

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8
Q

SAD 1st line tx

A

SSRI

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9
Q

Side Effects Important in Dentistry
(SSRI)

A
  • Increased risk for
    bleeding and bruising
  • Bruxism
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10
Q

SSRI Drug Interaction with NSAID

A

Pharmacodynamic interactions
– SSRI – decrease platelet aggregation
* INCREASED RISK FOR BLEEDING

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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)

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12
Q

Pregabalin (Lyrica) and Gabapentin
(Neurontin) strucutre

A

affect GABA

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13
Q

Pregabalin moa

A

affect GABA receptor, likely increase GABA but unknown

technically unknown

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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
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15
Q

pregabalin first line for?

A

GAD

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16
Q

pregabalin common side effects

A

Common side effects: dizziness, sedation, ataxia, blurred vision, and weight gain
] No life-threatening side effects

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17
Q

pregabalin oral effects?

A

none

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18
Q

pregabalin OD

A

safe

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19
Q

Pregabalin interactions

A

none

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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
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21
Q

gabapentin moa

A

unknown

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22
Q

gabapentin common side effects?

A
  • Common Side Effects
    – Dizziness, sedation and ataxia
  • No life-threatening side effects
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23
Q

gabapentin oral effects

A

none

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24
Q

gabapentin OD

A

safe

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25
Q

gabapentin interactions

A

none

26
Q

Buspirone (Buspar)
* Mechanism of Action

A

– 5-HT1A partial agonist
stablize 5ht levels (increase in low areas and decrease where too high)

27
Q

Buspirone (Buspar)
* Uses

A

– FDA approval for GAD (not recommend as first line therapy)
– Used as adjunctive therapy with an antidepressant for treatment refractory depression

28
Q

Buspirone:
*abuse/withdraw?
* Onset of action ?
* OD
* ddi

A
  • NO abuse or withdrawal potential
  • Onset of action 4-6 weeks
  • Safe in overdose situations
  • Low risk for drug interactions
29
Q

Buspirone Side Effects

A
  • Generally well tolerated
    – GI complaints
    – Sedation
    – Insomnia
    – Agitation
    – Headache
    – Weakness
    – Dizziness
    – No serious side effects
    – No oral side effects
30
Q

Role of Benzodiazepines (BZD) in the Treatment of Anxiety Disorders and Other Conditions
* Common Uses

A

– 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
Q

BZD moa

A

binds GABA A= increases Cl

agonist

32
Q

what substances can affect GABA-A

A
33
Q

GABA agonists effects

A
  • anxiolytic
  • sedative hypnotic
  • muscle relaxant
  • anticonvulsant
  • amnestic
  • dependency

BZDs

34
Q

GABA partial agonists effects

A

anxiolytic
only

35
Q

GABA antagonists effects

A

none

36
Q

GABA partial inverse agonist effects

A

promnestic (memory enhancing)
anxiogenic

37
Q

GABA inverse agonist effect

A

promnestic
anxiogenic
pro-convulsant

38
Q

Midazolam (Versed)
* onset
* duration
* use

A

Rapid
Ultrashort
Anesthetic

39
Q

Triazolam (Halcion)
* onset
* duration
* use

A

Rapid
Ultrashort
Hypnotic

40
Q

Alprazolam (Xanax)
* onset
* duration
* use

A

Rapid
Short
Anxiolytic

41
Q

Diazepam (Valium)
* onset
* duration
* use

A

Rapid
Long
Anxiolytic, Muscle relaxant, ETOH withdrawal, Anticonvulsant

42
Q

Lorazepam (Ativan)
* onset
* duration
* use

A

Intermediate
Medium
Anxiolytic, Hypnotic, ETOH withdrawal,
Anticonvulsant

43
Q

BZD Side Effects
Common

A
  • Drowsiness
  • Sedation
  • Psychomotor impairment
  • Blurred vision
  • Ataxia
  • Daytime sedation
  • Impairment in memory and recall

like being drunk

44
Q

BZD Side Effects
Less Common

A
  • Disorientation
  • Aggression
  • Confusion
  • Paradoxical Excitation
45
Q

BZD oral Side Effects

A

none

46
Q

BZD with CNS depressants

A

Synergistic effect with other CNS depressants
– Alcohol
– TCA
– Barbiturates
– Pain Medication (Opioids/Opiates)

47
Q

what is depressed in BZD OD

A

CNS and respiratory depression in overdose

48
Q

BZD ddi

A

Risk for pharmacokinetic and pharmacodynamic
drug interactions

49
Q

BZD tolerance

A

Tolerance develops to sedative/hypnotic effect
– Tolerance does NOT develop for other uses
* anticonvulsant, anxiolytic, muscle relaxant

50
Q

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??

A
  • 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
Q

Drug Interactions with BZD

A
  • BZD + CNS Depressants (ex. opioid pain medication) = additive CNS depressant effects
52
Q

Propranolol (Inderal)
* FDA approved uses

A
  • FDA approved uses include HTN, angina pectoris, atria; fibrillation, myocardial infarction, migraine prophylaxis, essential tremor, hypertrophic subaortic stenosis, pheochromocytoma
53
Q

Propranolol (Inderal) off label use

A

Used off-label for
“performance” anxiety

54
Q

Propranolol moa

A

nonselective beta-
adrenergic receptor
blocking agent

55
Q

Propranolol common side effects

A
  • Dizziness, weakness and
    fatigue
  • No life-threatening side
    effects
56
Q

propranolol oral effects

A

none

57
Q

propranolol od

A

Overdose –
hypotension and
bradycardia

58
Q

propranolol ddi

A

High risk for drug
interactions

59
Q

which BZD has a long duration

A

diazepam

60
Q

which BZD has an intermediate onset

A

lorazepam

pharm 2 (20 decks)

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