Anxiolytics Flashcards
Anxiety Disorders Based on DSM-5
(3)
* Other
(8)
- Generalized Anxiety Disorder (GAD)
- Panic Disorder (PD)
- Social Anxiety Disorder (SAD)
– Separation Anxiety Disorder
– Specific Phobia
– Selective Mutism
– Agoraphobia
– Substance/Medication-Induced Anxiety Disorder
– Anxiety Disorder Due to Another Medical Condition
– Other Specified Anxiety Disorder
– Unspecified Anxiety Disorder
Target Symptoms of Anxiety Disorders
Generalized Anxiety Disorder
(7)
- Excessive anxiety or worry
- Muscle tension
- Restlessness
- Fatigue
- Impaired Concentration
- Irritability
- Insomnia
Target Symptoms of Anxiety Disorders
Panic Disorder
* Recurrent 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
Target Symptoms of Anxiety Disorders
* Fear or anxiety about
social situations
(4)
– Concern regarding scrutiny
from others
– Concern regarding
humiliation
embarrassment
– Fear of rejection
– Concern regarding
offending others
Social Anxiety Disorder
Side Effects Important in Dentistry
(SSRI)
(2)
- Increased risk for
bleeding and bruising - Bruxism
SSRI Drug Interaction with NSAID
* Pharmacodynamic
interactions
– SSRI –
decrease
platelet aggregation
* INCREASED RISK FOR
BLEEDING
SSRI Drug Interactions with Opioid Medications
(codeine, hydrocodone and oxycodone)
* Pharmacokinetic interaction
* Drugs that INHIBIT CYP450 2D6
PREVENT the metabolism of
codeine, hydrocodone and
oxycodone to an active medication.
* OUTCOME:
* Antidepressants
(2)
pain relieving effects
are REDUCED
– Paroxetine (Paxil)
– Fluoxetine (Prozac)
Pregabalin
- FDA approved uses
include postherpetic
neuralgia, neuropathic
pain due to diabetic
peripheral neuropathy
and spinal cord injury,
seizures, and fibromyalgia - Considered a first-line
agent in treatment
guidelines for GAD
– NO FDA approval for GAD
– as effective as SSRI/SNRI
and BZD - MOA - unknown
- Common side effects:
dizziness, sedation,
ataxia, blurred vision, and
weight gain - No life-threatening side
effects - No oral side effects
- “Safe” in overdose
- Low risk for drug
interactions
Gabapentin
- FDA approved uses
include postherpetic
neuralgia and seizures - Used off-label for
anxiety – both
scheduled and prn - Limited evidence for
use in anxiety - MOA - unknown
- Common Side Effects
– Dizziness, sedation and
ataxia - No life-threatening side
effects - No oral side effects
- “Safe” in overdose
- Low risk for drug
interactions
Buspirone (Buspar)
- Mechanism of Action
– 5-HT1A partial agonist - Uses
– FDA approval for GAD (not recommend as first line
therapy)
– Used as adjunctive therapy with an antidepressant for
treatment refractory depression - NO abuse or withdrawal potential
- Onset of action 4-6 weeks
- Safe in overdose situations
- Low risk for drug interactions
Buspirone Side Effects
* Generally well tolerated
– GI complaints
– Sedation
– Insomnia
– Agitation
– Headache
– Weakness
– Dizziness
– No serious side effects
– No oral side effects
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 before medical/dental procedure
BZD Side Effects
Common
(7)
Less Common
(4)
* No oral side effects
- Drowsiness
- Sedation
- Psychomotor impairment
- Blurred vision
- Ataxia
- Daytime sedation
- Impairment in memory and
recall - Disorientation
- Aggression
- Confusion
- Paradoxical Excitation
BZD Characteristics
- Synergistic effect with other CNS depressants
– Alcohol
– TCA
– Barbiturates
– Pain Medication (Opioids/Opiates) - CNS and respiratory depression in overdose
- Risk for pharmacokinetic and pharmacodynamic
drug interactions - Tolerance develops to sedative/hypnotic effect
– Tolerance does NOT develop for other uses - anticonvulsant, anxiolytic, muscle relaxant
BZD Abuse
(4)
- 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 - Use with extreme caution in combination with
pain medications (opioids)
