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Meds > Anxiolytics > Flashcards

Anxiolytics Flashcards

1
Q

what do benzodiazepine receptors modulate

A

GABA activity

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2
Q

nonbenzodiazepine agonists

A

zolpidem
zaleplon
eszopiclone

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3
Q

benzodiazepine receptor antagonist

A

flumazenil

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4
Q

5 benzodiazepines A-D

A

alprazolam
clonazepam
chlordiazepoxide
clorazepate
diazepam

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5
Q

8 benzodiazepines E-T

A

lorazepam
oxazepam
midazolam
flurazepam
temazepam
triazolam
estazolam
quazepam

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6
Q

brand name of diazepam

A

valium

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7
Q

brand name clonazepam

A

klonopin

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8
Q

brand name alprazolam

A

xanax

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9
Q

brand name lorazepam

A

ativan

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10
Q

brand name oxazepam

A

serax

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11
Q

brand name chlordiazepoxide

A

librium

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12
Q

brand name clorazepate

A

tranxene

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13
Q

brand name midazolam

A

versed

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14
Q

brand name flurazepam

A

dalmane

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15
Q

brand name temazepam

A

restoril

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16
Q

brand name triazolam

A

halcion

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17
Q

brand name estazolam

A

prosom

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18
Q

brand name quazepam

A

doral

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19
Q

brand name zolpidem

A

ambien

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20
Q

brand name zaleplon

A

sonata

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21
Q

brand name eszopiclone

A

lunesta

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22
Q

brand name flumazenil

A

romazicon

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23
Q

brand name buspirone

A

buspar

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24
Q

brand name propranolol

A

inderal

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25
Q

which receptors do benzodiazepines work on in general

A

GABA

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26
Q

other uses for benzodiazepines

A

anesthetics
anticonvulsants
muscle relaxants
catatonia treatment

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27
Q

what is first line treatment for anxiety disorders and why

A

SSRI/SNRI d/t risk for sedation/dependence with benzodiazepines

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28
Q

absorption of all benzodiazepines except clorazepate

A

completely absorbed from GI after PO administration

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29
Q

absorption of clorazepate

A

converted in stomach to desmethyldiazepam which is then completely absorbed

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30
Q

benzodiazepines with fastest absorption, peak, and onset of action

A

diazepam
lorazepam
alprazolam
triazolam
estazolam

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31
Q

6 “long-acting” benzodiazepines

A

diazepam
chlordiazepoxide
clonazepam
clorazepate
flurazepam
quazepam

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32
Q

steady state of long-acting benzodiazepines

A

may take up to two weeks

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33
Q

half-life of long-acting benzodiazepines

A

30-100 hours

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34
Q

4 benzodiazepines with half-life 8-30 hours

A

lorazepam
oxazepam
temazepam
estazolam

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35
Q

half-life of alprazolam

A

10-15 hours

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36
Q

which benzodiazepine has the shortest half-life and what is it

A

triazolam
2-3 hours

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37
Q

how does high lipid solubility affect the onset and duration of action of benzodiazepines

A

causes rapid action in brain d/t diffusion across concentration gradient. when there is more drug in the brain than the blood the gradient reverses and effects rapidly leave the brain

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38
Q

therapeutic indications for benzodiazepines other than anxiety

A

insomnia
bipolar
catatonia
agitation
alcohol withdrawal

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39
Q

anxiety disorders treated with benzodiazepines

A

GAD
panic disorder
social anxiety
anxiety associated with depression

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40
Q

duration of benzodiazepine use for insomnia

A

7-10 days

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41
Q

3 benzodiazepines approved for insomnia

A

temazepam
flurazepam
triazolam

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42
Q

5 benzodiazepines approved for use as hypnotics

A

flurazepam
temazepam
quazepam
estazolam
triazolam

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43
Q

benzodiazepine treatment of GAD

A

predetermine duration of therapy at initiation
-some patients do require long term maintenance therapy

44
Q

commonly used benzodiazepines for panic disorder

A

alprazolam
clonazepam

45
Q

benzodiazepines v. SSRIs for panic disorder

A

-benzodiazepines have rapid onset w/ less sexual side effects and weight gain
-SSRIs are still preferred d/t less abuse potential and tolerance

46
Q

initiating benzodiazepines and SSRIs together

A

can initiate together and taper benzo in 3-4 weeks when SSRI effects are evident

47
Q

benzodiazepine typically used for social anxiety

A

clonazepam

48
Q

what role do benzodiazepines have in the treatment of bipolar disorder

A

treat acute mania and can be an adjunct to antidepressants instead of antipsychotics

49
Q

3 benzodiazepines typically used in bipolar disorder

A

clonazepam
lorazepam
alprazolam

50
Q

which med can decrease depressive episodes and time between cycles when used as an adjunct to lithium or lamotrigine

A

clonazepam

51
Q

what type of catatonia can be treated with benzodiazepines

A

acute
chronic does not respond well

52
Q

benzodiazepine used to treat acute catatonia

A

lorazepam

53
Q

what treats chronic catatonia

A

ECT

54
Q

first line treatment for akathisia

A

B-adrenergic antagonists

55
Q

which benzodiazepines are used for alcohol withdrawal

A

chlordiazepoxide
clorazepate

56
Q

what is administered for benzodiazepine OD

A

flumazenil

57
Q

administration of flumazenil in benzodiazepine OD

A

-0.2mg IV over 30 seconds
-if no response in 30 seconds give 0.3mg over 30 seconds
-then can give 0.5mg every 30 seconds - 1 minute to a total dose of 3mg

58
Q

what if sedation in benzodiazepine OD reoccurs after initially responsive to flumazenil

A

administer additional doses at 20 minute intervals with no 1 dose exceeding 1mg and total dose NTE 3mg in 1 hour

59
Q

when are seizures more likely with flumazenil administration

A

preexisting seizure disorders
benzodiazepine dependence
ingestion of large quantity

60
Q

administration of flumazenil in a multi-drug OD involving benzodiazepines

A

adverse effects of other meds that benzos may have been treating can emerge

61
Q

what needs to be in place prior to administration of flumazenil

A

IV access
reliable airway

62
Q

benzodiazepine most associated with anterograde amnesia

A

triazolam

63
Q

benzodiazepines in patients with preexisting brain damage

A

paradoxical agitation

64
Q

benzodiazepine administration with asthma or COPD

A

increased respiratory depression

65
Q

benzodiazepines during pregnancy and lactaton

A

contraindicated

66
Q

abrupt dc of benzodiazepines

A

can cause severe withdrawal

67
Q

symptoms of severe withdrawal from benzodiazepines

A

depression
paranoia
delirium
seizures
*may be delayed 1-2 weeks if using long acting meds

68
Q

which benzodiazepine is significantly associated with acute severe withdrawal

A

alprazolam

69
Q

benzodiazepine taper

A

25% weekly

70
Q

other strategies for discontinuing benzodiazepines

A

concurrent use of carbamazepine
switch from alprazolam to clonazepam then taper

71
Q

common CNS depressants that can interact with benzodiazepines

A

TCAs
DRAs
antihistamines
alcohol

72
Q

which meds cause ataxia and dysarthria when administered with benzodiazepines

A

lithium
antipsychotics

73
Q

benzodiazepines and clozaril

A

delirium

74
Q

benzodiazepines and antacids

A

reduced absorption

75
Q

which meds increase triazolam and alprazolam to toxic levels

A

nefazodone
fluvoxamine

76
Q

dosages for coadministration of triazolam or alprazolam with nefazodone or fluvoxamine

A

reduce alprazolam dose by 50%
reduce triazolam dose by 75%

77
Q

carbamazepine and alprazolam

A

decreased concentration of alprazolam

78
Q

benzodiazepines and smoking

A

increases metabolism

79
Q

which medications can have increased concentrations when administered with benzodiazepines

A

phenytoin
digoxin

80
Q

which benzodiazepine is available in a wafer

A

clonazepam

81
Q

classification of buspirone

A

azapirone

82
Q

actions of buspirone at serotonin and dopamine receptors

A

agonist/partial agonist at 5HT1A
agonists/antagonist at D2

83
Q

approved indication for buspirone

A

only GAD

84
Q

what effects does buspirone NOT produce

A

anticonvulsant
muscle relaxant
euphoria

85
Q

buspirone and food

A

reduced absorption

86
Q

half-life and peak plasma concentrations of buspirone

A

half-life 2-11 hours
peak plasma in 40-90 minutes

87
Q

what anxiety sx are buspirone more effective for

A

anger
hostility

88
Q

which anxiety symptoms are buspirone less effective for

A

somatic symptoms

89
Q

dosage at which full benefit is seen for buspirone

A

> 30mg

90
Q

what SSRI-induced adverse reactions can be treated with buspirone

A

bruxism
sexual dysfunction

91
Q

initiation of buspirone

A

5mg TID or 7.5mg BID then raise by 5mg q2-4 days until desired effect is reached
(15-60mg)

92
Q

2 strategies for switching from benzodiazepines to buspirone

A

-can taper down benzo while tapering up buspirone
-can give both until buspirone is effective then taper benzo

93
Q

most commonly used b-adrenergic receptor antagonist in psychiatry

A

propranolol

94
Q

therapeutic indications for b-adrenergic antagonists

A

anxiety
lithium-induced postural tremor
neuroleptic induced akathisia
aggression
alcohol withdrawal
antidepressant augmentation

95
Q

propranolol in anxiety; indication and dosage

A

social anxiety
10-40mh 20-30 minutes before performing

96
Q

propranolol dose for medication-induced postural tremor

A

20-60mg in 2-3 divided doses

97
Q

contraindications to b-adrenergic antagonists

A

-asthma
-insulin dependent DM
-CHF
-vascualr disease
-angina
-hyperthyroidism

98
Q

b-adrenergic antagonists in pregnancy

A

contraindicated

99
Q

which medications increase concentrations of propranolol

A

antipsychotics
anticonvulsants
theophylline
levothyroxine

100
Q

which meds contraindicate b-adrenergic antagonists

A

calcium channel blockers

101
Q

dc b-adrenergic antagonists

A

never abruptly
taper by 60mg daily until at 60mg
then reduce by 10-20mg q3-4 days

102
Q

therapeutic indications for barbiturates

A

ECT
seizures
narcoanalysis
insomnia

103
Q

which barbiturate is used for ECT

A

methohexital

104
Q

typical barbiturate used for seizures

A

phenobarbital

105
Q

barbiturate used for narcoanalysis

A

amobarbital (really been replaced by diazepam)

Meds (12 decks)

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