Anxiolytics

Question 1

What is anxiety

Answer 1

Normal response to threatening or harmful stimul

Question 2

What is pathological anxiety

Answer 2

Anxiety that is exhibited at inappropriate times that interferes with normal functioning

Question 3

Systems involved in anxiety

Answer 3

Noradrenergic
Seratonergic
GABA
CCK

Question 4

Way is the role of the noradrenergic system in anxiety

Answer 4

Locus ceruleus is the alarm center,becomes pathological when it is over active

Question 5

Role of seratonergic system in anxiety
What drugs target this system?
Were is it located?

Answer 5

This is an inhibitory NT, concentrated in the raphe nuclei,

SSRI’s help with anxiety

Question 6

Role of GABA in anxiety?

What drugs target this system

Answer 6

This is the major inhibitory nt in the brain.
Inhibits both serotonin and NE
Benzodiazepines act indirectly on this system

Question 7

What is the role of CCK in anxiety?

Where does it act?

Answer 7

Acts in locus ceruleus to enhance noradrenergic activity

Question 8

What drugs can induce anxiety?

Answer 8

Antidepressants such as SSRI’s, SNRI’s, and bupropion can cause transient anxiety.
Amantidine, dopa and its analogs
Sympathmimetics and stimulants

Question 9

Way drugs cause anxiety when going through withdrawal?

Answer 9

Barbiturates
Benzodiazepines- especially short acting ones
Ethanol
Narcotics

Question 10

Types of Anxiety disorders

Answer 10

General Anxiety Disorder
Panic Disorders
OCD
PTSD
Social Anxiety Disorder
Specific Phobias
Stage fright

Question 11

Describe General anxiety disorder

Answer 11

This is a fear of the future.

Experience fatigue, muscle tension, or this fear on mored days than not for more than 6 months

Question 12

Tx for General Anxiety Disorder

Answer 12

SSRI’s- venlafaxine, duloxetine, paroxetine, escitalopram
TCA
BZD- short term
Buspirone- esp if patients have- sleep apnea- h/o substance abuse, or falls

Question 13

What is a Panic Attack

Answer 13

Sudden onset fear of death with somatic symptoms including at least 4 of the following- fear of dying, chest pain/ discomfort, chills or hot flashes, choking, shaking, and tachycardia

Question 14

What is a Panic Disorder

Answer 14

A History of attack with 1 or more of the following after the attack- fear of another attack, concern of what will happen if another attack occurs, and agoraphobia b/c think that there are places that trigger the attack

Question 15

How to Tx Panic Disorder

Answer 15

SSRI- DOC
BZD- clonazepam on a scheduled basis, alprazolam has withdrawal symptoms and may cause seizures (SR formula may be better)
MAO, TCA, CBT- do not mi

Question 16

Describe OCD

Answer 16

Obsessive thoughts that are relieved by compulsive behaviors

Question 17

Treating OCD

Answer 17

SSRI- DOC- fluoxetine, fluvoxamine, sertaline, paroxetine- could req higher dose than for depression.
TCA with a significant serotonergic component- clomipramine
CBT- Meds require accompanying CBT. more effective than meds. Dont use BZD with CBT

Question 18

Describe Post Traumatic Stress Disorder

Answer 18

Occurs after a traumatic event

After the event the patient gets flashbacks, avoids certain beh, and is hyperarousable

Question 19

What is the role of pain medication in PTSD

Answer 19

Treating the acute trauma and pain that occurs at the time of the event lessens the PTSD

Question 20

what is the role of betablockers in preventing PTSD

Answer 20

Block the formation of the memories thus minimizing the rexeperience

Question 21

How do you treat PTSD

Answer 21

SSRI,- sertaline and paroxetine
TCA, MAOI
adjunct- antipsychotics, anticonvulsants, beta blockers
BZD- similar to alcohol only make things worse

Question 22

Social Anxiety Disorder

Answer 22

fear of embarrassment

Question 23

how do you treat social anxiety disorder

Answer 23

SSRI, MAOI

Question 24

How do you treat specific phobias

Answer 24

desensitization

Question 25

How do you treat stage fright

Answer 25

small amount of beta blocker

Question 26

What is the role of CBT

Answer 26

normally CBT and pharmacologic agents work best together. DO NOT GIVE BZD WHILE GIVING CBT. It is important to educate the patient

Question 27

What is the role of SSRI's in treating anxiety disorder

Answer 27

They work for all types of anxiety disorders

Question 28

what is the role of TCA in treating anxiety disorders

Answer 28

TCA's work well in panic disorders

Question 29

What is the role of venlafaxine in treating anxiety disorders

Answer 29

Work well in GAD and panic disorders

Question 30

What is the role of Bupropion in treating anxiety disorders

Answer 30

NONE, can inc anxiety

Question 31

How and why do you use antidepressants to tx anxiety disorders

Answer 31

start at a low dose to avoid anxiety that comes with initial therapy. it is Good fr patients with a history of substance abuse or concurrent depression

Question 32

Benzodiazepines- MOA

Answer 32

increase the frequency of GABA channel opening to enhance the ability of GABA to inhibit NE and 5HT

Question 33

DO benzodiazepines have a ceiling effect?

Answer 33

No

Question 34

Benzodiazepines- AE

Answer 34

sedation, ataxia, anterograde amnesia, respiratory depression, paradoxical excitement, and aggression

Question 35

How to differentiate between Benzodiazepine OD and an alcohol/ barbiturate OD

Answer 35

BZD are not assoc with a nystagmus, but alcohol and barbiturates are.

Question 36

Benzodiazepine Uses

Answer 36

1) Short term use while waiting for SSRI to kick in | 2) Long term use if there are somatic symptos

Question 37

What other conditions are BZS's used in

Answer 37

insomnia, akathesia, acute mania, RLS, seizures, and alcohol detox

Question 38

What are the two aspects of BZD dependence

Answer 38

Psychological and physiological

Question 39

what are the physiologic symptoms of BZD withdrawal

Answer 39

fatal seizures, insomnia, ataxia, tremors, anxiety, hallucinations. N/V

Question 40

How are the symptoms of BZD withdrawal avoided

Answer 40

Make sure that you taper down the dosage

Question 41

BZD- CI

Answer 41

concurrent alcohol or narcotic use- can be deadly | dont use during CBT

Question 42

BZD- tolerance

Answer 42

tolerance develops to the euphoria that BZD's can cause but not the anxilolytic effect- so be careful to examine why you are raising dose

Question 43

What may happen besides withdrawal symptoms when you stop taking BZD

Answer 43

pt may experience a relapse or rebound which will be worse than before

Question 44

What determines the absorption rate and distribution

Answer 44

liphollicity- the more fat soluble--> the faster it is absorbed into the CNS --> faster onset.

Question 45

BZD metabolism

Answer 45

Generally metabolized by the liver into active products

Question 46

Long Acting BZD's- names

Answer 46

Diazepam Clorazepate Chlordizaepoxide

Question 47

What are the advantages of long acting BZD's

Answer 47

Less frequent dosing, less rebound between doses, less severe withdrawal

Question 48

what is the metabolism of long acting BZD's

Answer 48

metabolized in the liver

Question 49

Short acting BZD's-names

Answer 49

Lorazepam | Oxazepam

Question 50

Short acting BZD's- pros and cons

Answer 50

More frequent dosing, more rebound between doses, and more severe withdrawal BUT there is less accumulation of drug in the system

Question 51

Short acting BZD's- metabolism

Answer 51

metabolized by glucoronidation

Question 52

Short acting BZD's preferred population

Answer 52

elderly and those with liver dz

Question 53

Most lipohillic BZD | Least lipohillic BZD

Answer 53

diazepam is the most lipophillic | temazepam- least lipophillic

Question 54

Flumenazil MOA

Answer 54

Competitive antagonist with BZD @ GABA-A receptors

Question 55

Flumenazil- AE

Answer 55

can precipitate withdrawal in pts that are BZD dependent

Question 56

Buspirone- MOA

Answer 56

partial presynaptic 5HT1A agonist which causes an increase in NE and 5HT activity

Question 57

Buspirone- Indications

Answer 57

Scheduled med in GAD | good in Sleep Apnea, for pts with a h/o substance abuse, and have no prior BZD tx

Question 58

Buspirone- AE

Answer 58

HA/N/dizziness and nervousness | overall mide SE- no rebound anxiety, no sedative effect, not associated with dependence

Question 59

Busiprone- how long does it take take effect

Answer 59

Very slow acting

Question 60

Does Busiprone interact with alcohol

Answer 60

NO