Anxiolytics Flashcards
What is anxiety
Normal response to threatening or harmful stimul
What is pathological anxiety
Anxiety that is exhibited at inappropriate times that interferes with normal functioning
Systems involved in anxiety
Noradrenergic
Seratonergic
GABA
CCK
Way is the role of the noradrenergic system in anxiety
Locus ceruleus is the alarm center,becomes pathological when it is over active
Role of seratonergic system in anxiety
What drugs target this system?
Were is it located?
This is an inhibitory NT, concentrated in the raphe nuclei,
SSRI’s help with anxiety
Role of GABA in anxiety?
What drugs target this system
This is the major inhibitory nt in the brain.
Inhibits both serotonin and NE
Benzodiazepines act indirectly on this system
What is the role of CCK in anxiety?
Where does it act?
Acts in locus ceruleus to enhance noradrenergic activity
What drugs can induce anxiety?
Antidepressants such as SSRI’s, SNRI’s, and bupropion can cause transient anxiety.
Amantidine, dopa and its analogs
Sympathmimetics and stimulants
Way drugs cause anxiety when going through withdrawal?
Barbiturates
Benzodiazepines- especially short acting ones
Ethanol
Narcotics
Types of Anxiety disorders
General Anxiety Disorder Panic Disorders OCD PTSD Social Anxiety Disorder Specific Phobias Stage fright
Describe General anxiety disorder
This is a fear of the future.
Experience fatigue, muscle tension, or this fear on mored days than not for more than 6 months
Tx for General Anxiety Disorder
SSRI’s- venlafaxine, duloxetine, paroxetine, escitalopram
TCA
BZD- short term
Buspirone- esp if patients have- sleep apnea- h/o substance abuse, or falls
What is a Panic Attack
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
What is a Panic Disorder
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
How to Tx Panic Disorder
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
Describe OCD
Obsessive thoughts that are relieved by compulsive behaviors
Treating OCD
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
Describe Post Traumatic Stress Disorder
Occurs after a traumatic event
After the event the patient gets flashbacks, avoids certain beh, and is hyperarousable
What is the role of pain medication in PTSD
Treating the acute trauma and pain that occurs at the time of the event lessens the PTSD
what is the role of betablockers in preventing PTSD
Block the formation of the memories thus minimizing the rexeperience
How do you treat PTSD
SSRI,- sertaline and paroxetine
TCA, MAOI
adjunct- antipsychotics, anticonvulsants, beta blockers
BZD- similar to alcohol only make things worse
Social Anxiety Disorder
fear of embarrassment
how do you treat social anxiety disorder
SSRI, MAOI
How do you treat specific phobias
desensitization