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Pharm main > Anxiolytics > Flashcards

Anxiolytics Flashcards

1
Q

What is anxiety

A

Normal response to threatening or harmful stimul

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2
Q

What is pathological anxiety

A

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

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3
Q

Systems involved in anxiety

A

Noradrenergic
Seratonergic
GABA
CCK

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4
Q

Way is the role of the noradrenergic system in anxiety

A

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

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5
Q

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

A

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

SSRI’s help with anxiety

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6
Q

Role of GABA in anxiety?

What drugs target this system

A

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

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7
Q

What is the role of CCK in anxiety?

Where does it act?

A

Acts in locus ceruleus to enhance noradrenergic activity

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8
Q

What drugs can induce anxiety?

A

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

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9
Q

Way drugs cause anxiety when going through withdrawal?

A

Barbiturates
Benzodiazepines- especially short acting ones
Ethanol
Narcotics

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10
Q

Types of Anxiety disorders

A 
General Anxiety Disorder
Panic Disorders
OCD
PTSD
Social Anxiety Disorder
Specific Phobias
Stage fright
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11
Q

Describe General anxiety disorder

A

This is a fear of the future.

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

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12
Q

Tx for General Anxiety Disorder

A

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

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13
Q

What is a Panic Attack

A

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

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14
Q

What is a Panic Disorder

A

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

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15
Q

How to Tx Panic Disorder

A

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

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16
Q

Describe OCD

A

Obsessive thoughts that are relieved by compulsive behaviors

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17
Q

Treating OCD

A

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

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18
Q

Describe Post Traumatic Stress Disorder

A

Occurs after a traumatic event

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

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19
Q

What is the role of pain medication in PTSD

A

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

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20
Q

what is the role of betablockers in preventing PTSD

A

Block the formation of the memories thus minimizing the rexeperience

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21
Q

How do you treat PTSD

A

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

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22
Q

Social Anxiety Disorder

A

fear of embarrassment

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23
Q

how do you treat social anxiety disorder

A

SSRI, MAOI

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24
Q

How do you treat specific phobias

A

desensitization

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25
Q

How do you treat stage fright

A

small amount of beta blocker

26
Q

What is the role of CBT

A

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

27
Q

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

A

They work for all types of anxiety disorders

28
Q

what is the role of TCA in treating anxiety disorders

A

TCA’s work well in panic disorders

29
Q

What is the role of venlafaxine in treating anxiety disorders

A

Work well in GAD and panic disorders

30
Q

What is the role of Bupropion in treating anxiety disorders

A

NONE, can inc anxiety

31
Q

How and why do you use antidepressants to tx anxiety disorders

A

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

32
Q

Benzodiazepines- MOA

A

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

33
Q

DO benzodiazepines have a ceiling effect?

A

No

34
Q

Benzodiazepines- AE

A

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

35
Q

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

A

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

36
Q

Benzodiazepine Uses

A

1) Short term use while waiting for SSRI to kick in

2) Long term use if there are somatic symptos

37
Q

What other conditions are BZS’s used in

A

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

38
Q

What are the two aspects of BZD dependence

A

Psychological and physiological

39
Q

what are the physiologic symptoms of BZD withdrawal

A

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

40
Q

How are the symptoms of BZD withdrawal avoided

A

Make sure that you taper down the dosage

41
Q

BZD- CI

A

concurrent alcohol or narcotic use- can be deadly

dont use during CBT

42
Q

BZD- tolerance

A

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

43
Q

What may happen besides withdrawal symptoms when you stop taking BZD

A

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

44
Q

What determines the absorption rate and distribution

A

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

45
Q

BZD metabolism

A

Generally metabolized by the liver into active products

46
Q

Long Acting BZD’s- names

A

Diazepam
Clorazepate
Chlordizaepoxide

47
Q

What are the advantages of long acting BZD’s

A

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

48
Q

what is the metabolism of long acting BZD’s

A

metabolized in the liver

49
Q

Short acting BZD’s-names

A

Lorazepam

Oxazepam

50
Q

Short acting BZD’s- pros and cons

A

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

51
Q

Short acting BZD’s- metabolism

A

metabolized by glucoronidation

52
Q

Short acting BZD’s preferred population

A

elderly and those with liver dz

53
Q

Most lipohillic BZD

Least lipohillic BZD

A

diazepam is the most lipophillic

temazepam- least lipophillic

54
Q

Flumenazil MOA

A

Competitive antagonist with BZD @ GABA-A receptors

55
Q

Flumenazil- AE

A

can precipitate withdrawal in pts that are BZD dependent

56
Q

Buspirone- MOA

A

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

57
Q

Buspirone- Indications

A

Scheduled med in GAD

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

58
Q

Buspirone- AE

A

HA/N/dizziness and nervousness

overall mide SE- no rebound anxiety, no sedative effect, not associated with dependence

59
Q

Busiprone- how long does it take take effect

A

Very slow acting

60
Q

Does Busiprone interact with alcohol

A

NO

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