Anxiolytics Flashcards
symptoms of anxiety
restlessness
tachycardia
sweating
insomina
brain structures involved in anxiety
hippocampus
amygdala
uses of anxiolytic drugs
anesthesia
anxiety and psychiatric disorders
acute anxiety
alcohol and other drug withdrawal
classes of anxiolytic drugs
barbiturates
benzodiazepines
buspirone
antidepressants
antidepressants used for anxiety
SSRI
SNRI
TCA
MAOI
first choice drugs for anxiety
SSRI
SNRI
benzos bind to GABA receptors and
increase frequency of opening
barbiturates bind to GABA receptors and
increase duration of opening
flumazenil
bento antagonist used for OD of benzos
limitations of flumazenil
doesn’t work for alcohol, barbiturate, or other anesthetic overdoses
clonazepam
benzo with slower onset of action
used to treat withdrawal from benzos
active metabolite of some benzos
desmethyldiazepam
formed by phase 1 oxidation at liver
benzo excretion
phase 2 glucuronidation and excreted by kidneys
long acting benzos
converted to desmethyldiazepam 30-200h chlordiazepoxide diazepam flurazepam
fluazepam
long acting benzo
chlordiazepoxide
long acting benzo
flurazepam
long acting benzo
short acting benzos
skips phase 1 oxidation used for hypnotics 3-27h alprazolam lorazepam oxazepam temazepam
alprazolam
short acting benzo
lorazepam
short acting benzo
oxazepam
short acting benzo
temazepam
short acting benzo
ultra short acting bentos
1-5h
triazolam
triazolam
short acting benzo
best sleep aid
contraindications to benzo use
required mental alertness
alcohol, drug, substance abuse
pregnant
breast feeding
ADR of benzos
drowsiness dizziness ataxia respiratory depression disinhibition rare- increased aggression, allergic reactions
risk factors of using benzos
impaired liver function, age renal disease COPD, sleep apnea myasthenia gravis history of substance abuse, cognitive disorders, CNS depression
risks associated with abruptly stopping benzos
rebound anxiety/insomina
withdrawal symptoms- paranoia, depression, suicidal ideation, delirium, seizures
worst class of drug for physical dependence
benzos
indications for benzo use (9)
GAD panic social anxiety PTSD acute stress adjustment disorder with anxiety bipolar anxiety associated with life events akathisia
benzo drug interactions
CYP interactions- increase plasma levels
rifampin and tobacco- decrease plasma levels
food and antacids- decrease absorption
additive with sedative and CNS depressants
buspirone MOA
5HT1a partial agonist
presynaptic dopamine antagonist
partial alpha1 agoinst
benefits of buspirone
no sedation, anticonvulsant, muscle relaxation
no tolerance or cross tolerance
no potential for addiction or dependance
buspirone use
chronic anxiety- takes days/weeks to see an affect
GAD
drugs for panic disorder
SSRI (gold standard) TCA SNRI benzos- used to accelerate onset and reduce side effects of the antidepressants MAOI- only if others don't work
GAD drugs
benzos
buspirone
SNRI
SSRI
SNRI for GAD
venlafaxine
SSRI for GAD
paroxetine
citalopram
SSRI for panic disorder
setraline
paroxetine
TCA for panic disorder
imipramine
clomipramine
SNRI for panic disorder
venlafaxine
benzos for panic disorder
alprazolam
clonazepam
lorazepam
drugs for social anxiety disorder
SSRI
bentos
beta blockers
antihistamines
SSRI for social anxiety disorder
sertraline
paroxetine
venlafaxine
beta blocker for social anxiety disorder
propranolol
antihistamines for social anxiety disorder
diphenhydramine
hydroxyzine
drugs for OCD
TCA
SSRI
drugs that do not work for OCD
buspirone
other TCAs
MAOI
buproprione
TCA for OCD
clomipramine
SSRI for OCD
sertraline
paroxetine
fluoxetine
fluvoxzamine
drugs for PTSD
SSRI- first line
bentos
TCA, SNRI, MAOI
adrenergic inhibitors
trazadone
for PTSD
augments SSRI effectiveness and reverses insomnia and sedation
adrenergic inhibitors for PTSD
alpha2 agonists
clonidine
guanfacine
effects of adrenergic inhibitors for PTSD
reduces hyperactivity, nightmares, startle, rage, hyper vigilance
