Anxiolytics Flashcards
What are anxiolytics?
Anti-anxiety drugs
What are the three anxiolytic classes?
Antidepressants
Benzodiazepines
Buspirone
Any antidepressant that increases ______ an be given for anxiety.
Seratonic
Out of the three classes, which is the most addictive?
Benzodiazepines
With all anxiety disorders, _____ is frequently comorbid.
Depression
What are benzodiazepines prescribed most commonly for?
Generalized anxiety disorder (GAD)
What are SSRIs (antidepressant) used for?
All anxiety disorders
What is GAD?
A chronic condition characterized by uncontrollable worrying
-Of all anxiety disorders, GAD is the least likely to remit
Antidepressants: Rapid onset of relief or delayed onset of relief?
Delayed
Benzodiazepines: Rapid onset of relief or delayed onset of relief?
Rapid
Buspirone: Rapid onset of relief or delayed onset of relief?
Delayed
When are benzodiazepines preferred?
For immediate stabilization, especially when anxiety is severe
When are antidepressants and buspirone drugs preferred?
For long term management
Where do the benefits of benzodiazepines derive from, aka the MOA?
Enhancing responses to GABA (an inhibitory neurotransmitter)
Review: GABA is an amino acid neurotransmitter- it is a relaxer and slows the process in the brain down. This is why benzodiazepine is a good drug for anxiety.
The side effects of benzodiazepines are similar to what other drug?
ETOH (alcohol)
What are the side effects of benzodiazepines?
Sedation
Slurred speech
Ataxia
Because of the abuse potential of the benzodiazepines, what patients should benzodiazepines be used with caution?
In patients known to abuse alcohol or other psychoactive substances
Of the 13 benzodiazepines, there are 6 that are approved for anxiety. Which one is the best for generalized anxiety?
Which one is the most commonly abused?
Best for generalized anxiety= Clonazepam
Most commonly abused=alprazolam
What are the 3 safety issues with benzodiazepines?
- Synergistic effect when combined with ETOH
- Habit forming
- Seizure risk when withdrawing
Do benzodiazepines treat the cause of anxiety?
No
What is the MOA of buspirone?
Unclear
Does buspirone work on GABA?
No
What does buspirone exert its effect on?
The serotonin system
Are there any addiction risks with buspirone?
No
What are the 3 advantages of buspirone?
- No sedation
- No tolerance/dependence
- No interaction with ETOH
What are the 2 disadvantages of buspirone?
- Slow onset of action (weeks)
- Low efficacy (has been called an expensive placebo)
Is buspirone a CNS depressant?
No
Is benzodiazepine a CNS depressant?
Yes
Which anti-anxiety drug is more suitable to give PRN or for patients who need immediate relief?
Benzodiazepine
How many antidepressants have been approved to be given for anti anxiety?
4; 2 SNRI and 2 SSRI
What anxiety disorder is this: chronic condition characterized by uncontrollable worrying?
Generalized anxiety disorder
What anxiety disorder is this: patients experience recurrent panic attacks, characterized by palpations, pounding heart, chest pain, derealization or depersonalization, and fear of dying or going crazy.
Panic disorder
Many patients with _____ experience agoraphobia, a condition characterized by anxiety of being in places or situations from which escape might be embarrassing or difficult, or in which help might be unavailable if a panic attach should occur.
Panic disorder
What are the first line drugs for panic disorders?
SSRIs
What anxiety disorder is this: persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day and significantly interfere with daily living?
Obsessive-compulsive disorder
*Side note review: the limbic nuclei associated with OCD is cingulate gyrus; with severe OCD, the anterior cingulate gyrus may be cut out–sometimes this completely cures a patient with severe OCD
What are the first line of drugs for OCD?
SSRI
What anxiety disorder is this: characterized by an intense, irrational fear of being scrutinized by others, or of doing something that could be embarrassing or humiliating.
Social anxiety disorder
What are the first-line drugs for most patients with social anxiety disorder?
SSRI
When is treatment with a benzodiazepine preferred to an SSRI for a patient with social anxiety disorder?
When the disorder is limited to fear of speaking or performing in public. These situations arise infrequently, so PRN treatment of a benzodiazepine may be preferred to long-term treatment of an SSRI
What anxiety disorder is this: develops following a traumatic event that elicited an immediate reaction of fear, helplessness, or horror
Post-traumatic stress disorder (PTSD)
What are the 3 core symptoms of PTSD?
Reexperiencing
Avoidance/emotional numbing
Hyperarousal
What are treatments for PTSD?
SSRIs for first line treatment of PTSD
Additional drugs used: SNRI (venlafaxine), TCAs, and MAOIs
