Anxiolytics

Question 1

What are anxiolytics?

Answer 1

Drugs that reduce the symptoms of anxiety, such as panic attacks, phobias, and generalized anxiety features like excessive fear and worry.

Question 2

What are the most commonly prescribe anxiolytics?

Answer 2

First line are SSRIs and Buspirone (not a benzo).

Second line are benzodiazepines and B-blockers and are short acting and short term treatments for symptoms relief.

Question 3

How do people respond to these medications?

Answer 3

Benzos relieve anxiety very quickly whereas the SSRIs and buspirone take a few weeks to take their full effect. Therefore benzos may be used as bridging therapy but never long term as people build up a tolerance to them.

Also, patients should not suddenly stop taking benzos if they’re prescribed as they can experience withdrawal symptoms, so they must be tapered appropriately.

Question 4

Side effects of anxiolytics.

Answer 4

SSRI side effects are the same as in antidepressant therapy.

Buspirone can lead to nausea, headache, dizziness, and EPS.

Common benzo side effects are tolerance, dependence, drowsiness, dizziness, nausea, blurred vision, confusion, and tiredness.

Question 5

When are benzodiazepines indicated?

Answer 5

Using benzos can be tricky but definite indications are:

• agitation
• anxiety (active)
• insomnia
• seizure
• alcohol withdrawal
• akathisia

Question 6

Buspirone

Answer 6

Buspar, 5-HT1A agonist

Used to reduce anxiety, agitation or tension. Does not impair motor function with muscle relaxation, doesn’t decrease alertness or act as a sleep agent and it is the most chemically separate group of anxiolytics. The MOA is poorly understood but it greatly reduces muscle tension, sweating, palpitations, increased vigilance, and aggression.

5-30mg dosing.

Question 7

Loazepam

Answer 7

Ativan, benzodiazepine

Used in anxiety and insomnia for ADULTS and CHILDREN >12 and just for adults in pre-medication for anesthetic procedures and status epilepticus.

Off label use for serial seizures in children, agitation, mania, schizophrenia (as a calming agent), delirium tremens/alcohol withdrawal symptoms, and severe vomiting (ex: chemo)

1-2mg dosing

Question 8

Clonazepam

Answer 8

Klonopin, benzodiazepine

Used in panic disorders and seizures for ADULTS and CHILDREN