anxiolytics

Question 1

uses of low/high/even higher doses of Benzodiazepines and Barbiturates

Answer 1

low dose –> anxiolytic, sedation
high dose –> hypnotic
even higher dose –> anesthesia

Question 2

what is 1 similarity and 1 difference btw benzodiazepines and barbiturates

Answer 2

similarity: bind to GABA –> so GABA can bind better to Cl-
- -> potentiate GABA-mediated Cl channel –> Cl- can come in more –> m is hyperpolarised, harder to depolarise –> decrease neural excitability

but both bind at different site

Question 3

list some benzodiazepines

Answer 3

diazepam (long acting)
Alprazolam (xanax)
clonazepam
lorazepam

midazolam, triazolam (short acting: for anesthetic)

Question 4

list uses of diazepam

Answer 4

sedation, anxiolytics, hypnotic, anti-epileptic, anesthetics

Question 5

SE of BZD

Answer 5

1. abuse, tolerance (if use more frequently esp for epilepsy bzd (those bzd has longer t1/2 than sleeping bzd also))
and dependence (withdrawal: rebound anxiety, rebound insomnia, tremour and may even go into fits) -> withdraw gradually*

2. overdose: resp depression (esp with alcohol)
3. GA: sedation, amnesia, confusion
4. impair muscle co-ordination*

Question 6

Important counselling point for BZD

Answer 6

1. dont take with alcohol –> higher risk of overdose –> higher risk of severe resp depression
2. taper slowly to reduce withdrawal sx (rebound anxiety, rebound insomnia, tremor, convulsion)
3. dont operate machinery as this medication impair manual skills

Question 7

barbiturates

SE

Answer 7

higher risk of developing dependence (more severe withdrawal sx) and tolerance than BZD

• overdose –> resp collapse, fatal
• high dose will be anesthetic

Question 8

What is the use flumazenil?

Answer 8

BZD antagonist to reverse overdosing of BZD.

not for barbiturates bc flumazenil bind at a site different from BZD.

Question 9

list some barbiturates

Answer 9

(ultra short DOA: in IV induction of anesthetic)
thiopental

(short DOA: anxiolytic, sedative, hypnotic)
amobarbital
pentobarbital

(long DOA: in anti epileptic)
phenobarbital

Question 10

Propanolol

hydroxyzine

Answer 10

propanolol can decrease physical szx associated with anxiety (e.g. tachycardia) –> treat social phobias, performance anxiety

Hydroxyzine: help with itching, anti-histamine, serotonergic and a-adrenergic activity

Question 11

other anxiolytic

TCA, SSRI, NASSA, SNRI

Answer 11

TCA: clonipramine
SSRI: fluoxetine, citalopram, sertaline, paroxetine
SNRI: venlafaxine, duloxetine
NASSA: mirtazapine

Question 12

what is pregabalin

Answer 12

GABA analogue –> cause more GABA to be released –> trigger Cl- channel to open more –> hyperpolarisation

Question 13

uses of pregabalin

Answer 13

for generalised anxiety disorder

adjunct for partial epileptic

Question 14

SE of pregabalin

Answer 14

suicidal thoughts

sedation

Question 15

Buspirone
MOA
Uses

Answer 15

MOA: 5-HT1 receptor partial agonist and bind to dopamine receptor
Use: for generalized anxiety disorder, lack anti-epileptic and muscle relaxant properties.