Anxiolytics

Question 1

What do benzo’s do?

Answer 1

They bind to GABA receptors, thereby increasing activity and increasing inhibition

Question 2

What is the most prevalent inhibitory neurotransmitter in CNS?

Answer 2

GABA (gamma-aminobutyric acid)

Question 3

What other substances also bind to GABA receptors?

Answer 3

Alcohol & barbiturates, although they have their own binding sites and slightly different ways of affecting the receptors

Question 4

Why shouldn’t alcohol, barbiturates, and BZD’s be combined?

Answer 4

Because together they have an additive/synergistic effects that can be fatal.

Question 5

What are the therapeutic effects of BZD’s?

Answer 5

Decrease anxiety temporarily
Induce anterograde amnesia for medical procedures
Induce sedation for agitation, sleep for insomnia
Relax muscles for spasms
Raise seizure threshold (e.g. alcohol withdrawal)

Question 6

What are the SE’s of BZDs?

Answer 6

• Paradoxical agitation (anxiety, aggression, behavioral disinhibition)
• Sedation, drowsiness, lethargy, depression (especially in elderly)
• Confusion, cognitive impairments, impaired learning, amnesia (even dementia)
  Ataxia, resulting in falls in elderly
  -Slurred speech
  -Dependence
  -Interactions with alcohol/other sedatives
  Possible fetal abnormalities

Question 7

Paradoxical agitation

Answer 7

One of the SE of BZD’s in which the pt experiences increases in anxiety, agression and behavioral disinhibition

Question 8

T or F: With few exceptions, BZD’s should only be used for a few weeks for temporary relief until other therapy techniques can take effect.

Answer 8

T

Question 9

T or F: BZD’s may interfere with CBT

Answer 9

T

Question 10

T or F: BZD’s are never prescribed for long periods

Answer 10

F; BZD’s are very commonly and inappropriately prescribed for long periods.

Question 11

What are the 1st-line Rx for anxiety disorders due to efficacy and to the SE’s of sedative-hypnotics?

Answer 11

SSRI’s

Question 12

What is considered responsible for effectiveness of SSRI’s for anxiety?

Answer 12

5-HT usually decreases anxiety and frequently inhibits behaviors; however, 5HT2 receptors may cause anxiety until they downregulate/desensatize

Question 13

What are the two biggest problems with prescribing mirtazapine (Remeron) (which is NOT a BZD)?

Answer 13

Weight gain

Hypersomnia

Question 14

Which antidepressants are commonly prescribed for anxiety?

Answer 14

See slides

Question 15

What is the first line treatment for OCD?

Answer 15

SSRI’s

Question 16

What is the second line treatment for OCD?

Answer 16

Best option are high doses of SSRI’s or augmentation with an atypical antipsychotic
Also used are clomipramine (Anafranil), MAOI, and SNRI.

Question 17

What is the 1st line treatment for PTSD?

Answer 17

• SSRI’s
• SNRI’s
• For patients who are left with residual sxs, an alpha1 antagonist at night may prevent nightmares.

Question 18

What is the second line treatment for PTSD?

Answer 18

alpha2sigma ligands, TCA’s, MAOI’s, BZD’s (w/ caution because many abuse substances)