anxiolytics Flashcards
what is the therapeutic rationale for anxiety disorders
sedation
hypnoses
anxiolytic
what is the dose dependent effects of anxiolytics
low dose: anxiolytic and sedative
higher doses: hypnotic
even higher: anaesthesia, used for surgery
what are some classes of anxiolytics (2)
benzodiazepines, non Benzos
what are some Benzos
diazepam, lorazepam, triazolam, temazepam, midazolam
which benzos are used as anxiolytics and sedatives (2)
diazepam, lorazepam
which benzos are used as hypnotics
diazepam, triazolam, temazepam
which benzos are used as pre-anaesthetics
diazepam, midazolam
which benzos may have anti convulsant effects
diazepam
what are some examples of non benzos
barbiturates (phenobarbital)
buspirone
zolpidem
propanolol
benzo MOA
GABA-inhibitory transmitter in brain region –> open more easily
potentiate influx of Cl- ions leading to hyper polarisation –> neutrons not firing
limbic system: alter mood
reticular activating system: cause drowsiness
motor cortex: relax muscles
ADR of benzos
OD (severe respiratory depression esp with use with alcohol)
drowsiness confusion amnesia
impaired muscle coordination
tolerance and dependence
how is benzo OD treated
flumazenil (benzo antagonist)
what is zolpidem
potentiates GABA mediated Cl- currents at the same site as benzos
good hypnotic effect
what is zolpidem primarily used to treat
insomnia
disadvantage of zolpidem
not effective as anxiolytic
what is buspirone
serotonin 5HT1a receptor partial agonist
also binds to dopamine receptors
indicated for GAD
disadvantage of buspirone
anxiolytic effects takes 1-2 weeks
lacks anticonvulsant and muscle relaxant properties
what are barbiturates
potentiate GABA mediated Cl- currents but at a site distinct from benzos
used as a sedative-hypnotic
disadvantage of barbiturates
severe withdrawal symptoms
flumazenil not effective to treat OD
Usage of long acting barbiturates
anticonvulsant (phenobarbital)
usage of short acting barbiturates
sedative and hypnotic (pentobarbital and amobarbital)
usage of ultrashort acting barbiturates
IV induction of anaesthesia (thiopental)
what is pregabalin
GABA analogue, increases synaptic GABA –> GABA receptor mediated Cl- currents resulting in hyper polarisation
acts on voltage-gated Ca2+ channels
does pregabalin have anticonvulsant effects
yes
SE of pregabalin
may be associated with emergence or worsening of suicidal thoughts
what is hydroxyzine
1st gen antihistamine with activities on serotonergic and alpha-adrenergic receptors
anxiolytic effects attributed to antagonism of serotonin 5-HT2 receptors
advantages of hydroxyzine
low addictive potential
helps with itching (during anxiety)
what is propranolol
beta adrenergic receptor antagonist
treat performance anxiety and social phobias
reduce physical symptoms associated with adrenergic activation
when is propranolol contraindicated
asthma and heart conditions
