Anxiolytics and Antipsychotics

Question 1

What are the 3 most common anxiety disorders?

Answer 1

Generalized anxiety disorder (GAD)
Panic disorder (PD)
Social anxiety disorder (SAD)

Question 2

What is the first line therapy for tx of anxiety disorders?

Answer 2

SSRI and SNRIs

Question 3

• Fear or anxiety about
  social situations
  – Concern regarding scrutiny
  from others
  – Concern regarding
  humiliation
  embarrassment
  – Fear of rejection
  – Concern regarding
  offending others

Answer 3

Social anxiety disorder

Question 4

• Recurrent panic attacks
  – Shortness of breath
  – Dizziness or faintness
  – Palpitations
  – Sweating
  – Trembling or shaking
  – Nausea
  – Dizziness
  – Paresthesias
  – Hot flashes or chills
  – Chest pain
  – Feelings of choking
  – Discomfort or fear

Answer 4

Panic disorder

Question 5

• Excessive anxiety or worry
• Muscle tension
• Restlessness
• Fatigue
• Impaired Concentration
• Irritability
• Insomnia

Answer 5

Generalized anxiety disorder

Question 6

What 2 drugs (antidepressants) have DDIs that decrease effectiveness of pain meds/opiods?

Answer 6

Fluoxetine
Paroxetine

Question 7

• FDA approved uses
  include postherpetic
  neuralgia, neuropathic
  pain due to diabetic
  peripheral neuropathy
  and spinal cord injury,
  seizures, and fibromyalgia
• Considered a first-line
  agent in treatment
  guidelines for GAD
  – NO FDA approval for GAD
  – as effective as SSRI/SNRI
  and BZD
• MOA - unknown
• Common side effects:
  dizziness, sedation,
  ataxia, blurred vision, and
  weight gain
• No life-threatening side
  effects
• No oral side effects
• “Safe” in overdose
• Low risk for drug
  interactions

Answer 7

Pregabalin

Question 8

• FDA approved uses
  include postherpetic
  neuralgia and seizures
• Used off-label for
  anxiety – both
  scheduled and prn
• Limited evidence for
  use in anxiety
• MOA - unknown
• Common Side Effects
  – Dizziness, sedation and
  ataxia
• No life-threatening side
  effects
• No oral side effects
• “Safe” in overdose
• Low risk for drug
  interactions

Answer 8

Gabapentin

Question 9

• Mechanism of Action
  – 5-HT1A partial agonist
• Uses
  – FDA approval for GAD (not recommend as first line
  therapy)
  – Used as adjunctive therapy with an antidepressant for
  treatment refractory depression
• NO abuse or withdrawal potential
• Onset of action 4-6 weeks
• Safe in overdose situations
• Low risk for drug interactions
  Few side effects
  No oral effects

Answer 9

Buspirone

Question 10

• FDA approved uses
  include HTN, angina
  pectoris, atria; fibrillation,
  myocardial infarction,
  migraine prophylaxis,
  essential tremor,
  hypertrophic subaortic
  stenosis,
  pheochromocytoma
• Used off-label for
  “performance” anxiety
• MOA - nonselective beta-
  adrenergic receptor
  blocking agent
• Common Side Effects
  – Dizziness, weakness and
  fatigue
• No life-threatening side
  effects
• No oral side effects
• Overdose –
  hypotension and
  bradycardia
• High risk for drug
  interactions

Answer 10

Propranolol

Question 11

How do BZDs work?

Answer 11

Increase CL channel which decreases GABA binding

Question 12

DA track:
EP system - movement

Answer 12

Nigrostriatal

Question 13

DA track:
Arousal, memory, motivation

Answer 13

Mesolimbic

Question 14

DA track:
Cognition, communication, social function, response to stress

Answer 14

Mesocortical

Question 15

DA track:
Regulates prolactin release

Answer 15

Tuberinfundibular

Question 16

What are the 2 first generation antipsychotics we need to know?

Answer 16

Haloperidol
Chlorpromazine

Question 17

What DA track is inhibited with FGAs?

Answer 17

Mesolimbic pathway