CLINICAL PHARMACOLOGY OF SEDATIVEHYPNOTICS TREATMENT OF ANXIETY STATES Flashcards
The psychological, behavioral, and physiological responses thatcharacterize anxiety can take many forms.
Typically, the psychic
awareness of anxiety is accompanied by _______________
.
enhanced vigilance, motor
tension, and autonomic hyperactivity
Anxiety is often secondary
to organic disease states—acute myocardial infarction, angina
pectoris, gastrointestinal ulcers, etc—which themselves require
specific therapy.
Another class of secondary anxiety states (situational
anxiety)results fromcircumstances that may have to be
dealt with only once or a few times___________
, including anticipation of
frightening medical or dental procedures and family illness or
other stressful event.
Even though situational anxiety tends to be
self-limiting, the short-term use of sedative-hypnotics may be
appropriate for the treatment of this and certain disease-associated
anxiety states.
Similarly, the use of a sedative-hypnotic as premedication
prior to surgery or some unpleasant medical procedure
is rational and proper ( Table 22–2 ).
Excessive or unreasonable anxiety about life circumstances
_______________
are also amenable to drug therapy, sometimes in conjunction
with psychotherapy.
(generalized anxiety disorder, GAD), panic disorders, and agoraphobia
The__________ continue to be used
for the management of acute anxiety states and for rapid control
of panic attacks.
They are also used, though much less commonly
than in the past, in the long-term management of GAD and panic
disorders.
benzodiazepines
Anxiety symptoms may be relieved by many benzodiazepines, but it is not always easy to demonstrate the superiority of
one drug over another.
________ has been used in the treatment
of panic disorders and agoraphobia and appears to be more selective in these conditions than other benzodiazepines.
Alprazolam
The choice of
benzodiazepines for the treatment of anxiety is based on several
sound pharmacologic principles:
(1) a rapid onset of action;
(2) a relatively high therapeutic index (see drug B in Figure 22–1 ), **plus **availability of flumazenil for treatment of overdose;
(3) a low risk of drug interactions based on liver enzyme induction; and
(4) minimal effects on cardiovascular or autonomic functions.
Disadvantages of the benzodiazepines include the__________.
- risk of dependence,
- depression of central nervous system functions, and
- amnestic effects
In addition, the benzodiazepines exert additive
central nervous system depression when administered with other drugs, including ___________.
The patient should be warned of this
possibility to avoid impairment of performance of any task requiring
mental alertness and motor coordination.
ethanol
In the treatment of generalized anxiety disorders and certain phobias, newer antidepressants,
including ________________ and ____________are
now considered by many authorities to be drugs of first choice (see
Chapter 30 ). However, these agents have a slow onset of action
and thus, limited effectiveness in acute anxiety states.
selective serotonin reuptake inhibitors (SSRIs)
and serotonin-norepinephrine reuptake inhibitors (SNRIs),
kaya for maintenance sila pero kapag severe panic attacks sedative- hypnotics med agad
Sedative-hypnotics should be used with appropriate caution so
as to minimize adverse effects. A dose should be prescribed that does not impair mentation or motor functions during waking
hours.
Some patients may tolerate the drug better if most of the
daily dose is given at bedtime, with smaller doses during the day.
Prescriptions should be written for short periods, since there is little justification for long-term therapy (defined as use of therapeutic doses for 2 months or longer).
The physician should make
an effort to assess the efficacy of therapy from the patient’s subjective
responses.
Combinations of antianxiety agents should be
avoided, and people taking sedatives should be cautioned about
the_____________
- **consumption of alcohol **
- and the concurrent use of over-thecounter medications containing antihistaminic or anticholinergic drugs (see Chapter 63 ).
