Craviso: Pharm Treatment for Anxiety Disorders Flashcards
(38 cards)
What neurotransmitter systems are targeted in the treatment of generalized anxiety disorder?
Antidepressants:
noradrenergic
serotonergic
Benzos:
GABAergic
Why are antidepressants superior to benzos for the treatment of generalized anxiety and other anxiety disorders?
- they lack potential for abuse and dependence
- they have better efficacy for the symptoms, such as excessive worry
- they also treat comorbid conditions, like depression (benzos do not)
Which meds work faster to relieve anxiety, benzos or antidepressants? How does this change the way you will prescribe them?
benzos are immediate-acting, while antidepressant effects occur over several weeks;
so, prescribe benzos in combination w/ non-benzos or antidepressants and then taper off the benzos eventually when the anti-depressant effects begin
This non-benzo can be used to treat GAD; used for long-term treatment (chronic GAD); effects take several weeks; used if there are no comorbid symptoms such as depression
Buspirone - partial agonist at 5HT1A receptors
What receptors does Buspirone act on?
5HT1A
What antidepressants can be used for generalized anxiety disorder?
venlafaxine (blocks 5HT and NE reuptake)
duloxetine (blocks 5HT and NE reuptake)
paroxetine (blocks 5HT reuptake - SSRI)
So when are benzos used in anxiety cases?
for short-term therapy when they are prescribed in combination w/ buspirone or an antidepressant;
also for short-term therapy of situational anxiety
What is the mechanism of action of benzos?
they bind to GABA-A receptors called benzo receptors, and enhance Cl- conduction by increasing the number of times that the Cl- channel is opened
Which benzos are N-desalkylated? Why is this important to consider?
Diazepam and Chlordiazepoxide;
this is important, because these benzos form long-lived pharmacologically active metabolites when they are broken down
Which benzos are shorter-acting, because they are not broken down into active metabolites or form short-lived active metabolites?
alprazolam (xanax)
lorazepam (ativan)
oxazepam (serax)
Which benzo has the very shortest 1/2 life and is thus the prime choice for elderly patients?
oxazepam
What can benzos also be used to treat?
alcohol withdrawal
What type of benzos should you use in patients with liver disease (ex: alcoholics)?
lorazepam; shorter half-life
The elderly are more likely to experience these effects when on benzos…
dizziness and ataxia
cognitive impairment
can’t form new memories
paradoxical rxns like anxiety and irritability
can lead to cumulative effects if using long-acting benzos
These two body systems can become depressed if you take benzos with other depressants like alcohol..
CNS
respiratory
Potent benzo that can be used in “date-rape”
Flunitrazepam (Rohypnol)
You can become physically dependent if you take benzos for too long. What are some symptoms of benzo withdrawal?
seizures anxiety agitation irritability insomnia tremor headache
Withdrawal symptoms are more intense with these types of benzos
short-acting (wear off quick) higher potency (lorazepam and alprazolam)
What do you give a patient if they are withdrawing intensely from benzos?
give them a dose of benzos, but slowly taper them off
Benzos can be used for 5 different things clinically. What are they?
- anxiolytic
- managing alcohol and barbituate withdrawal
- anticonvulsant (esp Lorazepam for status epilepticus)
- preanesthetic adjuncts (esp Midazolam for calming down before surgery)
- muscle relaxants (Zolpidem)
Which benzo can be used as an anti-convulsant for status epilepticus?
lorazepam
Which benzo can be used as a preanesthetic adjunct?
midazolam (Versed)
Which benzo can be used as a muscle relaxant?
diazepam (Valium)
Why are benzos no longer used as sleep aids?
they were replaced by non-benzodiazepines like zopidem (Ambien), bc these target very specific alpha1 benzo receptors so don’t have anxiolytic effects or cause cognitive impairment
