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Block 8 Week 6 > Craviso: Pharm Treatment for Anxiety Disorders > Flashcards

Craviso: Pharm Treatment for Anxiety Disorders Flashcards

1
Q

What neurotransmitter systems are targeted in the treatment of generalized anxiety disorder?

A

Antidepressants:
noradrenergic
serotonergic

Benzos:
GABAergic

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2
Q

Why are antidepressants superior to benzos for the treatment of generalized anxiety and other anxiety disorders?

A
  1. they lack potential for abuse and dependence
  2. they have better efficacy for the symptoms, such as excessive worry
  3. they also treat comorbid conditions, like depression (benzos do not)
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3
Q

Which meds work faster to relieve anxiety, benzos or antidepressants? How does this change the way you will prescribe them?

A

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

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4
Q

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

A

Buspirone - partial agonist at 5HT1A receptors

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5
Q

What receptors does Buspirone act on?

A

5HT1A

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6
Q

What antidepressants can be used for generalized anxiety disorder?

A

venlafaxine (blocks 5HT and NE reuptake)
duloxetine (blocks 5HT and NE reuptake)
paroxetine (blocks 5HT reuptake - SSRI)

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7
Q

So when are benzos used in anxiety cases?

A

for short-term therapy when they are prescribed in combination w/ buspirone or an antidepressant;
also for short-term therapy of situational anxiety

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8
Q

What is the mechanism of action of benzos?

A

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

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9
Q

Which benzos are N-desalkylated? Why is this important to consider?

A

Diazepam and Chlordiazepoxide;

this is important, because these benzos form long-lived pharmacologically active metabolites when they are broken down

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10
Q

Which benzos are shorter-acting, because they are not broken down into active metabolites or form short-lived active metabolites?

A

alprazolam (xanax)
lorazepam (ativan)
oxazepam (serax)

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11
Q

Which benzo has the very shortest 1/2 life and is thus the prime choice for elderly patients?

A

oxazepam

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12
Q

What can benzos also be used to treat?

A

alcohol withdrawal

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13
Q

What type of benzos should you use in patients with liver disease (ex: alcoholics)?

A

lorazepam; shorter half-life

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14
Q

The elderly are more likely to experience these effects when on benzos…

A

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

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15
Q

These two body systems can become depressed if you take benzos with other depressants like alcohol..

A

CNS

respiratory

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16
Q

Potent benzo that can be used in “date-rape”

A

Flunitrazepam (Rohypnol)

17
Q

You can become physically dependent if you take benzos for too long. What are some symptoms of benzo withdrawal?

A 
seizures
anxiety
agitation
irritability
insomnia
tremor
headache
18
Q

Withdrawal symptoms are more intense with these types of benzos

A 
short-acting (wear off quick)
higher potency (lorazepam and alprazolam)
19
Q

What do you give a patient if they are withdrawing intensely from benzos?

A

give them a dose of benzos, but slowly taper them off

20
Q

Benzos can be used for 5 different things clinically. What are they?

A
  1. anxiolytic
  2. managing alcohol and barbituate withdrawal
  3. anticonvulsant (esp Lorazepam for status epilepticus)
  4. preanesthetic adjuncts (esp Midazolam for calming down before surgery)
  5. muscle relaxants (Zolpidem)
21
Q

Which benzo can be used as an anti-convulsant for status epilepticus?

A

lorazepam

22
Q

Which benzo can be used as a preanesthetic adjunct?

A

midazolam (Versed)

23
Q

Which benzo can be used as a muscle relaxant?

A

diazepam (Valium)

24
Q

Why are benzos no longer used as sleep aids?

A

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

25
Q

Non-benzo that binds to alpha1 benzo receptors and specifically causes sedation, while not messing with anxiety or cognitive functioning

A

zolpidem (Ambien)

26
Q

This is used for benzo OD

A

Flumazenil

27
Q

How does Flumazenil work for benzo OD?

A

it is a competitive antagonist at benzo receptors, so it blocks the action of benzos and partially or completely reverses most central effects

28
Q

How is Flumazenil administered? What is CRUCIAL to remember about its metabolism?

A

IV route only; it has a rapid onset, but a short half-life

**need to continue to readmin the drug when it begins to wear off

29
Q

Why wouldn’t you give Flumazenil to like treat benzo addiction?

A

it will block the benzo receptors leading to severe abstinence syndrome

30
Q

What were barbiturates used for prior to benzos?

A

for anxiety and insomnia

31
Q

Why are barbiturates called “final exit” and “execution” drugs?

A

final exit bc they are used in physician-assisted suicide when legal; execution bc they are used in lethal injection

32
Q

How to barbiturates work? What makes them more dangerous than benzos?!

A

they increase GABAergic activity, like benzos, but they act at a different site and increase the LENGTH of time that Cl- channel is open vs the number of Cl- channels open

**in addition, they act to reduce glutamate depolarization at AMPA and kainate receptors, and they suppress the sensory cortex and decrease motor activity

33
Q

What meds can be used for panic disorder?

A

Anti-depressants: chronic treatment
Fluoxetine, Paroxetine, Sertraline (SSRIs)
Venlafaxine (SNRI)

Benzos: short term treatment
Alprazolam
Lorazepam

34
Q

This is given IV to stop severe panic attack (short-term solution)

A

Lorazepam

35
Q

What meds are used to treat social anxiety disorder?

A

Antidepressants:
Venlafaxine (SNRI)
Paroxetine (SSRI)

36
Q

What med can be used to treat performance anxiety?

A

propranolol

**blocks beta-adrenergic receptors to decrease palpitations, tachycardia, tremor

37
Q

What meds are used to treat OCD?

A

SSRI antidepressants:

Fluoxetine, Paroxetine, Sertraline

38
Q

What med is used to treat PTSD?

A

SSRIs:

Paroxetine (Paxil) and Sertraline (Zoloft)

Block 8 Week 6 (12 decks)

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