Drugs for Anxiety (Anxiolytics) Flashcards
State the psychological components of anxiety (4)
- worry, nervousness, uneasiness
- arousal
- lack of concentration
- insomnia
State the physical components of anxiety (5)
- tachycardia
- sob
- nausea
- gastric acid hypersecretion
- trembling
GENERALISED ANXIETY DISORDER (GAD)
- ____, ____ worry over everyday matters
- interferes with daily functioning
- has both psychological and physical symptoms
- diagnosed when present for > ____ months
- most common cause of disability in the workplace
GENERALISED ANXIETY DISORDER (GAD)
- EXCESSIVE, UNCONTROLLABLE worry over everyday matters
- interferes with daily functioning
- has both psychological and physical symptoms
- diagnosed when present for > 6 months
- most common cause of disability in the workplace
State some other anxiety and fear disorders (4)
- ptsd - post traumatic stress disorders
- phobias
- panic disorder
- ocd - obsessive compulsive disorder
State the 3 functions of CNS depressants to treat anxiety disorders
State the level of dosage required for each function to be effective.
- sedative –> causes sedation and relaxation (use at low dose)
- hypnotic –> induces drowsiness and sleep and can have amnestic effects (use at high dose)
- anxiolytic –> reduces anxiety (use at low dose)
at very high doses, CNS depressants can cauase anaesthesia required for surgery
State the 2 classes of drugs used in treatment of anxiety disorders
- benzodiazepines
- non-benzodiazepines (zolpidem, busiprone, barbiturates, hydroxyzine, propanolol)
State the MOA of benzodiazepines in treatment of anxiety disorders
Benzodiazepines bind to allosteric site on GABA –> potentiates influx of Cl- ions by increasing frequency of GABA-induced channel opening –> hyperpolarisation of cell –> decreased AP firing
State the names of the short acting, intermediate acting and long acting benzodiazepines.
Short acting:
1. midazolam
2. triazolam
Intermediate acting:
1. alprazolam (xanax)
2. clonazepram
3. lorazepam
4. oxazepam
5. temazepam
Long acting:
1. chlordiazepoxixde
2. diazepam (valium)
3. flurazepam
Is lorazepam a short-acting, intermediate-acting or long-acting benzodiazepine?
intermediate acting
Is temazepam a short-acting, intermediate-acting or long-acting benzodiazepine?
intermediate-acting
Is diazepam a short-acting, intermediate-acting or long-acting benzodiazepine?
long-acting
Is alprazolam a short-acting, intermediate-acting or long-acting benzodiazepine?
intermediate-acting
Is triazolam a short-acting, intermediate-acting or long-acting benzodiazepine?
short-acting
Is valium a short-acting, intermediate-acting or long-acting benzodiazepine?
long-acting
valium = diazepam
State a clinical scenario where short-acting and long-acting drugs are each used.
short-acting –> medical procedures/surgery since there is rapid onset and short half life which allows for faster recovery
long-acting –> chronic conditions
State the adverse effects of benzodiazepines.
- acute toxicity/overdose –> leading to severe respiratory depression (treat with flumazenil, benzodiazepine antagonsit)
- drowsiness, confusion, amnesia
- impaired muscle coordination –> impairs manual skills
- tolerance and dependency –> has abuse potential
State the intermediate acting benzodiazepines
A CLOT:
A = Alprazolam
C = Clonazepam
L = Lorazepam
O = Oxazepam
T = Temazepam
State the short-acting and long-acting benzodiazepines
Short-acting (MT)
M = Midazolam
T = Triazolam
Long-acting (CDF)
C = Chlordiazepoxide
D = Diazepam
F = Flurazepam
State the examples of non-benzodiazepines.
- zolpidem
- busiprone
- barbiturates
- pregabalin
- hydroxyzine
- propanolol
State the MOA of zolpidem
State the benefits and disadvantages of zolpidem
MOA = potentiates GABA-A mediated Cl- currents at the same site as benzodiazepines
benefit - good hypnotic effect - can treat insomnia
disadvantages - not effetive as anxiolytics
State the MOA of busiprone.
State the benefits and disadvantages of busiprone
MOA = Serotonin 5-HT2a receptor partial agonist + binds to dopamine R
benefit = treats GAD since anxiolytic effect takes 1-2 weeks
disadvantages = lacks anticonvulsant effect + lacks muscle relaxant properties
Name some barbiturates (long-acting, short-acting and very-short acting)
State the MOA of barbiturates.
State the benefits and disadvantages of barbiturates.
Long-acting:
- anticonvulsants - phenobarbital
Short-acting:
- sedative and hypnotic - pentobarbital + amobarbital
Ultra-short acting:
- IV indution anaesthesia - thiopental
MOA = potentiates GABA-a mediated Cl- currents at site distinct from benzodiazepines
benefits = at anaesthetic site, barbiturates can directly open CL- channels and block Na+ channels
disadvantages = sedative-hypnotic replaced by benzodiazepines due to tendency to develop tolerance and dependece + severe withdrawal symptoms + flumazenil not effective for treating barbiturate overdose
State the MOA of pregabalin.
State the benefits and disadvantages of pregabalin.
MOA = GABA analogue that acts on voltage gated Ca2+ channels –> increases synaptic GABA –> GABA-R mediated Cl- currents resulting in hyperpolarisation –> decreased AP firing
benefits = treats GAD + has anticonvulsant effects
disadvantages = worsens suicidal thoughts
State the MOA of propanolol.
State the benefits and disadvantages of propanolol.
MOA = beta-adrenergic receptor antagonist
benefits = treats performance anxiety and social phobia + less physical symptoms associated with adrenergic activation
disadvantages = contraindicated in asthma and heart conditions
State the contraindication for pregabalin
patients with suicidal ideation / previous suicidal attempts
State the contraindication for propanolol
patients with asthma + patients with heart conditions
State the MOA of hydroxyzine
State the benefits of hyroxyzine
MOA = first generation antihistamine with activities on serotonergic and alpha-adrenergic receptors + serotonin 5-HT2 receptor antagonism
benefits = low addictive potential + antihistamine properties helps treat itch
