Pharma of anxiolytics Flashcards
list drugs used to treat anxiety
benzodiazepines anti depressant drugs busoperine prcegablin BBs - propanolol
BZD types
midazolam loazepam loprazolam oxazepam temazepam alprazolam nitrazepam diazepam clonazepam
pharmacological effects of BZDs
reduce anxiety and aggression hypnosis/sedation muscle relaxation anticonvulsant effect anterograde amnesia
GABA is what
main inhibitory transmitter in the brain - glycine restricted to spinal cord and brainstem
causes hyperpolerisation of target cells
clinical uses of BZDs
acute treatment of anxiety hypnosis alcohol withdrawel mania delirium rapid tranquillisation premedication before surgery or during minor procedures status epilepticus
Problems with BZDs
fairly safe in overdose esp alone
paradoxical aggression
anterograde amnesia and impaired coordination (rohypnol)
cause tolerance and dependance
why are there withdrawel symptoms with BZDs
neuroadaption of the GABA response - chronic treatment leads to a decreased response to GABA. withdrawel results in anxiety/convulsions possibly due to decreased density of BZ receptors
what can rapid withdrawal of a BZD cause
confusion, toxic psychosis, convulsion, insomnia, anxiety, loss of appetite, loss of body weight, tremor, perspiration, tinnitus, perceptual disturbances
how should a patient be withdrawn off BZDs
transfer to equivalent daily dose of diazepam/chlordiaeperoxide preferably taken at night
reduce dose every 203 weeks in steps of 2 or 2.5mg, if withdrawal symp occur maintain this dose until symp improve
reduce dose further in smaller steps
stop completely - time needed for withdrawal can vary from 4 weeks to a year or more
what are some antidepressants for anxiety
SSRIs - panic disorder, OCD, PTSD, phobias, GAD [escitalopram, paroxetine]
tricyclics - 2nd line for panic disorder, OCD
venlafaxine - GAD
moclobemide - social anxiety disorder
how do anti depressants help
acutely DDRIs increase extracellular 5HT and have antigenic properties when given chronically
pregablin
calcium channel blocker, GABA enhancer
only considered if not responsive to other treatments
propanolol - BBs
best for somatic symptom - palpitation, tremor
