Pharmacologic Treatment of Anxiety Disorders - Craviso

Question 1

What are the three categories of anxiolytic meds?

Answer 1

noradrenergic
serotonergic
GABAergic (benzos)

Question 2

what class of drug is the recommended firstline Tx for GAD?

Answer 2

SSRIs/antidepressants
lower risk of dependence
better efficacy at treating excessive worry

Question 3

What is the difference in time of onset of benzos vs SSRIs?

Answer 3

antidepressants take weeks to onset while benzos happen immediately; can give benzos and antidepressants during initial treatment

Question 4

what is the partial 5-HT1a receptor agonist for long term GAD tx?

Answer 4

Buspar

Question 5

What are the SE of Buspar?

Answer 5

dizziness
light headedness
insomnia
HA
nausea

Question 6

What are the antidepressants used for GAD?

Answer 6

Effexor
Cymbalta
Paxil

Question 7

Which two antidepressants blocks reuptake of both S and NE?

Answer 7

Effexor and Cymbalta

Question 8

which antidepressant only an SSRI?

Answer 8

Paxil

Question 9

Besides GAD, what else can you use benzos for?

Answer 9

situational anxiety

Question 10

What is the MOA of benzos?

Answer 10

bind to BZ receptors on the GABA-a receptor

Question 11

Benzos enhance GABA-induced Cl- conductance via a (competitive/allosteric) mechanism

Answer 11

allosteric

Question 12

enhanced GABA-induced Cl- conduction facilitates transmission of GABA by doing what to the Cl- channel?

Answer 12

increases the number of times cl- opens when GABA is bound

Question 13

Phase I of benzo metabolism produces what class of compounds?

Answer 13

N-Desalkylated compounds

Question 14

Phase II of benzo metabolism produces what class of compounds?

Answer 14

3-hydroxylated compounds

Question 15

What is the phase I intermediate produced from chrlordiazepoxide?

Answer 15

demoxepam (L)

Question 16

What is the phase I intermediate produced from diazepam?

Answer 16

Nordazepam (L)

Question 17

What is the phase I intermediate prodcued from flurazepam (s)?

Answer 17

N-desalkylflurazepam (L)

Question 18

Demoxepam (L) can be converted to what other phase I intermediate/

Answer 18

Nordazepam (L)

Question 19

What is the half life for L compounds?

Answer 19

> 24 horus

Question 20

What is the half life for S compounds?

Answer 20

<6 hours

Question 21

Which two benzos form long lasting active metabolites?

Answer 21

Diazepam >100 hours

Chlordiazepoxide (librium) >100 hours

Question 22

Which benzos form short acting or no active metabolites?

Answer 22

Alprazolam 14 hours (most potent benzo)
Lorazepam 14 hours (not metabolized)
Oxazepam 9 hours (not metabolized)

Question 23

Cross dependence can happen between benzos and…

Answer 23

alcohol; means you can use benzos to help with alcohol withdrawal

Question 24

what concern should you have when using benzos to help with alcohol withdrawal?

Answer 24

hepatic insufficiency or continuation of use of alcohol

Question 25

which two benzos do you use for alcohol withdrawal?

Answer 25

diazepam | lorazepam

Question 26

what is one of the most common causes of confusion in the elderly?

Answer 26

benzo overuse

Question 27

What are the SE of benzos in the elderly?

Answer 27

dizziness and ataxia cog. impairment anterograde amnesia (especially with the short actings) paradoxical rxns (anxiety, hostility) cumulative effects with the long lasting ones

Question 28

what are the serious SE of benzos?

Answer 28

CNS and respiratory depression

Question 29

which benzo is used for date rape?

Answer 29

flunitrazepam aka rohypnol

Question 30

what can happen after prolonged use of benzos?

Answer 30

physical dependence | abruptly stopping = seizures, anxiety, agitation, insomnia, rebound effects of slow wave sleep and REM, tremor, headache

Question 31

which benzos have harder withdrawal symptoms?

Answer 31

``` short acting and higher potency Lorazepam Alprazolam both have high receptor affinity cause insomnia, REM rebound, anxiety ```

Question 32

which benzos can be used as antiepileptics to stop status epilepticus?

Answer 32

lorazepam

Question 33

which benzo can be used as a preanesthetic drug?

Answer 33

madazolam

Question 34

which benzo is used as a muscle relaxant?

Answer 34

valium

Question 35

benzos have been replaced by which category of drug for use as a sedative hypnotic?

Answer 35

ambiem

Question 36

which type of BZ receptor do benzos bind to on the GABA-a receptors?

Answer 36

BZ1

Question 37

which drug is a specific BZ1 receptor antagonist?

Answer 37

Romazicon

Question 38

what is the MOA of romazicon blocking bz1 receptors?

Answer 38

competitive

Question 39

what is the effects of bz1 antagonists?

Answer 39

partially or completely reverses most central effects (sedation, impairment of recall, etc)

Question 40

What is the effect of bz1 receptor antagonist in the absence of benzos?

Answer 40

no effect

Question 41

What is the only way to administer romazicon?

Answer 41

Iv

Question 42

What is the half life of romazicon?

Answer 42

onset in 1-2 minutes peak in 6-10 minutes short half life of 0.7-1.3 hours

Question 43

what is important to note when using romazicon in pts with a benzo dependency?

Answer 43

may precipiate severe abstinence syndrome

Question 44

what are the uses of barbiturates?

Answer 44

phenobarbitol: anticonvulsant thiopental: general anesthetic also used as final exit and execution drugs

Question 45

what is the MOA of barbiturates?

Answer 45

increase GABAergic transmission by increasing the length of time the Cl- channel is open. binds to a different site than benzos

Question 46

do barbiturates or benzos have a more potent effect on cl- influx?

Answer 46

barbiturates

Question 47

What is the effect of barbiturates on AMPA, kainate, and glutamate?

Answer 47

reduce glutamate induced depol via AMPA and kainate receptors

Question 48

barbitruates depress what parts of the brain?

Answer 48

depress the sensory cortex and decrease motor activity

Question 49

Which antidepressants are used for panic disorder?

Answer 49

prozac ssri Paxil ssri Zoloft ssri Effexor S and NE reuptake

Question 50

Which benzos are used for panic disorder?

Answer 50

Alprazolam | Lorazepam (IV to stop severe attack)

Question 51

which two antidepressants are used for social anxiety disorder?

Answer 51

Effexor S and Ne reuptake | Paxil ssri

Question 52

What is used for performance anxiety aka stage fright?

Answer 52

B-adrenergic receptor blocker propranolol | Inderal to preveent palpitations, tachycardia, tremors, etc

Question 53

which antidepressants are used for OCD?

Answer 53

prozac Paxil zoloft

Question 54

What are the two SSRIs used for PTSD?

Answer 54

paxil | zoloft