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Block 8 Week 6 Rhonda > Pharmacologic Treatment of Anxiety Disorders - Craviso > Flashcards

Pharmacologic Treatment of Anxiety Disorders - Craviso Flashcards

1
Q

What are the three categories of anxiolytic meds?

A

noradrenergic
serotonergic
GABAergic (benzos)

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

A

Buspar

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5
Q

What are the SE of Buspar?

A 
dizziness
light headedness
insomnia
HA
nausea
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6
Q

What are the antidepressants used for GAD?

A

Effexor
Cymbalta
Paxil

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7
Q

Which two antidepressants blocks reuptake of both S and NE?

A

Effexor and Cymbalta

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8
Q

which antidepressant only an SSRI?

A

Paxil

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9
Q

Besides GAD, what else can you use benzos for?

A

situational anxiety

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10
Q

What is the MOA of benzos?

A

bind to BZ receptors on the GABA-a receptor

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11
Q

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

A

allosteric

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12
Q

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

A

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

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13
Q

Phase I of benzo metabolism produces what class of compounds?

A

N-Desalkylated compounds

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14
Q

Phase II of benzo metabolism produces what class of compounds?

A

3-hydroxylated compounds

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15
Q

What is the phase I intermediate produced from chrlordiazepoxide?

A

demoxepam (L)

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16
Q

What is the phase I intermediate produced from diazepam?

A

Nordazepam (L)

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17
Q

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

A

N-desalkylflurazepam (L)

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18
Q

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

A

Nordazepam (L)

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19
Q

What is the half life for L compounds?

A

> 24 horus

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20
Q

What is the half life for S compounds?

A

<6 hours

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21
Q

Which two benzos form long lasting active metabolites?

A

Diazepam >100 hours

Chlordiazepoxide (librium) >100 hours

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22
Q

Which benzos form short acting or no active metabolites?

A

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

23
Q

Cross dependence can happen between benzos and…

A

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

24
Q

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

A

hepatic insufficiency or continuation of use of alcohol

25
Q

which two benzos do you use for alcohol withdrawal?

A

diazepam

lorazepam

26
Q

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

A

benzo overuse

27
Q

What are the SE of benzos in the elderly?

A

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

28
Q

what are the serious SE of benzos?

A

CNS and respiratory depression

29
Q

which benzo is used for date rape?

A

flunitrazepam aka rohypnol

30
Q

what can happen after prolonged use of benzos?

A

physical dependence

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

31
Q

which benzos have harder withdrawal symptoms?

A 
short acting and higher potency
Lorazepam
Alprazolam
both have high receptor affinity
cause insomnia, REM rebound, anxiety
32
Q

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

A

lorazepam

33
Q

which benzo can be used as a preanesthetic drug?

A

madazolam

34
Q

which benzo is used as a muscle relaxant?

A

valium

35
Q

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

A

ambiem

36
Q

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

A

BZ1

37
Q

which drug is a specific BZ1 receptor antagonist?

A

Romazicon

38
Q

what is the MOA of romazicon blocking bz1 receptors?

A

competitive

39
Q

what is the effects of bz1 antagonists?

A

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

40
Q

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

A

no effect

41
Q

What is the only way to administer romazicon?

A

Iv

42
Q

What is the half life of romazicon?

A

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

43
Q

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

A

may precipiate severe abstinence syndrome

44
Q

what are the uses of barbiturates?

A

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

45
Q

what is the MOA of barbiturates?

A

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

46
Q

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

A

barbiturates

47
Q

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

A

reduce glutamate induced depol via AMPA and kainate receptors

48
Q

barbitruates depress what parts of the brain?

A

depress the sensory cortex and decrease motor activity

49
Q

Which antidepressants are used for panic disorder?

A

prozac ssri
Paxil ssri
Zoloft ssri
Effexor S and NE reuptake

50
Q

Which benzos are used for panic disorder?

A

Alprazolam

Lorazepam (IV to stop severe attack)

51
Q

which two antidepressants are used for social anxiety disorder?

A

Effexor S and Ne reuptake

Paxil ssri

52
Q

What is used for performance anxiety aka stage fright?

A

B-adrenergic receptor blocker propranolol

Inderal to preveent palpitations, tachycardia, tremors, etc

53
Q

which antidepressants are used for OCD?

A

prozac
Paxil
zoloft

54
Q

What are the two SSRIs used for PTSD?

A

paxil

zoloft

Block 8 Week 6 Rhonda (12 decks)

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