Pharmacology - Anxiolytics

Question 1

what neural circuit controls the fear symptoms in anxiety?

Answer 1

amygdala centered circuit

Question 2

what neural circuit controls the worry symptoms of anxiety?

Answer 2

cortico striatal thalamic cortical circuit

Question 3

where in the brain is the affect of fear controlled?

Answer 3

anterior cingulate cortex/orbitofrontal cortex

Question 4

what part of the brain controls avoidance?

Answer 4

periaqueductal grey

Question 5

what part of the brain causes an increase in cortisol?

Answer 5

hypothalamus

Question 6

what part of the brain causes increased BP and HR?

Answer 6

locus coeruleus

Question 7

what five neurotransmitters are involved in amygdala centred circuits?

Answer 7

serotonin
GABA
glutamate 
CRF 
noradrenaline

Question 8

what is the main inhibitory transmitter in the brain?

Answer 8

GABA

Question 9

which drugs enhance the action of GABA?

Answer 9

benzodiazepines

Question 10

what are the three main GABA receptors?

Answer 10

A B and C

Question 11

which GABA receptor is the target of benzodiazepines?

Answer 11

GABA-A

also the target of barbiturates and alcohol

Question 12

name three examples of benzodiazepines

Answer 12

lorazepam
diazepam
chlordiazepoxide

Question 13

what pharmacological effects do benzodiazepines have?

Answer 13

reduce anxiety
sedation
muscle relaxation
anticonvulsant effect

Question 14

how do benzodiazepines act?

Answer 14

increase GABA mediated inhibition

Question 15

what is the antagonist used to treat benzodiazepine overdose?

Answer 15

flumazenil

Question 16

name three possible issues with benzodiazepine use

Answer 16

paradoxical aggression
anterograde amnesia
tolerance

Question 17

what is the first step in withdrawing a patient from benzodiazepines?

Answer 17

reduce the dose every few weeks in steps of 2mg

if symptoms occur maintain the dose until symptoms improve

Question 18

what antidepressants can be used acutely for anxiety?

Answer 18

SSRIs

increase extracellular serotonin

Question 19

what SSRIs can be used for GAD?

Answer 19

escitalopram

paroxetine

Question 20

what anxiety disorders can SSRIs be used for?

Answer 20

panic disorder 
OCD
PTSD
phobias 
GAD

Question 21

what anxiety disorders can tricyclics be used for?

Answer 21

panic disorder (2nd line) 
OCD

Question 22

what anxiety disorder can venlafaxine (SNRI) be used for?

Answer 22

GAD

Question 23

what anxiety disorder can moclobemide (MAOI) be used for?

Answer 23

social anxiety disorder

Question 24

what is the first line management for GAD?

Answer 24

high intensity CBT or SSRI

Question 25

what is the second line drug management for GAD?

Answer 25

SNRI

Question 26

what is the third line drug management for GAD?

Answer 26

pregabalin

Question 27

what is the last line treatment for GAD?

Answer 27

combined CBT and drug treatment

Question 28

what can be considered as short term management of GAD?

Answer 28

benzodiazepines <2 weeks

Question 29

what is the first line management for panic disorder?

Answer 29

CBT or SSRI

Question 30

what is the second line management for panic disorder?

Answer 30

tricyclics

Question 31

how long should treatment be continued in GAD?

Answer 31

18 months assess at 12 weeks

Question 32

how long should treatment be continued for in panic disorder?

Answer 32

6 months

Question 33

what is the first line management for OCD?

Answer 33

low intensity psychological intervention

Question 34

what is the second line management for OCD?

Answer 34

more intensive psychological intervention or SSRI

Question 35

how long should SSRI be continued for in OCD?

Answer 35

a year consider dose increase if needed afterr 4-6 weeks

Question 36

what is the second line drug management of OCD?

Answer 36

clomipramine

Question 37

what is the last line medical management of OCD?

Answer 37

augmentation with antipsychotic OR clomipraminen plus citalopram

Question 38

what is the management of mild PTSD within <4 weeks from the trauma?

Answer 38

watchful waiting

Question 39

what is the management of PTSD within three months of trauma?

Answer 39

trauma focused CBT | hypnotic medication for sleep disturbance

Question 40

what is the management of PTSD more than three months after the trauma?

Answer 40

trauma focused CBT | EMDR

Question 41

what is the first line management for social anxiety?

Answer 41

CBT

Question 42

outline the stages of drug management of social anxiety

Answer 42

1. SSRI 2. alternative SSRI or SNRI 3. MAOI

Question 43

what SSRIs can be used for social anxiety?

Answer 43

escitalopram or sertraline first line alternatives = fluvoxamine or paroxetine

Question 44

what SNRI can be used for social anxiety?

Answer 44

venlafaxine

Question 45

what MAOI can be used for social anxiety?

Answer 45

moclobemide

Question 46

when should SSRI use be reviewed in social anxiety?

Answer 46

at 12 weeks