Pharmacology of Anxiolytic Drugs

Question 1

benzodiazepines should be used in anxiety for less than _ weeks

Answer 1

2 weeks

Question 2

what symptoms are present in both anxiety and depression?

Answer 2

concentration
fatigue
sleep
arousal

Question 3

if you have 1 anxiety disorder you’re more likely to get another T or F

Answer 3

T

Question 4

what does the amygdala do?

Answer 4

integrates sensory and cognitive info

Question 5

an increase in cortisol is carried out by what structure?

Answer 5

hypothalamus

Question 6

what part of the brain is responsible for the autonomic symptoms in anxiety?

Answer 6

locus coeruleus

Question 7

which part of the brain is responsible for reexperiencing/traumatic memories?

Answer 7

hippocampus

Question 8

effect of GABA on the amygdala and CSTC circuits?

Answer 8

reduces activity of neurons there

Question 9

main GABA receptor in anxiety?

Answer 9

GABA-A

Question 10

benzodiazepines have what effect on GABA-A receptors in terms of their binding?

Answer 10

positive allosteric modulator (GABA binds to one site, benzo binds to other side)

Question 11

benzodiazepines __ neuron firing rate after binding to GABA-A

Answer 11

decrease

Question 12

valium is another name for…

Answer 12

diazepam

Question 13

pharm effects of benzos?

Answer 13

reduce anxiety and aggression
hypnosis
sedation
muscle relaxation
anti-convulsant effect
anterograde amnesia

Question 14

clinical uses of benzos?

Answer 14

acute Tx of extreme anxiety
hypnosis
alcohol withdrawal
mania
delirium
status epilepticus
acute tranquilisation

Question 15

antagonist for benzos?

Answer 15

flumazenil

Question 16

problems with benzos?

Answer 16

impaired coordination

tolerance

Question 17

symptoms of benzo withdrawal

Answer 17

abdo cramps
increased anxiety/panic attacks
autonomics
blurred vision
low mood
poor concentration
tingling in hands and feet
restlessness

Question 18

rapid withdrawal of benzodiazepines can cause what symptoms?

Answer 18

confusion
psychosis
convulsions
tachycardia
sweating
tremor 
HT

Question 19

presentation of acute benzo withdrawal can mimic what condition?

Answer 19

delirium tremens

Question 20

how to withdraw benzos?

Answer 20

take daily dose of diazepam at night
reduce dose every 2-3 weeks by 2mg
reduce further
stop completely

Question 21

how long should you decrease the dose of benzos before stopping

Answer 21

4 weeks to a year

Question 22

how long does it take for serotonin levels to increase after taking an SSRI?

Answer 22

hours

Question 23

1st and 2nd line medication for panic disorder

Answer 23

1. SSRI

2. tricyclics

Question 24

what SSRIs are good for GAD?

Answer 24

escitalopram

paroxetine

Question 25

when would B blockers be helpful in the treatment of anxiety

Answer 25

somatic symptoms eg palpitations/tremor

Question 26

1st to 6th line Tx for GAD?

Answer 26

1. psychoeducation 2. self help, psychoeducation groups 3. CBT or SSRI 4. SNRI or other SSRI 5. pregabalin 6. combine CBT and drugs

Question 27

what SNRI would you use for GAD?

Answer 27

venlaflaxine

Question 28

how long should you wait for an effect of treatment in GAD?

Answer 28

up to 12 weeks

Question 29

how long should you treat GAD?

Answer 29

treat for 18 months and stop gradually

Question 30

1st-4th line Tx of panic disorder

Answer 30

1. self help 2. CBT 3. SSRI 4, tricyclics

Question 31

how long should you treat panic disorder?

Answer 31

6 months

Question 32

what drugs should not be used in panic disorder?

Answer 32

benzos | sedating antihistamines

Question 33

1st-6th line treatment for OCD

Answer 33

1. CBT + ERP/self help 2. intensive psychological intervention or SSRI eg fluoxetine 3. increase dose after 4-6 weeks 4. SSRI + CBT and ERP 5. clomipramine 6. add antipsychotic OR clomipramine + citalopram

Question 34

how long should treatment of OCD be managed?

Answer 34

1 year

Question 35

when would watchful waiting be 1st line for a PTSD patient?

Answer 35

mild | <4 weeks from trauma

Question 36

what Tx should be given within 3 months of trauma in PTSD?

Answer 36

trauma focussed CBT | hypnotic meds for sleep disturbance

Question 37

Tx for PTSD after 3 months

Answer 37

trauma focussed CBT or EMDR

Question 38

what medication, if any, should you give for PTSD?

Answer 38

paroxetine | mirtazepine

Question 39

1st to 5th line treatment for social anxiety

Answer 39

1. individual CBT 2. SSRI 3. SSRI + CBT 4. change SSRI or SNRI 5. MAOI

Question 40

1st and 2nd line SSRIs for social anxiety

Answer 40

1. escitalopram or sertraline | 2. fluoxetine or fluvoxamine

Question 41

what MAOI should be given for social anxiety?

Answer 41

phenelzine