Pharmacology of Anxiolytic Drugs Flashcards
benzodiazepines should be used in anxiety for less than _ weeks
2 weeks
what symptoms are present in both anxiety and depression?
concentration
fatigue
sleep
arousal
if you have 1 anxiety disorder you’re more likely to get another T or F
T
what does the amygdala do?
integrates sensory and cognitive info
an increase in cortisol is carried out by what structure?
hypothalamus
what part of the brain is responsible for the autonomic symptoms in anxiety?
locus coeruleus
which part of the brain is responsible for reexperiencing/traumatic memories?
hippocampus
effect of GABA on the amygdala and CSTC circuits?
reduces activity of neurons there
main GABA receptor in anxiety?
GABA-A
benzodiazepines have what effect on GABA-A receptors in terms of their binding?
positive allosteric modulator (GABA binds to one site, benzo binds to other side)
benzodiazepines __ neuron firing rate after binding to GABA-A
decrease
valium is another name for…
diazepam
pharm effects of benzos?
reduce anxiety and aggression hypnosis sedation muscle relaxation anti-convulsant effect anterograde amnesia
clinical uses of benzos?
acute Tx of extreme anxiety hypnosis alcohol withdrawal mania delirium status epilepticus acute tranquilisation
antagonist for benzos?
flumazenil
problems with benzos?
impaired coordination
tolerance
symptoms of benzo withdrawal
abdo cramps increased anxiety/panic attacks autonomics blurred vision low mood poor concentration tingling in hands and feet restlessness
rapid withdrawal of benzodiazepines can cause what symptoms?
confusion psychosis convulsions tachycardia sweating tremor HT
presentation of acute benzo withdrawal can mimic what condition?
delirium tremens
how to withdraw benzos?
take daily dose of diazepam at night
reduce dose every 2-3 weeks by 2mg
reduce further
stop completely
how long should you decrease the dose of benzos before stopping
4 weeks to a year
how long does it take for serotonin levels to increase after taking an SSRI?
hours
1st and 2nd line medication for panic disorder
- SSRI
2. tricyclics
what SSRIs are good for GAD?
escitalopram
paroxetine
when would B blockers be helpful in the treatment of anxiety
somatic symptoms eg palpitations/tremor
1st to 6th line Tx for GAD?
- psychoeducation
- self help, psychoeducation groups
- CBT or SSRI
- SNRI or other SSRI
- pregabalin
- combine CBT and drugs
what SNRI would you use for GAD?
venlaflaxine
how long should you wait for an effect of treatment in GAD?
up to 12 weeks
how long should you treat GAD?
treat for 18 months and stop gradually
1st-4th line Tx of panic disorder
- self help
- CBT
- SSRI
4, tricyclics
how long should you treat panic disorder?
6 months
what drugs should not be used in panic disorder?
benzos
sedating antihistamines
1st-6th line treatment for OCD
- CBT + ERP/self help
- intensive psychological intervention or SSRI eg fluoxetine
- increase dose after 4-6 weeks
- SSRI + CBT and ERP
- clomipramine
- add antipsychotic OR clomipramine + citalopram
how long should treatment of OCD be managed?
1 year
when would watchful waiting be 1st line for a PTSD patient?
mild
<4 weeks from trauma
what Tx should be given within 3 months of trauma in PTSD?
trauma focussed CBT
hypnotic meds for sleep disturbance
Tx for PTSD after 3 months
trauma focussed CBT or EMDR
what medication, if any, should you give for PTSD?
paroxetine
mirtazepine
1st to 5th line treatment for social anxiety
- individual CBT
- SSRI
- SSRI + CBT
- change SSRI or SNRI
- MAOI
1st and 2nd line SSRIs for social anxiety
- escitalopram or sertraline
2. fluoxetine or fluvoxamine
what MAOI should be given for social anxiety?
phenelzine
