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Psychiatry > Pharmacology of Anxiolytic Drugs > Flashcards

Pharmacology of Anxiolytic Drugs Flashcards

1
Q

Drugs used to treat anxiety?

A 
Benzodiazepines
ADs
Buspirone
Pregabalin
Propanolol
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2
Q

Which area of the brain predominates in fear based anxiety (panic, phobia)?

A

Amygdala centred circuit

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3
Q

Which area predominantes in worry based anxiety (anxiety, apprehension, obsessions)?

A

Cortico-striatal thalamic-cortical circuit

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4
Q

What is the function of the amygdala in fear?

A

Integrates sensory and cognitive info

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5
Q

Which area of the brain mediates avoidance in fear (fight/flight)?

A

Periaqueductal gray area of brainstem

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6
Q

Which area of the brain mediates the autonomic output in fear (incr BP and HR)?

A

Locus coeruleus

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7
Q

Which area of the brain mediates the re-experiencing of traumatic memories?

A

Hippocampus

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8
Q

Neurotransmitters involved in amygdala centred circuits?

A 
Serotonin
GABA
Glutamate
CRF
NA
Voltage gated ion channels
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9
Q

Action of GABA in fear?

A

Reduced activity of neurones in amygdala and CSTC circuit

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10
Q

Which drug`s for anxiety target GABA-A receptors?

A

Benzodiazepines; enhance GABA action

Also alcohol and barbiturates

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11
Q

Which ion channel is affected when BDZ binds to GABA-A receptors?

A

Chloride channel via positive allosteric modulation

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12
Q

Which anaesthetic agents act on the GABA receptors?

A

Propofol
Steroids
Halothane

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13
Q

Pharmacological effects of BZD

A 
Reduce anxiety and aggression 
Hypnosis/ sedation 
Muscle relaxation 
Anticonvulsant effect
Anterograde amnesia
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14
Q

Clinical uses of BZD

A 
Acute treatment of extreme anxiety
Hypnosis
Alcohol withdrawal
Mania
Delirium
Rapid tranquilisation 
Premedication before surgery 
Status epilepticus
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15
Q

Problems with BZD?

A

Paradoxical aggression
Anterograde amnesia and impaired coordination
Tolerance and dependence

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16
Q

Symptoms of BZD withdrawal?

A 
Abdo cramps
Increased anxiety
Blurred vision 
Depression 
Insomnia, nightmares
Dizziness
Headaches
Inability to concentrate
N+V
Restlessness
Sensory sensitivity
17
Q

Symptoms of raid withdrawal of BZD

A 
Confusion 
Psychosis
Convulsions 
Tachy
Sweating
Hypertx
Agitation 
Tremor
18
Q

How to withdrawal BZDs?

A

Transfer patient to daily dose of diazepam/ chlordiazepoxide
Reduce dose every 2-3 weeks in steps o 2- 2.5 mg
Reduce dose further
Stop completely

19
Q

What is the key nT that innervates the amygdala?

A

Serotonin

20
Q

How do ADs treat anxiety?

A

SSRIs increase extracellular serotonin
Neuroadaptive changes; expression of receptors for serotonin and/or glucocorticoids that depend upon sustained exposure to high extracellular concs of serotonin
Increased neurosteroid synthesis

21
Q

For what anxiety disorders are SSRIs prescribed?

A

Panic, OCD, PTSD phobias

GAS (escitalopram, paroxetine)

22
Q

When are TCAs prescribed in anxiety?

A

2nd line for panic disorder, OCD

23
Q

Mode of action of pregabalin?

A

Calcium channel blocker, increases GABA

24
Q

What drug is best for somatic symptoms (palpitation, tremor) of anxiety?

A

Propanolol

25
Q

Management of GAD?

A

CBT
SSRI
SNRI
Pregabalin

26
Q

How long should treatment be continued in GAD?

A

Up to 12 weeks to assess efficacy
Contie for 18 months
When stopping, reduce dose over 4 weeks to avoid discontinuation syndrome

27
Q

What drugs should be AVOIDED in panic disorder?

A

BZD
Propranolol
Buspirone
Bupropion

28
Q

How long should treatment be continued in panic disorder?

A

6 months

29
Q

Management of OCD

A

CBT & ERP
SSRI
SSRI plus CBT ERP
Clomipramine (TCA)

30
Q

How long should the SSRI be continued if effective in OCD management?

A

1 year

31
Q

Management of mild PTSD?

A

Watchful waiting

32
Q

Management of PTSD more than 3 months after trauma?

A

Trauma focused CBT or EMDR

33
Q

Are drugs commonly given in PTSD?

A

No; if so use paroxetine or mirtazapine

Psychiatry (35 decks)

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