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Psychiatry > Pharmacology of Anxiolytic Drugs > Flashcards

Pharmacology of Anxiolytic Drugs Flashcards

1
Q

what drugs are used to treat anxiety

A 
benzodiazepines 
antidepressants
busiprone 
pregabalin 
beta-blockers (propanolol)
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2
Q

when is anxiety a disorder

A

when it affects concentration, fatigue, sleep and arousal

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3
Q

what is anxiety commonly co morbid with

A

substance abuse, BPAD, pain and sleep disorders, other anxiety disorders

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4
Q

what are the core symptoms of anxiety and what part of the brain is responsible for them

A

fear: panic and phobia = amygdala centered circuit
worry: anxiety, apprehension, obsessions = cortico- striatal- thalamic- cortical circuit

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5
Q

what does the amygdala do

A

intergrates sensory and cognitive information

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6
Q

what part of brain: affect of fear

A

anterior cingulate cortex/ orbitofrontal cortex

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7
Q

what part of brain: avoidance

A

periaqueductal gray (fight/ flight)

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8
Q

what part of brain: endocrine element of fear

A

hypothalamus (increases cortisol)

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9
Q

what part of brain: autonomic output during fear

A

locus coeuleus (increase BP and HR)

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10
Q

what part of brain: re-experiencing of fear

A

hippocampus (traumatic memories)

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11
Q

what neurotransmitters are involves in amygdala centred circuits

A 
5HT (Serotonin) 
GABA (gamm-aminobutyric acid) 
glutamate 
CRF (corticotophin releasing hormone)
NE (norepinephrine)
voltage gated ion channels
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12
Q

what is GABA

A

main inhibitory neurotransmitter

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13
Q

what does GABA do

A

reduced the activity of neurones in amygdala and CSTC (cortico-striato-thalamo-cortico) circuit

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14
Q

what do benzodiazepines do

A

enhance GABA action (inhibit neurones in maygdala and CSTC circuit)

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15
Q

what are the main GABA receptors

A

GABA-A

GABA-B
GABA-C

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16
Q

what else activates GABA-A

A

benzodiazepines, barbiturates, general anaesthetics: alcohol, steroids, propofol, haloethane

17
Q

explain the action of benzodiazepines

A

binds at allosteric site on GABA receptor
this increases effect of GABA on channel and increases the activity of the GABA recpetor
=increases amount of Cl- passing into neurone
this hyperpolarises membrane potential making it less likely for the neurone to produce an AP

18
Q

give examples of benzodiazepines

A 
lorazepam
midazolam 
diazepam (valium)
alprazolam (xanax)
chlordiazepoxide

all end in epam (-chlordiazepoxide)

19
Q

what are the pharmacological effects of benzodiazepines

A 
reduce anxiety and aggression 
hypnosis/ sedation 
muscle relaxant 
anticonvulsant effect 
anterograde amnesia
20
Q

what are the clinical uses of benzodiazepines

A 
acute treatment of extreme anxiety 
hypnosis 
alcohol withdrawal 
mania
delirium 
rapid tranquilisation 
premedication before surgery or during minor procedure 
status epilepticus
21
Q

what are potential problems with benzodiazepines

A

fairly safe in overdose (antagonist flumazenil)
paradoxical aggression
anterograde amnesia & impaired coordination
tolerance + dependence

22
Q

what are the symptoms of benzodiazepine withdrawal

A 
abdo cramps 
increased anxiety, panic attacks 
physical symptoms (muscle tension, chest pain, palpitations, sweating, shaking)
blurred vision 
insomnia 
dizziness 
headaches 
inability to concentrate 
nausea and vomiting 
tingling in hands and feet restlessness
sensory sensitivity
23
Q

what causes benzodiazepine withdrawal symptoms

A

rapid withdrawal - confusion, psychosis, convulsions, tachycardia, sweating, hypertension, agitation, tremor

neuroadaption of the GABA response: chronic treatment- anxiety/ convulsions

24
Q

how do you withdraw patient from benzodiazepines

A

transfer to equivalent dose of diazepam/ chlordiazepoxide- preferably taken at night

reduce tose every 2-3 weeks in 2-2.5mg steps (maintain dose is symptoms occur)

reduce dose further (if necessary in smaller steps)

stop completely (can take 4 weeks- year+)

25
Q

what increases serotonin by blocking the serotonin transporter

A

SSRIs and SNRIs

26
Q

how do antidepressants treat anxiety

A

acutely- SSRIs increase extracellular serotonin

chronically- anxiolytic properties appear (?neuroadaptove changes/ enhances neurosteroid synthesis)

27
Q

what antidepressants are used for anxiety

A

SSRIs - panic disorder, OCD, PTSD, phobias, GAD (escitalopram, paroxetine)

tricyclics (clomipramine, imipramine)- 2nd line for panic disorder, OCD

venlafaxine (SNRI)- GAD

moclobemide (MAOI)- social anziety disorder

28
Q

when should pregabalin be used for anxiety

A

only considered if not responsive to other treatments

29
Q

how does pregabalin work

A

Ca2+ channel blocker, GABA enhancer

30
Q

when should beta blocker be used for anxiety

A

best for somatic symptoms- palpitation, tremor

31
Q

what is the management pathway for GAD

A
  1. psychoeducation
  2. self help/ 3. psychoeducation groups
  3. CBT/ SSRI (consider short term use of benzodiazepines <2 weeks)
  4. SNRI
    pregabalin
  5. combo of CBT and drugs
32
Q

when do you review management of GAD

A

up to 12 weeks

no response in 4 weeks= unlikely to get response

33
Q

what is the management pathway for panic disorder

A
  1. self help
  2. CBT or SSRI
    (avoid benzos, propanalol, bupropion)
  3. tricyclics (clomipramine, desipramine, imipramine, lofepramine)

continue treatment for 3 months

34
Q

what is the management pathway for OCD

A
  1. low intensity psychological intervention (CBT and erp (exposure and response training), self help/ group)
  2. more intense psychotherapy/ SSRI
    - if effective continue for a year
  3. increase dose after 4-6 weeks
  4. SSRI plus CBT and ERT
  5. clomipramine (tricylic)
    • antipsychotic/ clomipramine and citalopram
35
Q

what is the management for PTSD

A
  1. watchful waiting if mild and within 4 weeks of trauma
  2. if within 3 months of trauma: CBT, hyponotic medication for sleep disturbance
  3. > 3 months: truama focussed CBT or eye movement desensitisation and reprocessing
  4. limited evidence for drugs
36
Q

what is the management pathway for social anxiety

A
  1. individual CBT
  2. SSRI (escitalopram or sertaline
  3. SSRI plus CBT
  4. alternative SSRI (fluvoxamine or paroxetine) or SNRI (venlafaxine)
  5. MAOI (moclobemide)
37
Q

how long should benzodiazepines be used for

A

2-4 weeks to prevent dependence

Psychiatry (27 decks)

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