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Psychiatry > Pharmacology of Anxiolytic Drugs > Flashcards

Pharmacology of Anxiolytic Drugs Flashcards

1
Q

What are some drugs used to treat anxiety?

A

Benzodiazepines, antidepressants, beta blockers, pregabalin, bispirone

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2
Q

What are some comorbid disorders of anxiety?

A

Substance abuse, ADHD, bipolar disorder, panic disorder, sleep disorder

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3
Q

What are the core symptoms of anxiety?

A

Significant symptom overlap with depression
Amygdala centred circuit = panic and phobia
Cortico-striatal-thalamic-cortical (CSTC) circuit = anxiety, apprehension, obsessions

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4
Q

What is the function of the amygdala in anxiety?

A

Integrates sensory and cognitive symptoms

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5
Q

Where in the brain is the affect of fear seen?

A

Anterior cingulate cortex and orbitofrontal cortex

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6
Q

What is the periaqueductal gray responsible for?

A

Fight or flight response

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7
Q

What part of the brain is ultimately responsible for increasing cortisol levels?

A

Hypothalamus

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8
Q

How does the locus coeruleus increase blood pressure and heart rate in fear?

A

Via autonomic output

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9
Q

What kind of memories is the hippocampus responsible for?

A

Traumatic memories

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10
Q

What neurotransmitters are involved in the amygdala centred circuit?

A

5-HT, GABA, glutamate, CRF, NE and voltage gated ion channels

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11
Q

What is GABA?

A

Main inhibitory transmitter in brain = reduces activity of neurons in the amygdala and CSTC circuit

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12
Q

What effect do benzodiazepines have on GABA?

A

Enhance GABA activity

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13
Q

What are the main GABA receptors?

A

GABA-A, GABA-B and GABA-C

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14
Q

What is GABA-A a target for?

A

Benzodiazepines, alcohol and barbiturates

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15
Q

What are some examples of benzodiazepines?

A

Lorazepam, diazepam and chlordiazepoxide

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16
Q

What effects do benzodiazepines have?

A

Reduce anxiety and depression, hypnosis and sedation, muscle relaxation, anticonvulsant, anterograde amnesia

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17
Q

What are the clinical uses of benzodiazepines?

A

Acute treatment of extreme anxiety, hypnosis, alcohol withdrawl, mania, delirium, rapid tranquillisation, status epilepticus

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18
Q

What are some side effects of benzodiazepines?

A

Paradoxical aggression, anterograde amnesia and impaired co-ordination, tolerance and dependence

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19
Q

What are some symptoms of benzodiazepine withdrawl?

A

Abdominal cramps, panic attacks, sweating, shaking, palpitations, blurred vision, depression, insomnia, dizziness, headaches, nausea/vomiting, tingling in hands/feet, restlessness, sensory sensitivity

20
Q

What causes the symptoms of benzodiazepine withdrawl?

A

Chronic treatment reduces response to GABA = withdrawl results in anxiety or convulsions due to reduced density of benzodiazepine receptors

21
Q

What is the first step when withdrawing a patient from benzoddiazepines?

A

Transfer patient to equivalent daily dose of diazepam or chlordiazepoxide preferably taken at night

22
Q

How often do you reduce dose of benzodiazepines when withdrawing a patient from this drug?

A

Reduce dose every 2-3 weeks in steps of 2-2.5mg = if withdrawl symptoms occur then maintain dose until they clear, reduce dose further after this

23
Q

How long can it take to withdraw a patient from benzodiazepines?

A

Can take anything from 4 weeks up to 1 year or more

24
Q

Where does 5-HT innervate?

A

The amygdala

25
Q

How do SSRIs and SNRIs increase 5-HT levels?

A

Block the 5-HT transporter

26
Q

How do SSRIs increase 5-HT levels?

A

Inhibit reuptake of 5-HT = leads to increased levels in the synaptic cleft

27
Q

What antidepressants can be used acutely to treat anxiety?

A

SSRIs = increase extracellular 5-HT

28
Q

What does chronic use of antidepressants to treat anxiety cause?

A

Anxiolytic properties begin to appear

29
Q

By which mechanisms do antidepressants treat anxiety?

A

Expression of receptors for 5-HT and glucocorticoids that depend upon sustained exposure to high extracellular concentrations of 5-HT
Enhanced neurosteroid synthesis

30
Q

What anxiety disorders can SSRIs be used to treat?

A

Panic disorder, OCD, PTSD and phobias

Paroxetine and escitalopram used for GAD

31
Q

What anxiety disorders are tricyclics used to treat?

A

Used for OCD

2nd line for panic disorder

32
Q

What is venlafaxine (SNRI) used to treat?

A

GAD

33
Q

What is moclobemide (MAOI) used to treat?

A

Social anxiety disorder

34
Q

What are some features of pregabalin?

A

Ca2+ channel blocker and GABA enhancer = only considered if patient not responsive to other treatments

35
Q

What are some features of propanolol?

A

Beta blocker = best used for somatic symptoms (e.g palpitations or tremor)

36
Q

What are the steps for treating GAD?

A 
1 = psychoeducation and self help/psychoeducation groups 
2 = CBT or SSRIs ( consider <2 weeks benzodiazepines)
3 = SNRI
4 = Pregabalin
5 = combination of CBT and drug treatment
37
Q

How often should you wait before reviewing treatment of GAD?

A

Up to 12 weeks to asses efficacy = unlikely to respond if no effect in 4 weeks

38
Q

How long should you stay with the treatment for GAD?

A

Continue for 18 months

When stopping, reduce dose gradually to avoid discontinuation

39
Q

What are the steps for treating panic disorder?

A 
1 = self help
2 = CBT or SSRI (if no benefit from longstanding CBT)
3 = tricyclics (e.g clomipramine)
40
Q

What drugs should be avoided when treating panic disorder?

A

benzodiazepines, sedating antihistamines, propanolol, bispirone, bupropion

41
Q

How long do you stick with treatment for panic disorder?

A

6 months

42
Q

What are the steps for treating OCD?

A 
1 = low intensity psychological intervention
2 = more intensive psychological intervention or SSRI, continue for 1 year if effective
3 = consider dose increase after 4-6 weeks 
4 = SSRIs plus CBT and ERP
5 = clomipramine 
6 = augmentation with antipsychotic/clomipramine plus citalopram
43
Q

What is the treatment of PTSD within 4 weeks of the traumatic event?

A

Watchful waiting

44
Q

What is the treatment of PTSD within 3 months of the traumatic event?

A

Trauma focused CBT

Hypnotic medication for sleep disturbance

45
Q

What is the treatment for PTSD over 3 months since the traumatic event?

A

Trauma focused CBT or EMDR

46
Q

Are drugs used to treat PTSD?

A

Limited evidence for their use = paroxetine, mirtazepine, amitriptyline

47
Q

What are the steps for treating social anxiety disorder?

A 
1 = individual CBT
2 = SSRI (escitalopram, sertraline), review in 12 weeks
3 = SSRI plus CBT
4 = SNRI or alternative SSRI
5 = MAO inhibitor (moclobemide)

Psychiatry (36 decks)

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