Pharmacology of Anxiolytics

Question 1

Drugs used to treat anxiety

Answer 1

Benzodiazepines
Antidepressant drugs
Busiprone (anxiolytic)
Pregabalin
B-Blockers (propanolol)

Question 2

Co-morbidities of anxiety

Answer 2

Substance abuse
ADHD
Bipolar 
Pain disorder
Sleep disorder

Question 3

symptoms of anxiety

Answer 3

Fear (panic, phobia)

Worry (anxiety, apprehension, obsessions)

Question 4

What is GABA?

Answer 4

Main inhibitory neurotransmitter in brain (benzodiazepines enhance GABA action)

Question 5

Circuit responsible for fear part of brain

Answer 5

Amygdala-Centred Circuit

Question 6

GABA-A (main receptor) targeted by …

Answer 6

Benzodiazepines, barbiturates + alcohol (has allosteric affect on GABA so increasing inhibition)

Question 7

examples of benzodiazipines:

Answer 7

Lorazepam

Diazepam

Question 8

Pharma effect of benzodiazipines:

Answer 8

Reduce anxiety
Hypnosis/sedation
Muscle relaxation
Anticonvulsant effect
Anterograde amnesia

Question 9

Clinical uses of benzos:

Answer 9

Acute treat extreme anxiety
Hypnosis
Alcohol withdrawal
Mania
Delirium
Rapid tranquillisation
Before surgery
Status epilepticus

Question 10

problems with benzos

Answer 10

-Fairly safe in overdose (unlikely to lead to resp depression)
BUT
-can increase aggression (paradox)
-Anterograde amnesia (new memories)
-Tolerance and dependence SO SHORT TERM USE RECOMMENDED (2-4 WEEKS)

Question 11

causes of withdrawal symptoms =

Answer 11

rapid withdrawal (confusion, psychosis, tachy, tremor)
Neuroadaptation of GABA response (chronic treatment > anxiety/convulsions)

Question 12

How to withdraw benzodiazepines

Answer 12

reduce dose every 2-3 weeks in steps of 2-2.5mg (if symptoms occur maintain dose until improvement)

Question 13

role of serotonin

Answer 13

• key neurotransmitter that innervates amygdala

- SSRIs + SNRIs increase serotonin by blocking the serotonin transporter

Question 14

How antidepressants treat anxiety?

Answer 14

Acutely (SSRIs increases serotonin)

Chronically (Anxiolytic properties appear)

Question 15

What is pregabalin?

Answer 15

Ca channel blocker
GABA enhancer
only considered if not responsive to other treatments

Question 16

B-Blockers

Answer 16

Propranolol

best for somatic symptoms (e.g. plapitation, tremor)

Question 17

Management of GAD

Answer 17

1. Psychoedcuation
2. CBT OR SSRI
3. SNRI
4. Pregabalin
5. Combine CBT + drug treatment

Question 18

Reviewing management of GAD

Answer 18

• up to 12 weeks to assess efficacy
• continue for 18 months
• on stopping, be gradual

Question 19

Management of panic disorder

Answer 19

1.self help
2.CBT or SSRI (no benzos)
3.TCAs
Continue treatment for 6 months

Question 20

Management of OCD

Answer 20

1. CBT + ERP
2. SSRI
3. Increase dose after 4-6 weeks
4. SSRI + CBT + ERP
5. Clomipramine
6. Augment with antipsychotic or clomipramine plus citalopram

Question 21

Management of PTSD

Answer 21

1. mild (watchful waiting)
2. CBT, hypno medication for sleeping
3. CBT or EMDR
4. maybe paroxetine

Question 22

Management of social anxiety

Answer 22

1. CBT
2. SSRI (escitalopram or sertraline)
3. SSRI + CBT
4. Alternative SSRI (paroxetine)
5. MAOi (moclodemide)

Question 23

what are anxiolytics?

Answer 23

Anti-Anxiety Medications