Treatment of Anxiety Flashcards
List some groups of medications used in the management of anxiety
Benzodiazepines Anti-depressants Buspirone Pregabalin Beta-blockers (mainly propranolol)
What is the main inhibitory transmitter found in the brain?
GABA
What does GABA do in the brain?
It reduces activity of neurons in the amygdala and CSTC circuits
Outline the mechanism of action of benzodiazepines:
They specifically target GABA-A receptors, enhancing the action of GABA
List some examples of benzodiazepines used in anxiety?
Diazepam
Lorazepam
Chlordiazepoxide
What effects do benzodiazepines have
Reduces anxiety Sedation Muscle relaxation Anti-convulsion properties Reduces aggression
Other than anxiety, what else can benzodiazepines be used for?
Hypnosis Alcohol withdrawal Mania Delirium Tranquilisation Status Epilepticus
Benzodiazepine overdose is fatal. True/False
False
They are fairly safe in overdose alone - unlikely to cause significant resp depression
List some side effects of benzodiazepines:
Paradoxical aggression Anterograde Amnesia Impaired coordination Tolerance Dependence
List some symptoms of benzodiazepine withdrawal:
Abdo cramps Increased anxiety Depression Palpitations Sweating Chest pain Headaches N & V Restlessness Blurred vision Insomnia
Why does withdrawal of benzodiazepines lead to anxiety?
Chronic use of benzodiazepines can lead to a decreased response to GABA in the body due to neuroadaption.
How do you withdraw a patient off benzodiazepines:
Initially change dose to night
Reduce dose gradually every 2-3 weeks and maintain dose until symptoms stabilize
Reduce further over time
Stopping completely can take up to a year or more
What anti-depressants are authorized in the treatment of anxiety?
SSRIs –> 1st line
Tricyclics –> 2nd line
Venlafaxine (SNRI)
MAOI - moclobemide
How does pregabalin work?
Ca2+ channel blocker which enhances GABA
When are beta-blockers used?
They can be used to treat somatic symptoms such as palpitations and tremors
