Week 2-anti-anxiolytics Flashcards
What drug classes can be used in the treatment of anxiety?
Benzodiazepines
Antidepressants
Beta blocker (blocks adrenaline so you don’t get the sweaty hands, shakiness etc)
Pregablin (used in epilepsy, generalised anxiety)
Buspirone (generalised anxiety drug)
Which benzodiazepine is used in alcohol withdrawal?
Chlordiazepoxide
What effects do benzodiazepines have on the body?
Reduce anxiety and aggression Sedation/hypnosis Muscle relaxation Anticonvulsive effect Anterograde amnesia (when you can't remember anything after the amnesia has come)
What is GABA? What does it cause to cells?
The main inhibitory neurotransmitter in the CNS
Causes hyper polarisation of cells.
How does GABA work? How do benzodiazepines affect GABA?
GABA binds to GABA receptors causing chloride entry into the cell. This causes hyperpolarisation. Benzodiazepines enhance the effects of GABA on the cells.
Which other conditions (other than anxiety) and scenarios are benzodiazepines used?
Hypnosis Alcohol withdrawal Mania Delirium Status epilepticus.
Rapid tranquilisation
Premedication before surgery
Meaning of anxiolytic?
Reduce anxiety
What are the issues with benzodiazepines?
They can cause paradoxical aggression
You can become tolerant to them
What are the issues with benzodiazepines and alcohol?
Alcohol also works on GABA, so if you use both you may overdose.
What issues may arise from rapid withdrawal of benzodiazepines?
May cause confusion, toxic psychosis and in some cases convulsions.
Also insomnia, anxiety, loss of appetite and body weight, tremor, perspiration and perceptual difficulties.
How does chronic treatment with benzodiazepines affect GABA?
Chronic treatment causes a decreased response to GABA.
How would you withdraw a patient from benzodiazepines?
Transfer patient to equivalent dose of diazepam/chlordiazepoxide (these have longer half lives).
Reduce dose every 2 weeks in steps of 2-2.5mg. Maintain this dose until symptoms improve
Reduce dose further, if necessary in smaller steps
Stop completely.
How can pregablin help in anxiety? When is it used?
Its a calcium channel blocker and enhances GABA effects.
Only considered if not responsive to other treatment.
When are beta blockers used to help anxiety?
Used for somatic symptoms e.g. palpitations, tremor.
Which antidepressants would you use for anxiety?
1- SSRIs
2-Tricyclics- clomipramine, imipramine
3- Venlafaxine (SNRI)
4-Moclobremide (atypical- reversible)
