Antianxiety Medications - Handbook Of Clinical Psychopharmacology For Therapists

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First benzodiazepine

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Choldiazepoxide

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Benzodiazepines

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are used for anxiety (sedatives) and insomnia (hypnotics)

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Benzodiazepines used as hypnotics

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are flurazepan, temazepam, and triazolam

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Benzodiazepines can cause

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sedation, slurred speech, incoordination, prolonged response time in higher doses, and lessening of inhibitors

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Main differences between drugs

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are half-life and metabolism

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Very short half-life drugs

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can cause anterograde amnesia (triazolam, midazolam, and lorazepam)

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Longer half-life

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tend to build up in the system

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Types of antianxiety drugs

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Benzodiazepines, atypical benzodiazepines, buspirone, antihistamines, beta blockers, clonidine, tiagabine

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Benzodiazepines

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work by integrating with bz receptors, of which there are three types

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BZ receptors

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are co-located with GABA receptors (presynaptic inhibiting receptors)

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BZ receptors

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have a high density in the limbic system

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Binding a benzodiazepine at the BZ receptor

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enhances the effect of GABA and increases the influx of chloride ions

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Atypical benzodiazepines

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new benzodiazepines derivatives being used as hypnotics

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Atypical benzodiazepines may be associated

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with less cognitive impairment and reduced risk of dependency

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Examples of atypical benzodiazepines

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are Estazolam (ProSom), quazepam (Doral), zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata)

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Zolpidem, eszopidone, and zaleplon

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have little effect on sleep architecture

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Most benzodiazepines tend to

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suppress REM sleep and Stage III and IV (delta) sleep

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Buspirone

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acts at the 5-HT 1A receptor

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Buspirone tend to have

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a delayed onset of action -as antidepressants

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Advantages of buspirone over benzodiazepines

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are that it is not associated w/ tolerance or dependence, it does not interact w/ other CNS depressants, and it is not associated w/ impaired psychomotor functions

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Buspiron disadvantages

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are its delayed onset of action and that it is not always effective

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Most common side effects of buspirone

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are nausea, dizziness, and anxiety

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Antihistamines

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are frequently used in the treatment of anxiety

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Examples of antihistamines

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are hydroxyzine and diphenhydramine

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Hydroxyzine and diphenhydramine

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act by blocking histamine receptors in the CNS, causing sedation

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Side effects of antihistamines

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are drowsiness and impaired performance

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Beta blockers

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act by blocking the effects of norepinephrine at the receptor

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Beta blockers are very effective

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at reducing the peripheral manifestations of anxiety (increased heart rate, sweating, tremor), but aren't very effective at blocking the internal experience of anxiety

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Beta blockers are used

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for the treatment of performance anxiety

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Most common beta blocker

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is propranolol (Inderal)

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Beta blockers side effects

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are dizziness and lower blood pressure, and can cause depression if used over a long period of time

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Beta blockers are used

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as an adjunctive agents in the treatment of panic disorders

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Clonidine

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is an alpha-2 adrenergic agonist

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Clonidine functions as

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a presynaptic inhibitor of norepinephrine release

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Clonidine is used

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to treat hypertension and opiate withdrawal

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Tiagabine

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is a selective GABA reuptake inhibitor used as an anticonvulsant

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Tiagabine is currently used in clinical trials for

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PTSD and panic disorders