Anxiolytics

Front 1

Anxiety disorder is the ___ psychiatric disorder in adults

Back 1

1. most common

Front 2

There are 4 pathways involved in the anxiety disorders:
1. Noradrenergic system which includes the _____ ______ (the alarm center) which may be hypersensitive, and may lead to increased noradrenergic transmission
2. the Serotonergic system-- serotonin in the amygdala turns on ___ which turns off the excittatory NT ____
3. GABA system-- which is the major ___ transmitter
4. Peptide system-- ____ enhances noradrenergic activity in the locus cerulus

Back 2

1. locus cerulus
2. GABA, glutamate
3. inhibitory
4. CCK

Front 3

Which classes of drugs are associated w/ anxiety sx?
1.
2.
3.
4.

Back 3

1. stimulants
2. sympathomimetics
3. SSRI adn SNRI, buprion-- transient increase
4. Doapminergics-- amntadine, bromocriptine, L Dopa, carpidopa/levodopa

Front 4

GAD is defined generally as a fear of the ___ w/o any _____. They find it difficult to control these worrisome thoughts.

Back 4

1. future
2. reason

Front 5

To meet the DSM IV criteria for GAD a person must have xs anxiety and difficulty controlling the worry and on top of these also have 3 or more of: restlessness, fatigue, muscle tension, irritability, difficulty concentrating, and sleep disturbance. How long must at least 5 of these sx persist?

Back 5

1. must have 5 of the listed sx (including xs worry and difficulty controlling the worry) for at least 6 mos

Front 6

PD- fear of ____. Has ___ periods of sudden feeling of impending doom and terror.
Will the precipitating cause usually be known?
PD may lead to what kind of phobia?
How long can an attack last?

Back 6

1. dying
2. discrete
3. ppt-ing cause will not be known
4. agoraphobia
5. starts abruptly and reaches a peak within 10 mins- does not last longer than 30 mins

Front 7

PD dx requires 1 or more attack plus
1.
2.
3.

Back 7

1. persistent worry about having another attack
2. worry abt what would happen if another attack happens-- might have heart attack or go crazy
3. pt has significant behavior change b/c of attack

Front 8

PTSD Sx
1. Re-experiencing--______
2. ____ behaviors- detachment, from ppl, locations, events etc
3. ___-insomnia, fear, irritability, anger, hyper vigilance

Back 8

1. flashbacks
2. avoidance
3. hyperarousal

Front 9

SAD- fear of ___
SP- fear of specific objects

Back 9

1. embarrassment

Front 10

CBT- is effective at preventing ___

Back 10

1. relapse

Front 11

Which antidepressant is generally less effective for anxiety tx, and completely ineffective for PD?
SSRIs are generally useful for all anxiety disorders except?

Back 11

1. buspirone

2. specific phobias

Front 12

B/c antidepressants often have initial phase of increased anxiety what should you do to minimize this SE?

Back 12

1. start at the lowest dose possible

Front 13

BZD- MOA

Back 13

- mediate inhibitory action of GABA by binding to POST synaptic receptors of GABA neurons opening up Cl- channels and hyperpolarizing the neurons
- will bind to GABA receptors and make them enter a high affinity state so that more GABA is bound-- hyperpolarizing the cell
- increase frequency of opening of GABA-ergic channels

Front 14

Barbituates- MOA
Do they have ceiling doses?

Back 14

- increase opening time of gaba-ergic channels -- so that more CL- can enter the neuron-will hypeorpolarize the neuron
- no

Front 15

BZD- PK
1. Which BZD has quickest absorption and distribution?
2. Which has the slowest absorption and distribution?
3. Which are long acting BZDs?
4. Which are short acting BZDs? When are they preferred?

Back 15

1. diazepam-- highest lipophillicity
2. Temazepam- lowest lipophilcity
3. chlorodiazepoxide, clorazepate, and diazepam
4. lorazepam and oxazepam- preferred in elderly pts and pts w/ hepatic involvement

Front 16

What is the main benefit of short acting BZDs?
What are the short term BZDs?

Back 16

1. less accumulation
2. lorazapam, oxazepam

Front 17

BZDs- Use
Which pts should not really be given BZDs?

Back 17

- alleviate anxiety more quickly than other antidepressant or buspirone-- may consider short term use w/ SSRIs while waiting fro ADs to work, only if very disabling anxiety
- short term -- when SSRIs might give transient increase in anxiety
- can be considered for long term use when lots of somatic sx w/ the anxiety
- pts w/ hx of substance abuse, not good for PTSD b/c of high levels of subst abuse
- not good for tx of OCD if pt is concomitantly undergoing CBT
- not good for depression tx

Front 18

BZDs- AE, Tox

Back 18

- sedation, ataxia, psychomotor/cog impairment, anterograde amnesia, pardox excitement and aggression (RARE), resp depression (rare)
Tox: have additive effects w/ other CNS depressants-- alcohol and benzos can be fatal if mixed

Front 19

Flumazenil- MOA, Use, Tox

Back 19

MOA- competitive antagonist at BZ receptor site
Use: reversing BZ induced sedation or amnesia
Tox: may ppt benzo withdrawal

Front 20

BZDs- tolerance to which of BZDs effects?
- Dependance-- what happens in physio withdrawal?, how to avoid?

Back 20

- tolerance to BZDs euphoria in 3-4 wks
- tolerance to anxiolytic effects uncommon
- may need to increase dose

- withdrawal-- may have 1-8 days after BZDs discontinued, leads to potentially fatal SZ-- to avoid must taper BZDs

Front 21

After discontinuation of BZD what can happen?
1.
2.
How to prevent 1?

Back 21

1. relapse
2. rebound- worse than original sx
2. prevent relapse by tapering-- 1 yr of use requires 2-4 mos of tapering

Front 22

Buspirone- MOA

Back 22

MOA: partial agonist at 5HT1A receptor presynaptically-- anxiolytic activity, has no intxn w/ BZD- Cl complex
- no anticonvulsant, muscle relaxant, or sedative properties

Front 23

Buspirone- Use, MOA

Back 23

MOA: partial agonist at 5HT1A site
- GAD, no efficacy for PD, has long onset of action-2-4 wks (not for PRN use)
- good for pts w/ hx of substance abuse or w/ sleep apnea
- high safety, doesnt have synergisitc effect w/ alcohol
- no rebound anxiety or withdrawal sx

Front 24

Beta blockers- Use

Back 24

- as ADJUNCT only for the autonomic sx of anxiety
- good for pts w/ PTSD

Front 25

MAO-I- Use

Back 25

- good for PD- not used often b/c of AE

Front 26

Antihistamines w/ sedating properties- Use

Back 26

- help reduce anxiety-- i.e. hydroxyzine- in pts w/ substance abuse problems

Front 27

Barbituates- Use
Antipsychotics--Use

Back 27

Barbituates- VERY RARELY and may be lethal
Antipsychotics- scant efficacy data- concerns about wt gain and metabolic deregulation

Front 28

PD- first choice drug?
Which may also work? Which drug will NOT work?

Back 28

1. First line- SSRIs
2. second line- TCAs and MAOIs
- long acting BZDs may be used, though short acting BZDs should not be used- risk of Sz
3. Buspirone does not work for PD

Front 29

OCD tx- DOC?
- other txs?

Back 29

- SSRIs- require higher doses than those used to tx depression
- need at least 10 wks to assesss effectiveness
- CBT more effective than meds

Front 30

PTSD Tx-
What drug should not be used?

Back 30

- SSRI, then TCAs and MAOIs
- worsen w/ BZDs

Front 31

What other meds should be used adjunctively in PTSD?

Back 31

- beta blockers- propanolol
- also alpha blocker-- clonidine-- alpha 2 agonist-- reduces NE release

Front 32

SAD tx?
Performance anxiety?
Specific phobias?

Back 32

1. SAD- SSRIs and MAOIs
2. performance anxiety- propranolol
3. not txed w/ meds-- instead systematic dessensitizaiton