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56 Cards in this Set
- Front
- Back
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When do we use Anxiolytics and Sedative-Hypnotics?
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Anxiety Disorders
Insomnia Presurgical/procedural Sedation Anesthetic/Amnesic |
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What is GAD?
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Generalized Anxiety Disorder
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Sx's of GAD?
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-Inappropriate, Excessive worrying that Persists
-Not Restricted to a set of circumstances -Difficulty Concentrating -Motor Tension, restlessness, tremor, autonomic sx's -often comorbid w/ depression -impairs function |
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Lifetime prevalence of GAD?
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5-6%
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When is typical onset of GAD?
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35-40yrs old
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Is GAD usually acute or chronic?
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Chronic
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What are specific AD's?
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Specific Phobias
OCD PTSD Acute Panic Attacks |
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Sx's of Insomnia
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-Difficulty initiating or maintaining sleep
-Nonrestorative Sleep-->daytime fatigue -Impaired concentration, reduced psychological wellbeing -Functional Impairment |
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Prevalence of Insomnia?
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10-30%
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What is there a high incidence of with insomnia?
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self-medication (booze)
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Different Types of Insomnia
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Primary
Secondary (comorbid) Circadian Rhythm Disorders (jet lag) |
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What is unique about the GABA receptor structure?
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It is a pentamer with 2 GABA binding sites. Due 5 parts, you can have various subtypes of binding sites.
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What are the most common subtypes?
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alpha 1, 2, and 3
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What is the progression of effects that goes along with increasing doses of valium?
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Sedation
Hypnosis Anesthesia |
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Which receptor part is associated with the hypnotic/anticonvulsant/amnestic effects
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Alpha 1
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Which receptor part is associated with the anxiolytic effect?
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Alpha 2 and 3
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Which receptor part is associated with tolerance?
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Alpha 5
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What are the available types of anxiolytics/sedatives?
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Antidepressant Drugs
Benzodiazepines Buspirone (5HT1A agonists) |
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Which is the first line?
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Antidepressants (SSRIs)
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Which one of the types is not prone to abuse?
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Buspirone
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What are the general characteristics of Antidepressants used for Anxiety Disorders?
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First Line Therapy
Delayed Onset of Action (ineffective in acute panic) Increased Anxiety upon initiation of therapy Effective with Comorbid Depression General SSRI SE's |
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Which antidepressants are used for anxiety disorders?
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Fluoxetine (prozac)
Escitalopram (lexapro) Fluvoxamine (Luvox; OCD) Paroxetine (paxil) Sertraline (zoloft) Venlafaxine (Effexor; SNRI) |
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Buspirone's Mechanism
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Partial 5HT1A Agonist
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General Characteristics of Buspirone?
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Slower Onset than BZD's, faster than AD's
Hepatic Metabolism No psychomotor impairment Well tolerated Non-sedative No Abuse Potential Monotherapy or with SSRI's |
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BZD's onset?
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Rapid onset
Effective in acute panic |
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BZD's chemical qualities???
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Lipophilic
Hepatic Metabolism Active Metabolites |
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What happens upon cessation of BZD's?
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Rebound Anxiety
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What do BZD's do with comorbid depression?
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NOTHING
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What about BZD adverse reactions?
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High Therapeutic Index so tough to OD on, but there is a high potential for interactions
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BZD's + ____ = fatal reaction?
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Other CNS Depressants (like booze)
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What other adverse effects come with BZD's?
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Sedation
Ataxia Amnesia |
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Why are BZD's second line therapy?
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They're effective, but prone to dependency/withdrawal
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Which BZD's can be used for anxiety disorders?
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Diazepam (valium)
Chlordiazapoxide (librium) Alprazolam (xanax) Clorazepate (tranxene) several others |
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What type of BZD's are being developed currently?
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More specific. So they can target specific receptors
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What are some non-pharmacological rx's for anxiety disorders?
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Fear conditioning and Extinction
Exposure Therapy (with D-cycloserine) |
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What do we give to folks with insomnia?
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HYPNOTICS!
BZD's Non-BZD's (Z-drugs) Ramelteon (MT1 agonist) Off-Label (AD's) and OTC's Exercise |
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What subtype do the BZD's for insomnia go after?
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Not Subtype selective (maybe alpha1)
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What is a bad part of BZD's and insomnia?
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Decrease REM and SWS
Increase stage 2 NREM Motor Impairment Amnesia Residual Sedation Risk of Dependency Risk of Tolerance |
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Due to adverse BZD effects, how are they prescribed?
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Therapy is limited to 4 weeks
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Which BZD's are used for insomnia?
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Triazolam
Estazolam Temazepam |
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What are the short-acting BZD's?
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Midazolam (versed)
Lorazepam (ativan) |
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When are the short acting BZD's used?
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Parenteral
Preanesthetic Preprocedure |
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What is up with Flumazenil?
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It is a BZD binding site antagonist
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When is Flumazenil used?
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For reversal of BZD Effect
or BZD OD |
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How is Flumazenil administered?
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IV only
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What is the first-line therapy for insomnia?
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The Z-drugs
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What is their mechanism of action?
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BZD Binding site Alpha-1 receptors
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Why are they better?
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Minimal Disruption of Sleep Architecture
No REM sleep rebound |
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Side Effects of Non-BZD's
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Motor Impairment
Amnesia Residual Sedation |
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How many prescriptions of Z drugs are out there?
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60 Million
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Who are the Z-drugs?
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Zolpidem (ambien)
Zaleplon (sonata) Eszopiclone (lunesta) |
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What are the benefits of Zaleplon?
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short half life (1hr)
So they're good to take if you have to get up soon |
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What is eszopiclone used for?
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its approved for chronic use
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What is Ramelteon's mechanism?
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MT1 Agonist (melatonin)
No effect on GABA transmission |
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Benefits of Ramelteon?
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No rebound
No Tolerance No Dependence Not a controlled substance Short Duration of Action |
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What is Ramelteon best used for?
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Circadian Desynchrony (jet lag) thanks to its short duration of action
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