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87 Cards in this Set
- Front
- Back
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Anxiety results from an __________
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anticipation of danger
may occur as a response to stress may not be an apparent precipitating stimulus normal adaptive response. |
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what do we see with anxiety physiologically?
BEHAVIORALLY? |
INCREASED SNS ACTIVITY, HYPERVIGILENCE.
BEHAVORIAL: CHANGE IN MOOD, FEAR AND OR APPREHENSION. |
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when is anxiety NOT considered normal?
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chronic
disproportionate to the situation or if it occurs without an identifiable stimulus it can interfere with normal behavior and lead to visceral organ dysfunction |
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Symptoms of anxiety?
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tension, apprehension, irratibility (psychic sx)
palpitations, sweats, breathlessness, tremor, fatigue, sleep disruption (somatic sx) single episode or multiple. |
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what are the 3 proposed models of anxiety?
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NORADRENERGIC
BENZODIAZEPINE SEROTONIN (5HT) |
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describe the serotonin model of anxiety?
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Generalized anxiety disorder symptoms reflect excessive 5HT transmission or overactivity of stimulatory 5HT pathways
OVERACTIVE 5HT |
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DESCRIBE THE BDZ model?
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Anxiety symptoms may be related to underactivity of GABA systems or down regulated BDZ receptors
UNDERACTIVE GABA |
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describe the NORADRENERGIC MODEL?
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ANS of anxious pts is hypersensitive and over reactive to various stimuli
Locus ceruleus plays a role in anxiety and activates NE release to stimulate ANS Chronic noradrenergic activity down regulates α2 receptors in generalized anxiety disorders and post traumatic stress disorder (PTSD) we see EVENTUAL DOWN REGULATION OF A2 RECEPTORS. |
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PTSD IS A TYPE OF?
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PRIMARY ANXIETY DISORDER
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GAD AND OCD ARE TYPES OF?
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PRIMARY ANXIETY DISORDER
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PANIC AND PHOBIAS ARE?
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PRIMARY ANXIETY DISORDER
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WITH PANIC ATTACKS WE SEE?
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Acute attacks of severe anxiety, overwhelming sense of doom,
Physical signs of sweating, tachycardia, tremor, other visceral symptoms Last about 20 minutes Persistent worry about another occurring Many patients develop agoraphobia |
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WHAT DO WE GIVE FOR PANIC ATTACKS?
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Benzodiazepines (alprazolam & clonazepam)
SSRI (fluoxetine) |
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IN GAD (GENERALIZED ANXIETY DISORDERS) WE SEE ?
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persistent state of fear and apprehension about future events causing significant distress
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HOW WOULD WE TX GAD?
ACUTE? CHRONIC? |
BDZ - may relieve acute symptoms and bridge for psychotherapy
Severity may be more or less over time BDZ may be useful for intermittent episodes BUSPIRONE - USEFUL FOR ALTERNATIVE CHRONIC STATES Non-sedating No tolerance or physical dependence Slow onset (3 – 4 weeks) |
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WHAT DISEASE IS DESCRIBED BY:
"features similar to other anxiety and mood disorders but is characterized by Obsessions (recurring thoughts and impulses) Compulsions (repetitive behaviors) Performance of rituals tend to relieve the anxiety " |
OCD
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OCD TX?
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PSYCHOTHERAPY & ANTI DEPRESSANTS (ssri)
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DISEASE WHERE WE SEE PERSON FEARFUL ABOUT A PARTICULAR SITUATION (OVERTLY FEARFUL) CAN EXIST WITH AGOROHOBIA?
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PHOBIAS
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MOST EFFECTIVE TX FOR ACUTE PHOBIAS?
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Most effective therapy involves drug and psychotherapy
BDZ help manage acute situations and facilitate psychotherapy |
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CHRONIC PHOBIAS TX?
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Antidepressants usually most effective for long-term therapy
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ADJUSTMENT DISORDER IS AN ACUTE ANXIETY DISORDER CAUSED BY __________________
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Caused by illness, separation, anticipation of stressful events
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ADJUSTMENT DISORDER IS USUALLY ______________ AND WILL RESOLVED IN A FEW WEEKS W/O TX
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SELF LIMITING
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SEVERE ADJUSTMENT DISORDER?
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BDZ may be used in more severe cases
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TX STAGE FRIGHT?
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Propranolol may be helpful in prevention of stage fright or performance anxiety
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SOME BDZ WE CAN USE FOR ANXIOLYTIC TX?
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BDZ
Chlordiazepoxide – oldest (Librium) Diazepam (Valium) Oxazepam ( Serax) Lorazepam (Ativan) Clorazepate (Tranxene) Prazepam (Centrax) Alprazolam (Xanax) |
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the BDZ selective antianxiety activity occurs at a dose_________ than hypnotic dose.
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much lower
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the hypnotic effect supresses REM sleep and stage __ sleep (BDZ)
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4
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for barbs the anxiolytic effects of barbs are associated with more _________ than seen w/ bdz
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sedation
**recall barbs are LESS SELECTIVE than BDZ. |
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when used orally do BDZ cause signficant respiratory depression coma or death?
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no, thus bdz are safer tha barbs
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BDZ can act as many different things , name a few?
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anticonvulsant - decrease seizure spread activity at motor cortex.
skeletal muscle relaxants - increase gaba activation, in the spinal cord. used to tx spasms associated w/ various forms of motor neuron disorders. |
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at HIGH DOSE what can BDZ cause?
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anterograde amnesia ( rare w/ oral dose)
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when would one see BDZ effects on CV and resp systems?
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a minor effect usually..
SEVERE INTOX SEE DEPRESSION. |
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THE CHANCES ONE DIES FROM A ORAL OVERDOSE FORM BDZ?
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SELDOM DUE TO LARGE TI.
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WHAT ARE THE ENDOGENOUS LIGANDS OF BDZ?
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BDZ RECEPTORS IN CNS
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BDZ'S EFFECT ON GABA -CHOLRIDE IONOPHORE?
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BDZ facilitate the effect of GABA stimulation of GABAA receptors as ‘positive allosteric modulators
In presence of GABA, BDZ increases frequency of channel opening Results in increased chloride permeability and increased inhibition (hyperpolarization) This mechanism is thought to be the basis of all BDZ effects in the CNS |
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TRUE OR FALSE?
ALL BDZ ARE EQUALLY EFFECTIVE AS ANXIOLYTICS AND HYPNOTICS? |
TRUE.
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METABOLISM OF BDZ
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Most are extensively metabolized by CYP3A4 or CYP2C19 but are not inducers
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READ SLIDE 25/26 (CHART)
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JUST DO IT.
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MOST COMMON BDZ ADV EFX?
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SIDE EFFECTS INCREASE W/ AGE, DOSE, DURATION OF TX, LIVER DISEASE, HYPOALBUMINURIA
CNS WE SEE SEDATION AS MOST COMMON SIDE EFECT |
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OTHER COMMON SIDE EFFECTS OF BDZ? OVERDOSE?? TERATOGENIC POTENTIAL?
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ATAXIA, CONFUSION, HEADAHCE, EUPHORIA, FATIGUE
PARADOXICAL HYPEREXCITABILITY - MORE ANXIOUS, INSOMNIA. Toxic doses can depress medullary function to produce respiratory arrest, hypotension, and CV collapse GI, hepatic, hematologic, menstrual disturbances, and disturbance of autonomic function – infrequent and mild Fatal overdose Incidence is low More likely to occur in combination with other CNS depressants such as ethanol Teratogenic potential – safety to the fetus has not been proven (pregnancy category D) |
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IN BDZ WE SEE TOLERANCE DEVELOP TO?
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CNS SIDE EFFECTS AND TO ANXIOLYTIC
BDZ tolerance may involve down-regulation of receptors Partial cross-tolerance occurs between BDZ, barbiturates, ethanol, and many other sedative-hypnotic drugs |
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WITH CHRONIC USE WE SEE BUILD UP OF TOLERANCE TO WHAT EFFECT OF BDZ?
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HYPNOTIC EFFECT
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PSYHCOLOGICAL AND PHYSICAL DEPENDENCE MAY DEVELOP UPON _________ DOSE AND CHRONIC ADMINISTRATION. THIS PSYCH DEPENDENCE CAN LEAD TO __________.
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HIGH
SUBSTANCE ABUSE |
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THE BARB WITHDRAWAL REACTION IS SIMMILAR TO THE BDZ WITHDRAWAL WE SEE FROM ACUTE ABSTINENCE, WHAT SYMPTOMS WOULD ONE SEE?
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Symptoms - Insomnia, agitation, recurrence of depression, exacerbation of psychosis, seizures
**Acute abstinence may precipitate withdrawal symptoms similar to barbiturate withdrawal reaction |
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severity of BDZ withdrawal syndrome is __________ proportional to the drug half-life
takes longer to develop and milder |
inversely.
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name 7 drug-drug interactions with BDZ?
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alcohol - ENHANCE!
cns depressants - ENHANCE! smoking - REDUCE! caffeine - REDUCE! SSRIs - INCREASE LEVELS, REDUCE METABOLISM. grapefruit juice - INCREASE LEVELS, REDUCE METABOLISM. flumazenil (BDZ specific receptor blocker), |
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WHICH DRUG IS Used to counteract adverse effects of BDZ HAS Rapid onset and short duration
May ppt seizures, arrhythmias, emotional lability ?? |
FLUMAZENIL
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WHAT ARE 6 OTHER THERAPEUTIC INDICATIONS FOR BDZs besides anxiety and insomnia??
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tx etoh withdrawal -DIAZEPAM, CHLORIDEZEPAM, LORAZEPAM
preanethetic meds, diazepam. sedation (while conccious) - midozolam NM DISORDERS ANTICONVULSANT THERAPHY. - DIAZEPAM, LORAZEPAM, DOC FOR STATUS EPILEPTICUS. PREMENSTRUAL DYSPHORIC DISORDER (PMS-DYSPHORIC - USE A "ZEPAM")!!! |
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name the bdz: which bdz is given orally, tx anxiety, agotpahobia, is intermediate acting???
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alprazolam (XaneX)
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name the bdz: which bdz is given either IV, IM OR ORAL, TX ANXIETY, MANAGES ETOH WITHDRAWAL, USED AS ANESTHETIC PREMEDICATION, AND IS LONG ACTIN??
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CHOLRDIAZEPAM.
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IN BDZ WE SEE TOLERANCE DEVELOP TO?
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CNS SIDE EFFECTS AND TO ANXIOLYTIC
BDZ tolerance may involve down-regulation of receptors Partial cross-tolerance occurs between BDZ, barbiturates, ethanol, and many other sedative-hypnotic drugs |
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WITH CHRONIC USE WE SEE BUILD UP OF TOLERANCE TO WHAT EFFECT OF BDZ?
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HYPNOTIC EFFECT
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PSYHCOLOGICAL AND PHYSICAL DEPENDENCE MAY DEVELOP UPON _________ DOSE AND CHRONIC ADMINISTRATION. THIS PSYCH DEPENDENCE CAN LEAD TO __________.
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HIGH
SUBSTANCE ABUSE |
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THE BARB WITHDRAWAL REACTION IS SIMMILAR TO THE BDZ WITHDRAWAL WE SEE FROM ACUTE ABSTINENCE, WHAT SYMPTOMS WOULD ONE SEE?
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Symptoms - Insomnia, agitation, recurrence of depression, exacerbation of psychosis, seizures
**Acute abstinence may precipitate withdrawal symptoms similar to barbiturate withdrawal reaction |
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severity of BDZ withdrawal syndrome is __________ proportional to the drug half-life
takes longer to develop and milder |
inversely.
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name 7 drug-drug interactions with BDZ?
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alcohol - ENHANCE!
cns depressants - ENHANCE! smoking - REDUCE! caffeine - REDUCE! SSRIs - INCREASE LEVELS, REDUCE METABOLISM. grapefruit juice - INCREASE LEVELS, REDUCE METABOLISM. flumazenil (BDZ specific receptor blocker), |
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WHICH DRUG IS Used to counteract adverse effects of BDZ HAS Rapid onset and short duration
May ppt seizures, arrhythmias, emotional lability ?? |
FLUMAZENIL
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WHAT ARE 6 OTHER THERAPEUTIC INDICATIONS FOR BDZs besides anxiety and insomnia??
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tx etoh withdrawal -DIAZEPAM, CHLORIDEZEPAM, LORAZEPAM
preanethetic meds, diazepam. sedation (while conccious) - midozolam NM DISORDERS ANTICONVULSANT THERAPHY. - DIAZEPAM, LORAZEPAM, DOC FOR STATUS EPILEPTICUS. PREMENSTRUAL DYSPHORIC DISORDER (PMS-DYSPHORIC - USE A "ZEPAM")!!! |
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name the bdz: which bdz is given orally, tx anxiety, agotpahobia, is intermediate acting???
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alprazolam (XaneX)
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name the bdz: which bdz is given either IV, IM OR ORAL, TX ANXIETY, MANAGES ETOH WITHDRAWAL, USED AS ANESTHETIC PREMEDICATION, AND IS LONG ACTIN??
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CHOLRDIAZEPOXIDE
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bdz used for???
Seizure disorders, adjunctive treatment in acute mania and certain movement disorders (Long Acting) oral. |
clonazepam
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BDZ USED FOR?
Anxiety disorders, seizure disorders, management of alcohol withdrawal (Short acting) |
clorazepate
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BDZ USED FOR?
Anxiety disorders, status epilepticus, skeletal muscle relaxation, anesthetic premedication (Long acting) ORAL, IM IV, RECTAL |
diazepam /valium
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BDZ USED FOR?
Insomnia (Intermediate acting) ORAL. |
estozolam
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BDZ USED FOR?
Insomnia (Long acting) ORAL. |
flurazepam
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BDZ USED FOR?
Anxiety Disorders (Long acting) ORAL. |
HALAZEPAM
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BDZ USED FOR?
Anxiety disorders, preanesthetic medication (Intermediate acting) ORAL, IM IV, |
LORAZEPAM
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BDZ USED FOR?
Preanesthetic and intraoperative medication (Short acting) IMIV |
MIDOZOLAM
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BDZ USED FOR?
Insomnia (Long acting) Insomnia (Intermediate acting) Insomnia (Short acting) ALL ORAL. |
QUAZEPAM - LONG
TEMEZAPAM - INTM TRIAZOLAM - SHORT |
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NON BDZ ANXIOLYTIC USED FOR ANXIETY REDUCTION (DUH) AND ACTS AS A PARTIAL 5HT 1A AGONIST ????
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BUSPIRONE
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BUSPRIONE DIFFERS FROM BDZ IN THAT...
________onset of activity (weeks) – no good for________anxiety attacks _________ sedation and lacks anticonvulsant activity, _____ muscle relaxation Little or no potential for abuse and is not effective in blocking WDS of BDZ, barbs, or other sedative-hypnotics _______________ CNS depressants such as alcohol. |
SLOW
LESS NO DOES NOT POTENTIATE. |
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ADV EFX OF BUSPIRONE?
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Tachycardia, palpitations, nervousness, GI distress, and paresthesias
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Slow onset makes buspirone unsuitable for___________________; but it is a good alternative for GAD especially with patients with a history of substance abuse
(3WORDS) |
ACUTE ANXIETY ATTACKS
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NAME A tricyclic antidepressant used in the treatment of obsessive-compulsive disorder (OCD)
5HT & NE reuptake blocker ?? |
CLOMIPRAMINE
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A SSRI USED EXCLUSIVELY FOR OCD?
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FLUVOXAMINE
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NAME 7 MISCELLANEOUS AGENTS USED TO REDUCE ANXIETY?
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BARBS
MEPROBAMATE ANTIHISTAMINE ' ANTIPSYCHOTICS ANTIDEPRESSANTS B BLOCKERS - PROPRANOLOL KAVA HERBAL - HEPTOX. |
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WHAT B BLOCKER CAN BE USED FOR PERFORMANCE ANXIETY?
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PROPRANOLOL
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FOR PANIC DISORDERS USE??
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SSRI, CLONAZEPAM
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FOR OCD USE?
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clomipramine, SSRI
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FOR PTSD USE?
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cognitive behavioral therapy, SSRI
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FOR SITUATION ANXIETY USE?
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NO PHARM TX.
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FOR ANXIETY IN RESPONSE TO ILLNESS USE?
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BDZ
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FOR GAD USE?
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BDZs, SSRI, buspirone, therapy
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FOR SOCIAL PHOBIA?
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cognitive behavioral therapy, SSRI, clonazepam
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BZD IS DOC FOR GAD WHAT ABOUT CHRONIC GAD?
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SSRI
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For elderly patients (or patients with liver cirrhosis) reduce the dosage of chlordiazepoxide and diazepam, or prescribe ______________________ as alternatives
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oxazepam and lorazepam
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what to avoid in BDZ TX?
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Buspirone used for new patients not previously treated with benzodiazepines.
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