Pharm Ii - Anti-Anxiety

Front 1

Problems with Benzodiazepines

Back 1

Sedation
Dependence/discontinuation syndrome
Short lasting

Side effects of benzodiazepenes: "SAD" Sedation, Ataxia, Dependence

Front 2

DSM anxiety disorders

Back 2

Generalized anxiety disorder
Social phobias
Simple phobias (fear of specific object/place)
Panic disorder
Post-traumatic stress disorder
Obsessive compulsive disorder

Front 3

Length of treatment for benzodiazepines

Back 3

Administer the lowest effective dose for the shortest period of time

Front 4

Treatment for generalized anxiety

Back 4

Benzodiazepines
SSRI

Front 5

Treatment for panic disorder

Back 5

SSRI
Behavioral therapy

Front 6

Treatment for post traumatic stress disorder

Back 6

Behavioral therapy

Front 7

Treatment for social phobia

Back 7

SSRI
Behavioral therapy

Front 8

Treatment for specific phobia

Back 8

Behavioral therapy

Front 9

Treatment for obsessive compulsive disorder

Back 9

SSRI
Behavioral therapy

Front 10

Long-acting Benzodiazepine Anxiolytics

Back 10

Clonazepam (Klonopin)
Diazepam (Valium)
Chloazepate (Tranxene)
Chlordiazepaxide (Librium)
Flurazepam (dalmane)

Front 11

Short-acting Benzodiazepine Anxiolytics

Back 11

Alprazolam (Xanax)
Lorazepam (Ativan)
Oxazepam (Serax)

Short acting benzos need to be taken a LOT (lorazepam, oxazepam, triazolam)

Front 12

Serotonergic Drugs: 5-HT1A Agonist

Back 12

Buspirone (Buspar)

Front 13

Serotonergic Drugs: SSRI

Back 13

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Fluvoxamine (Luvox)

Front 14

DDI of SRI:
CYP2D6

Back 14

Inhibition by paroxetine, fluoxetine, sertraline
CYP2D6 metabolizes anti-arrhythmics, haloperidol, propranolol, codeine

Front 15

DDI of SRI:
CYP3A4

Back 15

Inhibition by norfluoxetine which it metabolizes

Front 16

DDI of SRI:
CYP1A2

Back 16

Inhibited by fluvoxamine which it metabolizes

Front 17

Problems with SRIs as an anxiolytic

Back 17

Delayed onset of therapeutic efficacy
Side effects: Sexual dysfunction, GI, no anti-cholinergic effects
Significant fraction of non-responders

Front 18

Diazepam (Valium)

Back 18

Anti-anxiety drug (long-acting)
Anti-epileptic (status epilepticus)

Enhances binding of GABA to its Rc, thus inhibitory to neuronal firing

"CHLORine makes you DIe slowly" (chlordiazepoxide, chlorazepate, and diazepam are long-acting benzos)

Front 19

Chlordiazepoxide (Librium)

Back 19

Anti-anxiety drug (long-acting)

"CHLORine makes you DIe slowly" (chlordiazepoxide, chlorazepate, and diazepam are long-acting benzos)

Front 20

Chlorazepate (Tranxene)

Back 20

Anti-anxiety drug (long-acting)

"CHLORine makes you DIe slowly" (chlordiazepoxide, chlorazepate, and diazepam are long-acting benzos)

Front 21

Oxazepam

Back 21

Anti-anxiety drug (short-acting)

O is for take it On time (short-acting)
(or don't Omit a single dose!)

Front 22

Lorazepam (Ativan)

Back 22

Anti-anxiety drug (short-acting)
Anti-epileptic (status epilepticus)

Enhances GABA binding to its Rc, thus is inhibitory to neuronal firing

You start to run LO on benZO (short-acting)

Front 23

Triazolam (Halcion)

Back 23

Anti-anxiety drug (short-acting)

T is for Tongue Tied (short acting benzo, good for stage fright)

Front 24

buspirone (Buspar)

Back 24

Anti-anxiety - 5HT1A agonist

"buSPirONE: busts anxiety. S is for serotonin. P is for partial agonist. ONE is for 5ht-one-a activity."

Front 25

Benzodiazepines

Back 25

Enhances the activity of GABA by keeping the GABA Rc open for a longer time period. Normally GABA binds to its receptor and opens a chloride channel which results in inhibition of neuronal firing and a consequent reduction in anxiety. Benzodiazepines do not compete with GABA for its binding site.

Front 26

Benzodiazepines

Side effects

Back 26

a. Sedation
b. Ataxia
c. Dependence liability - more limited than the general CNS depressants
d. Even large oral doses of diazepam are not lethal. When combined with other CNS depressants, e.g., alcohol, death can occur.

Front 27

Severe, chronic anxiety disorder

Back 27

Chronic benzodiazepine treatment is acceptable. In general, benzodiazepines are associated with few medical complications and do not interact adversely with most other medications.