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56 Cards in this Set

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What are general types of anxiety?
• Situational: related to a stressful event
• Traumatic: due to unexpected, tragic events
• Toxic: from high doses of psychoactive drugs
• Free-floating: not caused by a specific event
What are different classifications of anxiety disorders?
• Atypical anxiety disorder: unknown cause
• Generalized anxiety disorder (GAD)
• Obsessive Compulsive Disorder (OCD)
• Panic disorer
• Phobia
• Post traumatic stress disorder
What are the prototypical anxiolytic drugs?
• Clordiazepoxide
• Diazepam
What are CNS effects of benzodiazipines?
• enhances the inhibitory effects of GABA at all levels of the neuroaxis (spinal cord, hypothalamus, hippocampus, substantial nigra, cerebellum, and cerebral cortex)

• blocks ascending reticular activating system, which mediates arousal (BZD leads to sedation & ataxia)
• depresses descending reticular tracts that maintain muscle tone (can be used as a muscle relaxant)
• affects locus cerulus (brainstem)
• increases threshold for convulsions
What drug is used to treat a benzodiazipine overdose?
Flumazenil (Romazicon) 0.4 mg IV
What are side effects of benzodiazipines?
• addiction
• drowsiness
• euphoria
• memory impairment
• requires gradual tapering off (to avoid withdrawl symptoms)
• worsening of depression
What is the definition of generalized anxiety disorder (GAD)?
• unrealistic or excessive anxiety or worry about 2 or more life circumstances for a period of greater than 6 months
• absence of any organic factors with greater than 6 symptoms
What are general categories of symptoms of GAD?
• Motor tension
• Autonomic hyperactivity
• Scanning
What is the drug of choice for anxiety disorders?
Benzodiazipines are drugs of choice
Give specific examples of motor tension symptoms of GAD
• easily fatigued
• muscle tension, aches, soreness
• restlessness
• trembling, twitching, or feeling shaky
What are the indications and equivalent dosing of Alprazolam (Xanax)?
• Indications: anxiety, depression, panic disorder
• Equivalent Dosing: 0.5 mg
Give specific examples of autonomic hyperactivity symptoms seen in GAD
• Difficulty swallowing
• Dizziness
• Dry mouth
• Frequent urination
• Nausea
• Palpitations
• Shortness of breath
• Sweating
List some of the benzodiazepines used for treatment of anxiety disorders
• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Clorazepate (Traxene)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Oxazepam (Serax)
Give examples of scanning symptoms associated with GAD
• difficulty concentrating
• feeling keyed up on something
• irritability
• starting things easily, but never finishing
• trouble falling asleep
What are indications and equivalent dosing of Clonazepam (Klonopin)?
• Indications: seizures (can be used for anxiety, but not an FDA indication)
• Equivalent dose: 0.25 mg
Which benzodiazepines are available in an injectable form (either IV or IM)?
• Diazepam (Valium)
• Lorazepam (Ativan)
What are indications and equivalent dosing for Clorazepate (Tranxene)?
• Indications: anxiety, seizure
• Equivalent dosing: 7.5 mg
What are indications and equivalent dosing for Diazepam (Valium)?
• Indications: anxiety, alcohol withdrawl symptoms, pre-op sedation, spams, status epilepticus
• Equivalent dosing: 5 mg
What are indications and equivalent dosing of Lorazepam (Ativan)?
• Indications: anixety, seizures, pre-op
• Equivalent dosing: 1 mg
What are indications and equivalent dosing for Chlordiazepoxide (Librium)?
• Indications: anxiety, alcohol withdrawl symptoms
• Equivalent dosing: 10 mg
What are indications and equivalent dosing for Oxazepam (Serax)?
• Indications: anxiety, alcohol withdrawl symptoms
• Equivalent dosing: 15 mg
Which drug is more lipophilic, Diazepam (Valium) or Lorazepam (Ativan)?
Diazepam (Valium)
What is the effect of alcohol on benzodiazepines?
• causes dereased clearance of Chlorodiazepoxide and Diazepam
• will cause more sedation if taken with benzodiazepines
What is effect of antacids on benzodiazepines?
will decrease rate of absorption of BZDs
What is the effect of Disulfiram and Fluxoetine on BZDs?
will decrease the clearance of the BZDs
What is the effect of Isoniazid on BZDs?
acts as an inhibitor (will decrease metabolism)
What is the effect of Rifampin on BZDs?
will acts as an inducer (will increase metabolism)
Which BZDs are rapid acting (absorbed quickly)?
• Alprazolam (Xanax)
• Clorazepate (Traxene)
• Diazepam (Valium)
Which BZDs are intermediate acting?
• Chlodiazepoxide (Librium)
• Lorazepam (Ativan)
Which BZDs are slow acting (or absorbed slowly)?
• Clonazepam (Klonopin)
• Oxazepam (Serax)
• Temazepam (Restoril)
Which BZD has a short length of action (or is elimated quickly)?
• Diazepam (Valium)
• should be eliminated from the body in ½ hr
Which BZD has a long length of action (or is eliminated slowly)?
Lorazepam (Ativan)
Which BZDs do not have active metabolites?
All BZD have active metabolites except:
• Lorazepam (Ativan)
• Oxazepam (Serax)
• Temazepam (Restoril): use for sleep

* Pneumonic: LOT
* these drugs are safer for elderly patients
Anterograde amnesia is common will all BZD, but it is most common with which BZD?
Lorazepam (Ativan)
Buspirone (Buspar) is a good drug for what type of patients?
good drug for patients with a history of alcohol or substance abuse
What is the MOA of Buspirone (Buspar)?
• 5HT partial agonist (will increase serotonin)
• has no BZD-GABA complex activity
• no anticonvulsive properties (not good for seizures)
• no muscle relaxation
What is the onset of action of Buspirone (Buspar)?
• 2-4 weeks
• usually started at the same time with a BZD and then the dose of BZD is slowly tapered off
What is the dosage of Buspirone (Buspar)?
• 15 mg PO TID (max of 60 mg QD)
• comes in 5 & 10 mg tablets
What are adverse effects of Buspirone (Buspar)?
• dizziness
• dysphoria
• headaches
• weakness
• EPS, gynecomastia (RARE)
What are drug that interact with Buspirone (Buspar)?
• Haldol
• MAOIs (can cause Serotonin syndrome)
• Prozac ( SSRI + Serotonin agoninst will cause too much Serotonin release)
What is the definition of panic disorder?
• at least 4 attacks occur in a 4 week period
• at least 1 attack has occurred totally "out of the blue" OR
• at least 4 symptoms developed under one attack
What are symptoms of panic disorders?
• chest pain
• choking
• dyspnea
• dizziness
• fear of going crazy
• fear of dying
• nausea
• palpitations
• paresthesias
• sweating
• trembling

* must develop within 10 minutes of first symptoms
What drugs can be used for treatment of panic disorders?
• Tricyclic Antidepressants (TCA): Imipramine and desipramine
• MAOIs: may take 6 weeks to start effects
• BZD: can use any, but probably use rapid onset (Diazepam or Lorazepam)
• SSRI: usually use lower doses; effects seen in 2-3 days (not good for acute panic attack, but can be used as prophylaxis)
What is the difference between primary and secondary insomnia?
• Primary insomnia is difficulty initiating or maintaining sleep or persistently non-restorative sleep; not due to any other condition

• Secondary insomnia results from medical, psychiatric, or drug causes
What is narcolepsy?
disorder of excessive somnolence
What are characteristics of the ideal hypnotic drug?
• little residual sedation
• no disturbance of normal sleep
• no tolerance
• rapid onset
• safe
• sufficient duration
What are BZDs that can be given to treat sleep disorders?
• Estazolam (Prosam)
• Flurazepam (Dalmane)
• Temazepam (Restoril)
What are characteristics of Flurazepam (Dalmane)?
• has an active metabolite (half-life 30hrs)
• accumulates in the elderly
• longer to reach steady states
• has hang over effects
What is the dose of Flurazepam (Dalmane)?
15-30 mg at night
What are characteristics of Temazepam (Restoril)?
• long-half life (10-15 hrs)
• has less hangover effect than Flurazepam
• no active metabolite
What are characteristics of Estazolam (Prosom)?
• half life is 10-15 hrs
• has some daytime sedation
• usually given if patient fails Temazepam
What are characteristics of Barbituates?
• not used as much (usually used for seizures)
• short term efficacy (2 weeks)
• inducers
• can cause respiratory depresion
List 2 non-barbituates or BZDs used to treat sleep disorders
• Chloral hydrate (Noctec)
• Zolpidem (Ambien)
What are characteristics of Chloral hydrate (Noctec)?
• used in children
• efficacy is lost very fast
• must take with water
What are characteristics of Zolpidem (Ambien)?
• acts at BZD-GABA receptor complex, but not defined by BZD effects in locus cerelus
• has a short half life
• not much abuse potential
What are other agents that can be used to treat sleep disorders?
• Diphenhydramine (Benadryl): probably wouldn't use in elderly patients
• Hydroxyzine (Vistaril)
• TCAs
• Trazadone: an SSRi with some norepi effects