Question | Answer |
Benzo and Barb. dose effects ? | *given at lower dose, as to not cause sleep induction
*Benzos - create dose related anterograde amnesia (can't remember anything after drug given) |
Anxiolytic Drug List ? | *Alprazolam
*Buspirone
*Clonazepam
*Chlordiazepoxide
*Clorazepate
*Diazepam
*Halazepam
*Lorazepam
*Oxazepam
*Phenobarbital (not first line) |
Antidepressants? | *Selective serotonin reuptake inhibitors (SSRIs)
*Serotonin-norepinephrine reuptake inhibitors (SNRIs)
*Tricyclic antidepressants (TCADs) |
Generalized Anxiety Disorder 1st line drugs ? | *Selective serotonin reuptake inhibitors
-Paroxetine, sertraline, citalopram, escitalopram |
GAD 2nd line ? | *Serotonin-norepinephrine reuptake inhibitors
-Venlafaxine
*Tricyclic antidepressants
-Imipramine
*Benzos
-use cautiously for acute or mono-therapy
*Buspirone |
Buspirone MoA ? | *relieves anxiety without sedation or euphoric effects
*may work on 5-HT receptors
-NOT GABA |
Length to work/withdrawal issues ? | * takes 1 week to see results... So not for ACUTE cases
*no withdrawal issues with sudden stoppage and low abuse potential |
Metabolism and active metabolite of Buspirone ? | * first pass metabolism
*metabolie - 1-PP (crosses BBB and reaches higher levels than parent drug) |
Elimination of Buspirone ? | * t 1/2 is 2-4 hours, but liver disease can slow it down |
Buspirone side effects ? | *palpatations, tachycardia, chest pain, tinnitus
*OK in Preggo use - use if they are or are wanting to be preg |
First Line for Generalized Social Anxiety ? (specific stimuli...ex. anxious talking to girls) | *Selective serotonin reuptake inhibitors (paroxetine)
*Serotonin norepinephrine reuptake inhibitors (venlafaxine)
*Take 4-6 weeks to achieve effect up to 16 weeks for full effect |
First line for Non-Generalized Social Anxiety ? (ex. performance anxiety) | **Beta-blockers
(Propranolol)
*Benzodiazepines
(Alprazolam and clonazepam)
*Effects seen within minutes
*Used “as needed” |
Used to treat Acute Procedural Anxiety ? | *Benzos - anxiolysis and sedation
-use a short term (may have to give an oral dose in surgery if procedure is long)
*Administered IV prior to procedure
(Diazepam-Alprazolam-Lorazepam-Midazolam) |
Benzos MoA ? | * Increase the frequency of chloride channel opening in GABAA receptors |
Active metabolite of Benzos ? | *Oxazepam |
Barbiturates MoA ? | * Increase the duration of chloride channel opening in GABAA receptors |
Drug that can act as GABA itself (GABA-mimetic) in high doses ? | *Phenobarbital (Barbiturates) |
Sedative Hypnotics on the CV System? | *Healthy ppl don't have any issues
*ppl with impaired cardiac function (CHF, hypovolemia, etc) they will cause CV Depression even at low doses |
Sedative Hypnotics on the Resp. System ? | *in healthy ppl, you see normal changes in resp system just as in sleep induction.
*if too much is given, they can stop the medullary resp center (reason for death in overdose) |
Pros of using Benzos for Anxiety ? | *fast onset
*high TI (use flumazenil if OD)
*minimal CV/ANS effects |
Cons of using Benzos for Anxiety ? | *dependence/withdrawal/misuse-abuse issues
*CNS depression and amnesic effects
*exacerbate depressive effects of alcohol (have to change doseage) |
Why do we try to stay away from the Barbiturates for anxiety ? | *bc since they can mimic GABA, they can cause serious issues if OD and harder to reverse drug actions |
Barbiturates and pregnancy ? | * NO- category D, so can use as last resort drug |
Major contraindication in using barbiturates ? | *do not use in ppl with porphyria issues |
Phobia 1st line treatment ? | * cognitive behavior therapy |
If you have a phobia and the stimuli can not be avoided? | * Benzos (short acting- lorazepam)
* SSRIs (escitalopram or sertraline)- Used when benzos aren’t effective OR when patient will be repeatedly exposed to phobic stimulus |
Panic Attack/Disorder 1st line Drug ? | *SSRIs - Fluoxetine, sertraline, citalopram, paroxetine, citalopram, escitalopram |
Panic Attack/Disorder 2nd line Drug ? | * Benzo - reduces all 3 components of the attack and rapid onset!
-Clonazepam (specifically this drug bc it has a longer t 1/2) |
Obsessive Compulsive Disorder 1st line therapy ? | *SSRIs - can use all of them EXCEPT citalopram and escitalopram ! |
OCD therapy after 1st line is administered or did not work? | *Tricyclic antidepressants (TCADS)– clomipramine only
(SSRIs and TCADs improve symptoms in 40-60% of OCD patients) |
Posttraumatic Stress Disorder (PTSD)first line therapy ? | *tmt shoul begin ASAP !!!
* SSRIs - Paroxetine, Sertrraline, Fluvoxamine, Fluoxetine, Citalopram, Excitalopram |
PTSD next line treatments after 1st line or after 1st line failure ? | *Serotonin Norepinephrine Reuptake Inhibitors
- Venlafaxine ER
*Benzos - can be added to treat hyperarousal and anxiety (not to be used in substance abusers) |
Take home message about using Benzos and Barbs in anxiety disorders ? | *only use in an acute attack
*not for long term use due to dependence, abuse/misuse, side effects, and withdrawal issues |
When would Benzos be used first-line for tmt? | *Acute Procedural Anxiety
*Phobia (not as the primary tmt, but only if the stimuli can not be avoided by the person) |
A person gets nervous every time he has to meet new people. He has a job in sales. What class of medications would be appropriate? | *SSRIs
-issue is clearly a General Social Anxiety attack |
A person gets nervous every time he has to make a presentation at work. This happens at least four times a year. He stutters, sweats, and fears he will make mistakes in front of his colleagues. What class of medications would be appropriate? | *Beta-Blockers
*Benzos
-issue is clearly a Non-General Social Anxiety attack |
When would Antidepressants be used first-line for tmt? | *Panic Attack
*Generalized Anxiety Disorder
*PTSD
*OCD |
**Should be first slide, but when saved, program moved it to here**
- What are the 2 groups of anxiolytics ? | *Sedatives-Hypnotics
-Benzos and Barbiturates
*Antidepressants |