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Anxiety Pharm

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
Created by: thamrick800