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Anxiety Pharma

Behavioral Medicine Pharmacology

Anti-anxiety med: adequate trial = 6-8 weeks
Classes of anti-anxiety drugs Benzodiazepines; SSRIs; SNRIs; Buspirone; other (hydroxyzine, imipramine, and propranolol)
Which drugs are firstline for anxiety? Benzodiazepines; SSRIs; SNRIs
Tx of choice for acute anxiety relief Benzodiazepines
Anxiety tx of choice for noncompliance / avoidance of withdrawal sx Diazepam
Advantage of buspirone lack of sedation AE; good if pt h/o substance abuse
Advantage of beta blockers in anxiety tx good for pt w/ hx of CV sx; adjunct for refractory
MOA: Benzodiazepines Potentates inhibitory effect of GABA
MOA: SSRIs Selectively inhibit the reuptake of 5-HT by blocking the 5-HT transporter
MOA: SNRIs Block the reuptake of 5-HT and NE (and DA)
MOA: Buspirone SSRI
MOA: Hydroxyzine Potent antihistaminergic, anticholinergic, and antispasmodic effects
MOA: Imipramine (TCA) Blocks reuptake of 5-HT and NE
MOA: propranolol beta-blocker
Bz side effects CNS depression / sedation; anterograde amnesia; dependence / abuse
Shorter acting benzodiazepines Alprazolam; Lorazepam; Oxazepam
Longer acting benzodiazepines Chlordiazepoxide; clonazepam; Diazepam
Benzodiazepines: increased toxicity / mortality if: taken with other CNS depressants
Benzodiazepine OD mild sx drowsy, confusion, somnolence, impaired coordination, diminished reflexes, lethargy
Benzodiazepine OD serious sx ataxia, hypotonia, hypotension, hypnosis, coma, death
Benzodiazepine OD: Tx: gastric lavage, supportive measures, flumazenil
Benzodiazepine Withdrawal Sx anxiety, restlessness, insomnia, agitation, muscle tension, irritability
Bz withdrawal sx more likely in: users of high doses for long periods of time
Tx: Bz withdrawal Taper over several weeks when discontinuing
Antidepressants for anxiety dz: SSRIs; Venlafaxine; Mirtazipine; TCA; MAOI
SSRI dosing for anxiety delayed tx response; initiate w/smaller dose than AD dose
Anxiety: MAOI reserved for: refractory cases
FDA approved for panic disorder paroxetine, fluoxetine, sertraline, venlafaxine XR, alprazolam, clonazepam
Tx for OCD CBT firstline for mild; CBT and SSRI for severe (clomipramine if 2-3 failed SSRIs); tx mania, depression, or psychosis first
Created by: Abarnard