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Anxiety Pharma
Behavioral Medicine Pharmacology
| Question | Answer |
|---|---|
| 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
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