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Behavioral Pharm
Anxiolytics
| Question | Answer |
|---|---|
| Drugs that relieve anxiety are called what? | Anxiolytics |
| At what dose would you use benzodiazapines and barbituates compared to use for sleep aid? | lower dose |
| benzodiazapines exert what kind of dose dependent amnesic effects? | anterograde amnesia |
| describe some anxiety disorders treated via anxiolytics | generalized anxiety, social anxiety, acute procedural anxiety, panic attacks/disorders, phobias, OCD, PTSD |
| what is the first line drug class used for generalized anxiety disorder? | SSRI |
| what is the second line drug class used for GAD? | SNRI (equally as good as SSRIs but not available as genetic yet), tricyclic antidepressants, benzos, buspirone |
| describe the significance of Buspirone | relieves anxiety without causing marked sedatin, hypnotic, or euphoric effects. takes one week to see effects (not for acute anxiety), may work by acting as a partial agonist of 5HT receptors, does not work on GABA, no anxiety rebount or withdrawal w/ D/C |
| what liver enzyme breaks down buspirone? | CYP3A4 |
| what are some adverse drug reactions ofr Buspirone? | nonspecific chest pain, tachycardia, palpitations, dizziness, nervousness, tinnitis, GI distress, paresthesias, and dose dependent pupillary constriction. BP may be sig elev in patients taking MAOIs |
| what pregnancy category is Buspirone? | B |
| what are the first line drug classes for GAD? | SSRI, |
| what are the second line drug classes for GAD? | MAOI's (not FDA approved), takes four to six weeks to exhibit effects, up to sixteen weeks for full effect |
| what is the first line drug class for non-generalized anxiety (ex: performance anxiety) | first line: beta blockers, benzos. (effects seen within minutes, used "as needed" |
| what is the drug of choice class for acute procedural anxiety? | benzos (used to induce anxiolysis and/or sedation), administered as IV prior to procedure |
| how do benzodiazepines work? | increase frequency of the chloride channel opening the GABA-A receptors |
| what pharmacological agent can act as a GABA-mimetic? | phenobarbital (at high doses) |
| what CV effects are seen with sedative hypnotics in patients with CV compromise? | impaired cardiac function (hypovolemia, CHF, etc), normal doses cause CV depression (medullary vasomotor centers) |
| what respiratory problems do sedative hypnotics cause in patients with respiratory compromise? | significant respiratory depression |
| CV and respiratory side effects with sedative hypnotics are more prominent when the drug is given via what? | IV |
| on a graph of CNS increasing CNS effects (sedation, hypnosis, anesthesia, coma) vs. increasing dose, what does the barbituate curve look like? | linearly increases, because the GABA channel stays open for longer periods of time, so it is difficult to stop it, and barbs cross the BBB faster |
| on a graph of CNS increasing CNS effects (sedation, hypnosis, anesthesia, coma) vs. increasing dose, what does the benzodiazepine curve look like? | it plateaus |
| list some pros with using Benzodiazepines for anxiety | rapid onset of action, relatively high therapeutic index, lower risk of drug interactions based on liver enzyme induction, minimal effects on CV or autonomic function |
| what are some cons with using benzodiazepines for anxiety? | dependence, CNS depression and amnestic effects, additive depressive effects with other CNS depressants |
| what is the first line drug of choice class for panic attacks/disorders? | SSRIs,second line: SNRIs, benzo(used more frequently with panic attacks because of long term effect, quick onset), tricyclic antidepressants |
| what is the first line treatment for phobias? | cognitive behavioral therapy |
| what is the treatment choice for phobias if the stimulus cannot be avoided (ex: flying) | benzodiazepines. short acting ones are preferred. |
| what is the drug of choice for phobias if the stimulus cannot be avoided long term (ex: if someone hates flying, and is a flight attendent for their job) | SSRIs |
| what is the first line treatment class of choice for OCD? | SSRI (all are approved except citalopram and escitalopram, tricyclic antidepressants, SNRIs are well tolerated but not FDA approved |
| what is the first line treatment for PTSD? | SSRI, second line: SNRI, benzos rarely studied but used frequently to treat symptoms of anxiety and hyperarousal-not used in pts with substance abuse history, can be used in acute settings under appropriate care |
| what are examples of when benzodiazepines can be used first line? | hypnotics, sleep aids, sedation, anti-anxiety, peri-operative state, suppress seizures, spasticity reduction, withdraw agents |
| a person gets nervous every tie he has to meet new people. he has a job in sales. what sales of medications would be appropriate? | SSRIs |
| 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 a mistake in front of his colleagues, what class of medicaitons would be appropriate? | beta blockers, benzodiazepines |
Created by:
aferdo01
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