Week 2-anti-anxiolytics

Question 1

What drug classes can be used in the treatment of anxiety?

Answer 1

Benzodiazepines
Antidepressants
Beta blocker (blocks adrenaline so you don’t get the sweaty hands, shakiness etc)
Pregablin (used in epilepsy, generalised anxiety)
Buspirone (generalised anxiety drug)

Question 2

Which benzodiazepine is used in alcohol withdrawal?

Answer 2

Chlordiazepoxide

Question 3

What effects do benzodiazepines have on the body?

Answer 3

Reduce anxiety and aggression
Sedation/hypnosis
Muscle relaxation
Anticonvulsive effect 
Anterograde amnesia (when you can't remember anything after the amnesia has come)

Question 4

What is GABA? What does it cause to cells?

Answer 4

The main inhibitory neurotransmitter in the CNS

Causes hyper polarisation of cells.

Question 5

How does GABA work? How do benzodiazepines affect GABA?

Answer 5

GABA binds to GABA receptors causing chloride entry into the cell. This causes hyperpolarisation. Benzodiazepines enhance the effects of GABA on the cells.

Question 6

Which other conditions (other than anxiety) and scenarios are benzodiazepines used?

Answer 6

Hypnosis
Alcohol withdrawal
Mania
Delirium
Status epilepticus. 

Rapid tranquilisation
Premedication before surgery

Question 7

Meaning of anxiolytic?

Answer 7

Reduce anxiety

Question 8

What are the issues with benzodiazepines?

Answer 8

They can cause paradoxical aggression

You can become tolerant to them

Question 9

What are the issues with benzodiazepines and alcohol?

Answer 9

Alcohol also works on GABA, so if you use both you may overdose.

Question 10

What issues may arise from rapid withdrawal of benzodiazepines?

Answer 10

May cause confusion, toxic psychosis and in some cases convulsions.
Also insomnia, anxiety, loss of appetite and body weight, tremor, perspiration and perceptual difficulties.

Question 11

How does chronic treatment with benzodiazepines affect GABA?

Answer 11

Chronic treatment causes a decreased response to GABA.

Question 12

How would you withdraw a patient from benzodiazepines?

Answer 12

Transfer patient to equivalent dose of diazepam/chlordiazepoxide (these have longer half lives).
Reduce dose every 2 weeks in steps of 2-2.5mg. Maintain this dose until symptoms improve
Reduce dose further, if necessary in smaller steps
Stop completely.

Question 13

How can pregablin help in anxiety? When is it used?

Answer 13

Its a calcium channel blocker and enhances GABA effects.

Only considered if not responsive to other treatment.

Question 14

When are beta blockers used to help anxiety?

Answer 14

Used for somatic symptoms e.g. palpitations, tremor.

Question 15

Which antidepressants would you use for anxiety?

Answer 15

1- SSRIs
2-Tricyclics- clomipramine, imipramine
3- Venlafaxine (SNRI)
4-Moclobremide (atypical- reversible)