Drugs for Anxiety

• Repolarization - change in the membrane potential that returns it to negative, happens after depolarization
• Excitatory Neurotransmitters - Opens Na or Ca channels/influx — depolarization (more positive) — nerve impulse
• Dopamine, Acetylcholine, Glutamate, Norepinephrine, Aspartate - are excitatory neurotransmitters (Mnemo: DAGNA)
• Inhibitory Neurotransmitters - opens Cl channels — hyperpolarization (more negative) — no nerve impulse
• Glycine, Gamma-aminobutyric acid - are inhibitory neurotransmitters (Mnemo: GG)
• Memorize!!

  A) Anxiety

  B) Psychosis

  C) Depression

  D) Mood Disorder

  E) Seizure

  F) Parkinson's

  G) Alzheimer's

  
• Anxiety - is an emotional state commonly caused by the perception of real or potential danger that threatens the security of an individual
• Sedative and Hypnotic - are commonly known as anti-anxiety/minor tranquilizers
• Panic disorder - recurrent unexpected panic attacks that can occur with agoraphobia in which patients fear places in which escape might be difficult
• Specific phobia - intense fear of particular objects or situations (e.g. snakes, heights); most common psychiatric disorder
• Social phobia - intense fear of being scrutinized in social or public situations (e.g. giving a speech, speaking in class)
• Generalized anxiety disorder (GAD) - intense pervasive worry over virtually every aspect of life
• Post-traumatic stress disorder - persistent re-experience of trauma, efforts to avoid recollecting the trauma, and hyperarousal
• Obsessive-compulsive disorder (OC) - recurrent obsessions and compulsions that cause significant distress and occupy a significant portion of one’s life
• Benzodiazepines - most widely used anxiolytic, drug of choice for GAD
• Chlordiazepoxide - first ever benzodiazepine
• Clonazepam, Oxazepam, Midazolam, Triazolam (COMT) - are short acting (2-8hrs), used in order to induce sedation and hypnosis before operation
• Flunitrazepam, Lorazepam, Alprazolam, Temazepam (FLAT) - are intermediate acting (10-20hrs), commonly used as anti-anxiety supplements
• Diazepam, Flurazepam, Chlordiazepoxide - are long acting (1-3 days), commonly used for anti-seizure supplements
• Alprazolam, Diazepam - drugs used for anxiety
• Diazepam, Clonazepam, Lorazepam - drugs used for seizures
• Flurazepam, Midazolam - drugs used for insomnia
• Midazolam - drug used for pre-operative sedation
• All benzodiazepines are converted to N-desmethyldiazepam as their metabolite
• Sedative - at low doses, exert calming effects with concomitant reduction of anxiety (Clinical uses: Anxiety (GAD) and panic disorders, phobias)
• Hypnotic - at high doses (Clinical use: for insomnia)
• Anesthesia - at high doses: CNS depression to the point known as stage III of GA
• Diazepam, Lorazepam - is used for IV anesthesia
• Midazolam - is used for induction of anesthesia
• Anticonvulsant - can exert anticonvulsant effects without marked central nervous system depression, so that mental and physiologic activity are relatively unaffected (Clinical use: some forms of epilepsy)
• Clonazepam, Nitrazepam, Lorazepam, Diazepam - is used for some forms of epilepsy
• Muscle Relaxant - carbamates and bzd exert inhibitory effects on polysynaptic reflexes and internuncial transmission and at high doses may also depress transmission at the skeletal neuromuscular junction (Clinical uses: muscle spasms, spastic disorders)
• Anterograde amnesia – loss of the ability to create new memories after the event that caused the amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories before the event remain intact
• Diazepam - can be initiated as loading dose (40% of daily consumption), followed by a daily tapering of 10%
• Clonazepam - an alternative agent to treat withdrawal symptoms for benzodiazepine
• Phenobarbital - for mixed BZD and alcohol dependence
• Flumazenil - doc for benzodiazepine poisoning, a benzodiazepine antagonist, GABA receptor antagonist
• Alcohol + BZD - additive effect; lowers the therapeutic index of BZD
• CNS depressants + BZD - synergism of adverse sedative effects
• Lorazepam + Clozapine - respiratory suppression and death