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What is the Treatment of Panic disorder?
- Antidepressants
- -TCAs (imipramine, clomipramine)
- -MAOI's
- -SSRI/SNRI
- Benzodiazepines (rapid onset of effect)
- -1st choice
- -Alprazolam
- -clonazepam
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What are the Main adverse effects of :
Antidepressants?
SSRI/SNRI?
Benzodiazepines?
- Initial jitteriness (Gradual dose recommended)
-Sexual dysfunction, Withdrawl syndrome
-Sedation, dependence, withdrawls syndrome, potentiation of alcohol.
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What are the treatments for OCD?
- clomipramine
- fluoxetine
- fluvoxamine
- paroxetine
- sertraline
- citalopram
- escitalopram
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What is the treatment for Social anxiety disorder?
- SSRI/SNRI
- BZD (alprazolam, clonazepam)
- MAOI
- BB (propranolol)
- Cognative behavioral theropy
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What are the treatments for PTSD?
- TCA
- MAOI
- SSRI (sertraline and paroxetine)
- BB
- Lithium anticonvulsants (carbamazepine, valproic acid)
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What is the treatment of GAD?
- Benzodiazepines
- Buspirone
- Antidepressants
- -TCA ( imipramine)
- -SSRI
- -SNRI (venlafaxine, duloxetine)
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What is Benzodiazepines effect on GABA receptors?
They increase the frequency of the Chloride ion channel opening and cause it to be open longer--> hyperpolarization of the neuron and decreased firing.
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What is Benzodiazepines indications?
- GAD
- Panic Disorder
- EtOH withdrawal
- Hypnotic
- Anticonvulsant - i.v. diazepam
- Adjunct to anesthesia (midazolam)
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Name the Benzodiazepines
- Anxiolytics
- -Chlordiaepoxide
- -Diazepam
- -Alprazolam
- -Lorazepam
- Hypnotics
- -Flurazepam
- -Triazolam
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What are the adverse effects of Benzodiazepine?
- Sedation
- Psychomotor impairment
- Ataxia
- Amnesia (particularly Triazolam)
- Risk for dependence
- Withdrawl syndrome
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Describe benzodiazepines Withdrawal effects
After high dose usage, with drawl my include what???
- -Anxiety/agitation
- -Sleep disturbance
- -Myoclonic jerks
- -Sensory disturbances
- -Paresthesias
- -Muscle cramps
- -Dizziness
-Seizures and Delirium
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Name the Benzodiazepine antagonist
How does it work???
Flumazenil
- -does not antagonize the central nervous system
- effects of drugs affecting GABA-ergic neurons by means other than the benzodiazepine receptor
- -does not reverse the effects of opioids
- -used to reverse BZD conscious sedation
- -may be useful in suspected BZD overdose
- -Onset 1-2 minutes; duration of effect 4-5 hours
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What are some non-Benzodiazepine treatments for anxiety
- -Buspirone
- -SSRI
- -SNRI
- -Venlafaxine
- -Duloxetine
- -Clonidine
- -buspirone
- -Clonidine
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What is Buspirone?
- -Presynaptic 5-HT1A full agonist
- -Hypothesized 5-HT excess
- -⇩ Neuronal firing
- -⇩ 5-HT synthesis
- -Postsynaptically, partial agonist
- -With 5-HT excess, acts as antagonist
- -With 5-HT deficit, acts as agonist
- -No effects on BZD-GABA receptor complex
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When is Buspirone prefferred over Benzodiazepines?
- -Elderly
- -Patients with Medical conditions
- -It may improved the sexual dysfunction
- - may be an anti depressent at higher doses
- -Has a slower onset than BZD
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What is clonidine?
It is an A2 agonist
- -Alpha-2 agonist can be anxiolytic by decreasing NE release.
- It decreases: Tachycardia, Sweating, Tremor
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What are the Denzo and Non-Benzo hypnotics?
- -flurazepam
- -temazepam
- -triazolam
- ______________________
- -zolpidem
- -zaleplon
- -zopiclone
- -eszopiclone
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