Mental health 17

three causative factors of anxiety

autonomic nervous system deregulation
inhibition of GABA
neuroendocrine overactivity
faulty thinking
autonomic nervous system over performs

Autonomic (adrenergic system) symptoms of anxiety

Tachycardia
dilated pupils
tremor
sweating

feeling associated with panic attacks

feeling dizzy, lightheaded, unsteady, faint
derealization
fear of losing control or going crazy
fear of dying
tingling sensation
chills or hot flashed

symptoms associated with panic attacks continued

palpitations sweating
trembling or shaking
SOB
feeling of choking
chest pain
nausea and abdominal distress

Medications that can cause anxiety while withdrawing

Alcohol
social drinking(rebound effect)
nicotine
benzodiazepines

medications that cause anxiety while taking

asthma - albuterol
beta agonists-isoproterenol
herbal drugs- mahuag, gensing
corticosteroids
antidepressants: SSRI, NDRI, TCA
Illegal or abused street drug (uppers)

Disorders that can cause anxiety include

hypothyroidism
asthma
cardiac arrythmias

When are benzodiazepines appropriate Tx for anxiety

-coadminisrtaion 2-4 weeks when innitially Tx with SSRI
-patients wanting to avoid the sexual side effects of antidipressants
- patients on long term NSAID Tx
-patients with comorbid epilepsy or bipolar disorders

Antacids

neutralize the acids in the stomach
impair absorption rate of benzodiazepine

Cimetide (tagamet)

increased plasms levels of benzodiazepines (diazepam)

Phenytoin

Dilantin-Anticonvulsant
interacts with benzo's
causing increased serum anticonvulsant levels

Alprazolam (Xanax)

Benzodiazepine
-uses: generalized anxiety, adjustment disorders, ---panic disorders, anxiety associated with depression
-potential for addiction and dependence
-may induce violent or aggressive behavior

Chlordiazepoxide

Librium - Benzodiazepine anxiolytic/sedative/hypnotic.
uses: anxiety disorders, acute alcohol withdrawal
can be used as an antitremor agent
accumulation occurs with this drug

clonazepam

Klonopin
Benzodiazepine
Used most often as an anticonvulsant but also has clinical use in panic disorders
tapper withdrawal from this drug: abrupt DC of the drug can precipitate status epilepticus

Diazepam

Valium
Benzodiazepine
anxiety disorders, used preoperatively to relieve presurvey jitters, for muscle spasms, status epilepticus, and as an adjunct to endoscopic procedure. symptomatic alcohol withdrawal

lorazepam

Ativan
Benzodiazepine
uses: anxiety disorders, antitremor agent, antipanic agent, antiemetic, anticonvulsant,
Used in combination with haloperidol and bendryl for agitated and combative patients.
Benadryl 50mg, haloperidol 5mg, Ativan 2mg
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Benzodiazepine side effects

Anterograde amnesia- no new memories
ataxia-loss of fall control
confusion
depression
drowsiness
dysarthria-difficult unclear articulation of speach
HA

Buspirone

Buspar Antianxiety
First line agent for anxiety
It is nonsedating
does not cause a high, so it has almost no abuse potential
no cross tolerance
does not produce dependence or withdrawl
Disadvantage: it takes 1-6 weeks to work( delayed onset) 7-10 days
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Buspirone side effects

dizziness, headache; stimulation, insomnia, nervousness; light-headedness, numbness; N, diarrhea, constipation; tachycardia, palpitations

SSRI

First line agents for anxiety spectrum disorders
generalized anxiety disorders
OCD
panic attacks
PTSD
social phobias

SSNI

venlafaxine (effexor).
duloxetine(cymbalta)

Major interactions with benzodiazepines

TCA- increased sedation, confusion

clomipramine

Anafranil (TCA)
Most effective for OCD
other is the SSRI Fluvoximine

Clomipramine side effects?

HA, reduced labido, nervousness, myoclonus( spasmodic jerky contractions), increased appetite
Peripheral SE include dry mouth, constipation, ejaculation failure, erectile dysfunction and weight gain

Hydroxyzine

Atarax, Vistaril (Histamine H1 antagonist, first generation, piperazine derivative )
blocks histamine and cholenergic receptors
also blocks seritonin receptors- this property thought to be responsible for its anxiolytic properties

Pregabalin (Lyrica)

Anticonvulsant/Antineuralgic/treatment of anxiety disorders
second line agent but found to be effective

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