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Drugs used in anxiety and panic disorders

Drugs used in anxiety and panic disorders. Prof. Hanan Hagar Pharmacology Unit College of Medicine. Objectives By the end of this lecture you will be able to: Define different types of anxiety disorders Classify types of drugs used for treatment of anxiety

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Drugs used in anxiety and panic disorders

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  1. Drugs used in anxiety and panic disorders Prof. Hanan Hagar Pharmacology Unit College of Medicine

  2. Objectives • By the end of this lecture you will be able to: • Define different types of anxiety disorders • Classify types of drugs used for treatment of anxiety • Recognize the different characteristics of anti-anxiety drugs

  3. Antianxiety drugs Drugs that can relieve anxiety without interfering with mental or physical function.

  4. What is anxiety ? Physical and emotional distress which interferes with normal life.

  5. Symptoms of anxiety Emotional or psychic symptoms. Physical or somatic symptoms.

  6. Emotional Symptoms of anxiety Irrational and excessive fear and worry Irritability Restlessness Trouble concentrating Feeling tense

  7. Physical Symptoms of Anxiety Sweating Tachycardia Shortness of breath Stomach upset Frequent urination or diarrhea Sleep disturbances (Insomnia) Fatigue

  8. Types of anxiety Generalized anxiety disorder Post-traumatic stress disorder (PTSD). Obsessive-compulsive disorder (OCD). Panic disorder Phobia

  9. Generalized Anxiety Disorder (GAD) Patients are usually and constantly worried about health, money, work with no apparent reasons.

  10. Obsessive-Compulsive Disorder (OCD) An anxiety disorder in which people cannot prevent themselves from unwanted thoughts or behaviours that seem impossible to stop as Washing their hands

  11. Panicdisorder An disorder in which people have sudden and intense attacks of anxiety in certain situations.

  12. Post-traumatic stress disorder (PTSD) An anxiety disorder that affects people who have experienced a severe emotional trauma, such as rape or dramatic car accident, or even war.

  13. Phobia An intense, uncontrolled fear of a specific situation such as open spaces & heights

  14. Treatment of anxiety • Psychotherapy (cognitive behavioral therapy). • Anxiolytics

  15. Classification of anxiolytic drugs Benzodiazepines ( BDZ ). 5HT1A agonists. 5HT reuptake inhibitors. Antidepressants Beta-adrenergic blockers MAO inhibitors

  16. Benzodiazepines

  17. Nomenclature of Benzodiazepines Have the suffix “zolam” or “zepam” Alprazolam Estazolam Triazolam Lorazepam Oxazepam Temazepam Diazepam Flurazepam

  18. Classifications of Benzodiazepines are classified according to duration of action into: Short acting(3-8 hours): triazolam- Oxazepam Intermediate(10-20 hours): “ALET” Alprazolam - Lorazepam Estazolam - Temazepam Long acting: ( 24-72 hours) Chlordiazepoxide -Diazepam -Flurazepam

  19. Mechanism of Action Benzodiazepines act by binding to BZ receptors in the brain enhance GABA action on brain  chloride channels opening   chloride influx to the cell  hyper- polarizationreduction of neural excitability. GABA (γ-aminobutyric acid): is an inhibitory neurotransmitter

  20. Pharmacokinetics are lipid soluble well absorbed orally, can be given parenterally Chlordiazepoxide- Diazepam(IV only NOT IM) widely distributed. cross placental barrier (Fetal depression). excreted in milk (neonatal depression). metabolized in the liver to active metabolites (long duration of action- cumulative effect).

  21. Pharmacological Actions Anxiolytic action. Depression of cognitive and psychomotor function Sedative & hypnotic actions Anterograde amnesia Minimal depressant effects on cardiovascular system respiratory system Some have anticonvulsant effect: clonazepam, diazepam.

  22. Therapeutic Uses of Benzodiazepines Anxiety disorders: short term relief of severe anxiety General anxiety disorder Obsessive compulsive disorder Panic attack with depression Alprazolam (antidepressant effect) Sleep disorders (Insomnia). Triazolam, Lorazepam, Flurazepam

  23. Therapeutic Uses Treatment of epilepsy Diazepam – Lorazepam In anesthesia Pre-anesthetic medication (diazepam). Induction of anesthesia (Midazolam, IV)

  24. Adverse Effects Ataxia (motor incoordination) Cognitive impairment. Hangover: (drowsiness, confusion) Tolerance & dependence Risk of withdrawal symptoms: (rebound insomnia, anorexia, anxiety, agitation, tremors & convulsion). Respiratory & cardiovascular depression in large doses only (toxic effects).

  25. Drug interactions

  26. Precautions: pregnant women or breast-feeding. Liver disease Old people. Dose reduction is recommended.

  27. 5HT1A agonists Buspirone acts as agonist at brain 5HT1A receptors rapidly absorbed orally. Slow onset of action (delayed effect) T½ : (2 – 4 h).

  28. Buspirone Only anxiolytic No hypnotic effect. Not muscle relaxant. Not anticonvulsant. No potentiation of other CNS depressants. Minimal psychomotor and cognitive dysfunctions. Does not affect driving skills. Minimal risk of dependence. No withdrawal signs.

  29. Usesof buspirone As anxiolytic in mild anxiety & generalized anxiety disorders.

  30. Disadvantages of buspirone Slow onset of action (delayed effect) GIT upset, dizziness, drowsiness Not effective in severe anxiety/panic disorders Drug interactions with CYT P450 inducers and inhibitors

  31. Beta Blockers Drugs as Propranolol – atenolol act by blocking peripheral sympathetic system. Reduce somatic symptoms of anxiety. Decrease BP & slow HR. Used in performance anxiety. are less effective for other forms of anxiety should be used with caution in asthma, cardiac failure, peripheral vascular disorders

  32. Tricyclic Antidepressants Doxepin- imipramine act by reducing uptake of 5HT & NA. Used for anxiety especially associated with depression. Effective for panic attacks. Delayed onset of action (weeks).

  33. Side effectsof tricyclic antidepressants Atropine like actions (dry mouth-blurred vision, tachycardia). α-blocking activity (Postural hypotension). Sexual dysfunction. Weight gain.

  34. Selective serotonin reuptake inhibitors (SSRIs) Fluoxetine acts by blocking uptake of 5HT Orally Delayed onset of action (weeks). Long half life Used for panic disorder – OCD depression- Generalized anxiety disorders - phobia.

  35. Side effects of SSRIs Nausea, diarrhea Weight gain Sexual dysfunction Dry mouth Seizures Sleep disturbance

  36. Monoamine oxidase inhibitors (MAOIs) Phenelzine act by blocking the action of MAO enzymes. Used for panic attacks and phobia. Require dietary restriction Avoid wine, beer, fermented foods as old cheese that contain tyramine. Side effects Dry mouth, constipation, diarrhea, restlessness, dizziness.

  37. Conclusion of anxiolytics

  38. Conclusion of anxiolytics

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