ILOs By the end of this lecture you will be able to Define different types of anxiety disorders

1. ILOs 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 antianxiety drugs Drugs used in Anxiety & Panic Disorders

2. What is anxiety ? Physical and emotional distress which interfere with normal life.

3. Emotional Symptoms of anxiety irrational and excessive fear and worry Irritability Restlessness Trouble concentrating Feeling tense Physical Symptoms of Anxiety Sweating Tachycardia Stomach upset Frequent urination or diarrhea Sleep disturbances (Insomnia) Fatigue

5. Types of anxiety disorders 1- Generalized anxiety disorder 2- Panic disorder

6. 3- Phobia • 4-Post traumatic stress disorder 5- Obsessive compulsive disorder

7. Treatment of anxiety • Psychotherapy • Anxiolytics

8. Classification of anxiolytic drugs: Benzodiazepines ( BDZ ). 5HT1A agonists. 5HT reuptake inhibitors. Tricyclic Antidepressants beta-adrenergic blockers MAO inhibitors

9. Benzodiazepines

10. Can be classified according to the duration of action into short, medium & long- acting

11. Mechanism of Action Benzodiazepines act by binding to BZ receptors in the brain enhance GABA action on brain

13. 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).

15. Pharmacological Actions Anxiolytic action.

16. Pharmacological Actions 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.

17. Therapeutic Uses 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

18. Therapeutic Uses Treatment of epilepsy Diazepam – Lorazepam In anesthesia Preanesthetic medication (diazepam). Induction of anesthesia (Midazolam, IV)

19. Adverse Effects Ataxia (motor incoordination) Cognitive impairment. Hangover: (drowsiness, confusion) Tolerance & dependence Risk of withdrawal symptoms Rebound Insomnia, anorexia, anxiety, agitation, tremors and convulsion.

20. Adverse Effects Toxic effects: respiratory & cardiovascular depression in large doses.

21. Drug interactions

22. Dose should be reduced in Liver disease Old people. Precaution Should not be used in pregnant women or breast-feeding. People over 65.

23. 5HT1A agonists Buspirone acts as agonist at brain 5HT1A receptors rapidly absorbed orally. t½ : (2 – 4 h). liver dysfunction   its clearance.

24. 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.

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

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

27. Beta Blockers 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

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

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

31. 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.

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

33. 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.

34. Conclusion of anxiolytics

35. Conclusion of anxiolytics