Medical Colleges of Northern Philippines

Anxiety
Presentation by Group 5

Clinical Pharmacy | 2022

 Medical Colleges of Northern Philippines

Abstract
Anxiety Disorders are the most common psychiatric disorders. Theres a substantial
correlation exists between anxiety disorders, particularly generalized anxiety disorders
or panic disorders, and depressive illnesses, making treatment more difficult. Because
of its potential negative effects, current recommendations do not suggest using
benzodiazepines as first-line therapy. First-line therapies include selective serotonin
reuptake inhibitors and selective serotonin norepinephrine reuptake inhibitors. Better
efficacy is linked to psychotherapy when combined with medication. Finally, a bio-
psycho-social model for anxiety disorders is proposed.

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Overview
Introduction Non-Pharmacologic Interventions

Pathophysiology Treatment

Risk Factors

Pharmacologic INterventions

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Introduction
WHAT IS ANXIETY?
A feeling state consisting of physical,
emotional, and behavioural response to
perceived threats.

Diffuse, unpleasant sense of apprehension

accompanied by physical symptoms such
as headache, sweating, palpitations, chest
tightness, stomach upset, restlessness

Normal and necessary part of everyday life.

Presentation by Group 5
 ANXIETY AS AN DISORDER

WHEN DOES ANXIETY BECOME A DISORDER?

1. Greater intensity and/or duration than expected given the
circumstances
2. Leads to impairment or disability
3. Daily activities are disrupted by avoidance of certain situations
or objects to decrease anxiety
4. Includes clinically significant unexplained physical symptoms,
obsessions, compulsions or intrusive recollections of trauma.
 ANXIETY
Anxiety is a feeling of unease
that may be caused by an
event or worry about the
future.
A response to a threat that is
unknown, internal, vague or
conflictual.
VS FEAR
Fear is a response to
an immediate threat
Response to a known,
definite threat.
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Pathophysiology

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Presentation by Group 5

Anxiety occurs when there is a disturbance of the arousal systems in the brain.
Interconnected systems:
A general arousal system
An emotional arousal system
Endocrine/autonomic arousal system
These arousal systems activate somatic responses to arousal;
increased muscle tone
increased sympathetic activity
increased output of interior and posterior pituitary hormones.
Inappropriate increases in autonomic activity are often associated with anxiety
states: the resulting symptoms (palpitations, sweating, tremor, etc.) may initiate
a vicious circle that increases the anxiety.
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Several neurotransmitters have been implicated in the arousal systems:

Acethylcholine inthe main tram=nsmitter maintaining general arousal
Noradrenegic and serotonergic are associated with emotional arousal
activity
Drugs which antagonize such activity have anxiolytic effects
In addition, the inhibitory neurotransmitter y-aminobutyric acid (GABA)
exerts an inhibitory control on other transmitter pathways and increased
GABA activity may have a protective effect against excessive stress
reaction
Many drugs which increase GABA activity, such as the benzodiazepines, are
potent anxiolytics

Presentation by Group 5
COMMON SIGNS AND SYMPTOMS OF ANXIETY
Feeling nervous, restless or tense
Having a sense of impending danger, panic or doom
Having an increased heart rate
Breathing rapidly (hyperventilation)
Sweating
Trembling
Feeling weak or tired
Trouble concentrating or thinking about anything other than the present worry
Having trouble sleeping
Experiencing gastrointestinal (GI) problems
Having difficulty controlling worry
Having the urge to avoid things that trigger anxiety
Page 10 Presentation by Group 5

Risk Factors
01 Trauma 04 Alcohol

05
Having Blood Relatives with an Axiety
02 Stress Build-up Disorder

03 Personality
06 Other Mental Health Disorders
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Pharmacologic
Interventions
Antidepressants
Citalopram (Celexa)
Escitalopram(Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (luvox)
Paraxetine (Paxil)
Sertraline (zoloft)

BENZODIAZEPAM

Lorazepam
Diazepam
Buspirone
Flouxetin

SNRI BRANDS

Pristiq
Cymbalta
Effexor XR
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Non-Pharmacologic
Interventions

Presentation by Group 5
YOGA
MEDITATION

BREATHING EXERCISE

EXERCISE
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
COGNITIVE BEHAVIORAL THERAPY (CBT)
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Treatment
THERAPIES :

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PSYCHOTHERAPY AND COUNSELING
Presentation by Group 5

- a physiological technique use to facilitate positive

changes in personality, behavior, or adjustments.
COGNITIVE BEHAVIORAL THERAPY (CBT)
is the most effective form of psychotherapy for
anxiety disorders

MEDICATIONS
Benzodiazepam : Lorazepam -Actions
Most potent of the available benzodiazepines. Effects
(anxiolytic, sedative, hypnotic, and skeletal muscle
relaxant) are mediated by the inhibitory neurotransmitter
GABA. Action sites: thalamic, hypothalamic, and limbic
levels of CNS.
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Presentation by Group 5
Benzodiazepam : Diazepam - Actions
Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in
antianxiety and anticonvulsant activity, with somewhat shorter duration of action.
Like chlordiazepoxide, it appears to act at both limbic and subcortical levels of
CNS.
Benzodiazepam : Buspirone (BuSpar) - Actions
An anxiolytic that focuses mainly on the brain D2-dopamine receptors. It has
agonist effects on presynaptic dopamine receptors and also a high affinity for
serotonin (5-HT1A) receptors.
Benzodiazepam : Fluoxetine - Actions
Oral antidepressant chemically unrelated to tricyclic, tetracyclic, MAOI, or other
available antidepressants. Antidepressant effect is presumed to be linked to its
inhibition of CNS neuronal uptake of serotonin, a neurotransmitter. Known as a
selective serotonin reuptake inhibitor (SSRI).
Benzodiazepam :Escitalopram Oxalate - Actions
Selective serotonin reuptake inhibitor (SSRI) in the CNS. Antidepressant effect is
presumed to be linked to its inhibition of CNS presynaptic neuronal uptake of
serotonin which results in antidepressant activity. Does not produce any
sympathomimetic response or anticholinergic activity.
Medical Colleges of Northern Philippines

Thank
You!
Presentation by Group 5

Clinical Pharmacy | 2022