What is an Anxiolytic?

Anxiolytics are drugs that are mainly used to relieve anxiety and tension. It is mainly composed of benzodiazepines, including lemienine, diazepam and its derivatives. These drugs have good therapeutic effects, high safety, and low side effects. They also have anti-epileptic and anti-anxiety, relaxation muscle tension, sedative and sleeping effects, and have the most extensive clinical applications.

Drug Name: Anxiolytics
Foreign name: antianxiety drugs

Main indications: Anxiety and tension
Function: Relieves anxiety and tension from various causes

Overview of Anxiolytics

Anxiolytic

antianxiety drugs

Anxiolytics

Used to relieve anxiety and tension caused by various causes, such as various types of neurosis and depression in psychiatry, as well as brain trauma, cerebral arteriosclerosis and other organic mental illness; hypertension and hyperthyroidism in internal medicine; women's Premenopause and menopause; anxiety reactions caused by antipsychotics; stress states, such as before and after surgery, after special or unexpected events. The drug is quickly absorbed after oral administration, is mainly metabolized in the liver, and is excreted by the urine. Although the pharmacological effects and efficacy of this group of drugs are similar, the methods of use are not exactly the same. Such as the stability of long-term effect, usually 1 to 2 times a day can be effective, most patients take medicine once a night before bed, which can improve sleep at night, and can control the symptoms of anxiety during the day; Zolane and other drugs have a short duration of action and need to be administered 3 to 4 times a day. Fluoxetine and nitroazepam have good sleeping effects and are used as sleeping pills once a night before bedtime. Long-term use of this group of drugs can produce dependence, and generally should not exceed 6 weeks. Gradually reduce the dose when stopping the drug to avoid withdrawal reactions, such as insomnia, headache, irritability, excitement, nausea, vomiting, muscle pain or tics, and severe cases may have seizures or acute excitement. This group of drugs is relatively safe, and even a large number of drugs rarely cause severe poisoning or death. Side effects are mild, mainly drowsiness, dizziness, dizziness, excessive doses can cause tremor, ataxia, sweating, dizziness, shortness of breath, rapid heartbeat, cold and fever in the body, cold or fever in the hands and feet, and uncomfortable stomach Excessive urination and obstruction of throat. ; Sometimes it can affect reaction time and coordinated actions, affecting driving cars.

Anxiolytics drug classification

There are four main categories of anti-anxiety drugs:

(1) Benzodiazepines. Such drugs include diazepam, clonazepine, norhydroxylazepam, nitroazepam, and fluazepam. These drugs have anxiolytic, sedative, and hypnotic effects at high doses. They are also effective muscle relaxants and antiepileptic drugs. Its drugs mainly act on the reticular structure and limbic system of the brain, thus producing a sedative and hypnotic effect.

(2) Carbamates. Such as meprobamate, Cariptop and so on. This class of drugs has sedative and anxiolytic effects and can be used for insomnia. This drug is mainly used for the nervous anxiety of neurosis.

(3) Diphenylmethanes. Such as Ding Tai Le, this class of drugs have sedative, weak stability and muscle relaxation, and have antihistamine effect, so they can be used to treat insomnia. Generally used mainly for mild anxiety, anxiety, and anxiety in menopause.

(4) Other categories, such as Fenalu and Oryzanol. Oryzanol mainly regulates autonomic nerve function, reduces endocrine balance disorders, improves mental and neurological disorders, not only improves anxiety, but also has a good effect on insomnia caused by anxiety.

In addition to the above four categories, there are -adrenergic receptor blockers, phenothiazines, tricyclic antidepressants, barbiturates and other sedatives, etc., sometimes also used clinically.

What is anxiolytics ?

Different from normal anxiety:

First, it is anxiety, tension, and fear for no reason and without a clear object and content;

Second, it is pointing to the future. It seems that some threats are coming, but the patients themselves cannot tell what kind of threats or dangers exist;

Third, it lasts for a long time. Without active and effective treatment, it can be difficult to heal for weeks, months, or even years. In the end, anxiety disorders, in addition to presenting persistent or episodic panic states, are accompanied by a variety of physical symptoms.

In short, pathological anxiety is an unfounded panic and nervousness. The psychological experience is a generalized, unfixed target of fear and panic, with physical symptoms associated with increased alertness.

These symptoms are not limited to simple anxiety disorders. Some mental disorders may also produce anxiety symptoms, such as schizophrenia, obsessive-compulsive disorder and other mental illnesses. The anxiety symptoms of this type of disease are just one of the symptoms. This type of anxiety symptoms is clinically and psychiatrically not different from pure anxiety. It may be more complicated to treat than pure anxiety because At the same time as the symptoms of anxiety, other symptoms of these patients must be treated, so it needs to be distinguished from pure anxiety.

Anxiety disorder is commonly called anxiety state, which is called anxiety neurosis.

Anxiety disorder is a type of brain dysfunction with persistent anxiety, fear, nervousness, and autonomic nervous disorders, often accompanied by motor disturbances and physical discomfort. Onset in young adults, there is no significant difference between men and women.

Anxiolytic indications

It is most commonly used for secondary anxiety states caused by anxiety symptoms and various neurosis, as well as physical illness or various organic causes. Medications before and after surgery, before endoscopy, and in some special circumstances, have the effect of stabilizing emotions and relieving tension.

The indications for treatment are quite wide, most commonly used for various neuroses with symptoms of anxiety, such as anxiety, panic attack, phobia, obsessive-compulsive disorder, suspected disorder and neurasthenia. Secondary anxiety due to physical illness or various organic causes, such as hyperthyroidism in patients with hypertension, and premenstrual tension often associated with anxiety symptoms, can be used for symptomatic treatment of this class of drugs. Excessive anxiety during stress, such as before and after surgery or after special or unexpected events, can also be temporarily taken temporarily. In addition, it is often used clinically as a sleeping drug, and is mainly suitable for those with difficulty falling asleep.

Clinically, drugs are mainly selected according to the condition, and those with long-term effects such as diazepam or limening are selected for long-term chronic anxiety; those with intermittent episodes of anxiety or temporary use should choose drugs with short-term effects, such as noroxylazepam Wait.

The course of treatment should be flexibly mastered according to the condition. Those who only need short-term treatment will be sufficient for 1 to 2 weeks of medication. For chronic anxiety, it should not exceed 6 weeks. When discontinuing the drug, a gradual reduction method should be adopted, and sudden stop should not be taken to prevent the withdrawal reaction from occurring. Take more oral method, the daily dose can be given in divided doses, or once before bedtime. Injections are only available for severe acute anxiety states.

However, abuse of this class of drugs (for those who do not need to use this class of drugs) or excessive doses and long treatment periods can cause drug dependence. This situation has caused concern, and most countries have listed anxiolytics as managed drugs, which must be administered by prescription and cannot be purchased on their own.

Anxiolytic adverse reactions

At the therapeutic dose, the side effects are slight, mainly including sleepiness, weakness, dizziness and dizziness, and occasional drug rash. Excessive doses can cause side effects such as excessive sedation, tremor, and ataxia; sometimes it can affect fine motor and coordination functions, but the drug user cannot notice this, which can lead to a car accident or accident. Long-term use of drugs can lead to drug dependence. Patients become more tolerant of drugs, resulting in higher doses. Sudden withdrawals can cause withdrawal reactions, such as insomnia, headaches, irritability, excitement, nausea, vomiting, muscle pain or tics. In severe cases, there may be seizures or acute excitement. Overdose can cause poisoning, manifested as unconsciousness, drowsiness, lethargy, coma or delirium, accompanied by muscle relaxation, bradycardia, decreased blood pressure and other symptoms.

Reasonable use of anxiolytics

Anxiety is one of the common symptoms of neurasthenia patients. Patients are anxious, nervous, and feared, often accompanied by physical symptoms such as headache, palpitations, irritability, and insomnia. Anxiolytics have the effects of reducing anxiety, stabilizing mood, and improving sleep, and can relax the tension of muscles. They are currently a widely used class of drugs.

At present, it is thought that the main parts controlling emotional activity are the limbic system of the brain (such as the thalamus, hippocampus, amygdala, etc.), and these parts play an important role in the pathogenesis of neurasthenia. Anxiolytic drugs mainly selectively inhibit the hippocampus and amygdala of the limbic system and produce anxiolytic effects. At the same time, they can also inhibit the reticular structure of the brainstem, reduce the excitability of the cerebral cortex, and produce sedative and hypnotic effects. Neurons produce central skeletal muscle relaxation and other effects.

At present, benzodiazepines are generally first selected. There are many varieties of this class of drugs, each with its own characteristics. Generally can be selected according to their sedative and hypnotic effects, anxiolytic effects and muscle relaxation effects. The order of its sedative and hypnotic effects is as follows: nitrostilbine> stilbene> Lianmining> salonine> deoxyazepam. The anti-anxiety effect was diazepam deoxyazepam Limening> Anning> Nitro-Diazepam. The effect of muscle relaxation is: diazepam> hydroxylazepam.

Anxiolytic drugs contraindications

This class of drugs is relatively safe, except for those who are allergic to and dependent on drugs, without special contraindications. Caution should be used with severe cardiovascular, liver, kidney disease and alcoholism.

Anxiolytic anxiety

Anxiety is a common symptom of many psychiatric disorders. Anxiety disorder is a neurosis characterized by repeated episodes of acute anxiety and accompanied by autonomic dysfunction. At the time of the attack, patients were more conscious of fear, tension, anxiety, palpitations, cold sweats, tremors, and sleep disturbances. Whether it is an anxiety disorder or an anxiety state, clinical anxiolytic drugs are often used. Commonly used are benzodiazepines (see Chapter 14 for details).

Guidance on anxiolytic medicinal drugs

Anxiolytics, also known as weak stabilizers, are a group of drugs that are mainly used to eliminate symptoms of tension and anxiety. In particular, benzodiazepines have sedative, anti-anxiety, anti-epileptic and muscle-relaxing effects in the amount of treatment subjects, and hypnotic effects at higher doses. Its pharmacology is mainly produced by increasing the activity of two inhibitory neurotransmitters, -aminobutyric acid (GABA) and glycine. The anti-anxiety effect is related to the inhibition of 5-HT energy activity of the brainstem reticular structure and limbic system. See Table 6 for pharmacological effects of various anxiolytics

(1) Indications and contraindications: It is most commonly used for secondary anxiety states caused by anxiety symptoms and various neurosis, as well as physical diseases or various organic causes. Medications before and after surgery, before endoscopy, and in some special circumstances, have the effect of stabilizing emotions and relieving tension.

(II) Medication method: See Table 7 for commonly used doses of anxiety. It can be taken orally or once before bedtime. It should not be taken for a long time to avoid drug dependence. Generally, it should not exceed 2 weeks, and patients with chronic anxiety should not exceed 6 weeks. If the condition requires, anxiolytic use with similar pharmacological effects can be used alternately.

Benzodiazepines are generally preferred. For intermittent episodes of anxiety (pre-operative anxiety), short-acting drugs such as Jiajing Dianding and clodrolidine are used. For persistent anxiety state, long-acting drugs should be selected, such as diazepam, nitroazepam, and fluoroazepam. Drugs can also be selected based on clinical symptoms and pharmacological effects: anti-anxiety effects are preferably Jiajing Dianding, chlorhexidine and sulbutanil; sedative and hypnotic effects are preferably fluorobutadione, nitroandridine, sulbutan and diazepam; muscles The relaxation effect is preferably diazepam, chlorhexidine and nordroxyzol.

Diphenylmethanes also have antihistamine effects, and are suitable for patients with skin diseases or pruritus, such as atalol. Tetracycline, a tetracyclic compound, has strong sedative and anxiolytic effects, and can also produce anticholinergic side effects. Propylene glycol has few special advantages.

(3) Side effects: The side effects at the treatment dose are slight, showing sleepiness, weakness, dizziness, and dizziness, and occasional rashes. Tremors, ataxia, and blurred vision can occur at high doses. Long-term use can lead to increased drug demand, and sudden withdrawal can lead to withdrawal reactions. Such as insomnia, headache, irritability, nervousness, nausea, vomiting, muscle pain or tics, severe cases can be accompanied by seizures or agitation.

Anxiolytic preparations and usage

Chlorpromazine hydrochloride is generally administered orally in an amount of 12.5-50 mg / time, 2 times / day. Intramuscular injection, 25-50mg / time. Treatment of mental illness should start with a small dose, 300 mg / day for mild, 600-800 mg / day for severe, and gradually reduce the maintenance amount (50-100 mg / day) after improvement. Those who refuse to take the medicine should use 50-100mg / times, and add it to 20ml of 25% glucose solution, then slowly intravenously.

Perphenazine is usually 2 to 4 mg / time, 3 times / day. 5-10mg / time, intramuscular injection. Treatment of mental illness: mild 20-30 mg / day, severe 40-60 mg / day, divided into two intramuscular injections.

Trifluperazine hydrochloride 10 30mg / time, divided into 3 times.

Fluphenazine hydrochloride 2 20mg / day.

Fluphenazine decanoate was injected intramuscularly at 25 mg every 2 weeks.

Fluprothixene (chlorprothixene) is mild 150 mg / day, severe 300-600 mg / day, orally.

Haloperidol is administered orally 2-10 mg / time, 3 times / day, intramuscularly, 5 mg / time.

Droperidol for the treatment of schizophrenia: 10-30 mg / day, divided into 1 or 2 times, intramuscular injection. Neuroleptic analgesia: 5mg each time, adding 0.1mg of fentanyl, slowly intravenously within 2 to 3 minutes, if the level of superficial anesthesia is not reached within 5 to 6 minutes, an additional half to double the amount. Administration before anesthesia: intramuscular injection of 2.5 to 5 mg half an hour before surgery.

Mipramine hydrochloride 25-75mg / time, 3 times / day. The elderly and infirm started gradually from 12.5mg daily.

Amitriptyline (amitriptyline) 75-150mg / day, orally in 3 divided doses.

Lithium carbonate (lithium carbonate) starts from a small dose, 0.5g / day, increases to 0.9-1.8g / day, and is taken orally in 3 to 4 times.