Anxiety, Benzodiazepines & Sleep Pharmacology

Vocabulary flashcards covering pharmacology, clinical indications, mechanisms of action, and safety warnings for benzodiazepines, buspirone, hydroxyzine, Z-drugs, and anxiety treatments.

Benzodiazepines (Mechanism of Action)

Positive allosteric modulation of GABA-A receptors, increasing inhibitory neurotransmission.

Common Benzodiazepines

A class of medications that includes lorazepam, clonazepam, alprazolam, and diazepam.

Buspirone

A non-benzodiazepine anxiolytic that acts via partial agonism at serotonin 5-HT1A receptors; it is not an immediate rescue medication for acute panic because its effect develops with consistent dosing over time (brand: Buspar; pronounced byoo-SPYE-rone).

Key Benzodiazepine Harms

Sedation, falls, impaired memory, dependence, withdrawal, misuse, and respiratory risk when combined with depressants.

Abrupt Benzodiazepine Cessation

A dangerous practice after dependence that can provoke seizures and other serious symptoms; discontinuing therapy requires an individualized taper.

FDA Boxed Warning on Benzodiazepines

A formal warning addressing abuse, misuse, addiction, physical dependence, and potentially life-threatening withdrawal, particularly when combined with opioids, alcohol, or other CNS depressants.

Geriatric Risks of Benzodiazepines

Increased risks of falls, delirium, cognitive impairment, and fractures in older adults; shorter-acting agents do not eliminate fall risk and are not automatically safer.

Hydroxyzine

A sedating first-generation antihistamine used for anxiety or pruritus that carries anticholinergic and QT concerns; often problematic in geriatrics due to strong anticholinergic effects, sedation, and fall/delirium risk.

Z-drugs

Nonbenzodiazepine GABA-A receptor agonist hypnotics, such as zolpidem and eszopiclone, used for insomnia.

FDA Boxed Warning on Z-drugs

A warning regarding complex sleep behaviors, such as sleepwalking or sleep-driving, that can cause serious injury or death.

CBT-I

Cognitive behavioral therapy for insomnia; the first-line treatment for chronic insomnia.

First-Line GAD Treatments

Cognitive behavioral therapy (CBT) and/or an evidence-based SSRI or SNRI; selection depends on individual patient factors.

Propranolol

A medication that may reduce performance-related physical anxiety symptoms but is not a core treatment for all anxiety disorders; contraindicated or inappropriate in asthma/bronchospasm, bradycardia, or hypotension.

Lorazepam

A common benzodiazepine medication sold under the brand name Ativan (pronounced lor-AZ-eh-pam).