Antianxiety Medications

Benzodiazepines

Benzodiazepines are used to treat anxiety disorders, sleep disorders, alcohol withdrawal, and seizures.

The mechanism of action is depression of the CNS at the limbic system, RAS, and cortex. Benzodiazepines bind to GABA-chloride receptors, facilitating the action of GABA.

• All benzodiazepines undergo hepatic microsomal oxidation (except for lorazepam, oxazepam, and temazepam, which undergo glucuronide conjugation).
• Side effects include sedation, insomnia, addiction, falls (elderly), confusion, and disinhibition.

Buspirone

Buspirone is used for generalized anxiety disorder and other anxiety disorders when possible abuse of benzodiazepines is a concern. It has no withdrawal effect and is not potentiated by alcohol.

The mechanism of action works on serotonin, not on GABA.

• Full effect is seen >7 days
• Some sedation is seen
• Has low-abuse potential

Recall Question

1. A 25-year-old G1P1 woman presents to the clinic for a follow-up. She has a well-documented history of bipolar disease for which she takes lithium. Which of the following potential cardiac-relevant teratogenic effects does lithium have on the fetus?

   1. Ventral septal defect
   2. Tetralogy of Fallot
   3. Transposition of the great arteries
   4. Atrial septal defect
   5. Displacement of the tricuspid valve

Answer: E