Pharmacology of Anxiolytic Sedative-Hypnotics抗焦虑、镇静安眠药药理学.pptVIP

Pharmacology of Anxiolytic/ Sedative-Hypnotics Philip G. Janicak, MD Professor of Psychiatry and Pharmacology University of Illinois at Chicago Abstract Recent anxiolytic and sedative-hypnotic agents offer comparable efficacy, fewer serious adverse effects, and less risk of a fatal consequence due to accidental or intentional overdose in comparison to alcohol, barbiturates and other non-barbiturate agents (e.g., meprobamate). Unfortunately, they have not entirely eliminated the hazards of tolerance, dependency, and withdrawal syndromes, although they have a lower abuse potential than their predecessors. For these reasons, it is important to become knowledgeable about the basic pharmacology of these drugs, in addition to their appropriate clinical indications, dosages, and duration of usage. Most importantly, their limitations must receive as much attention as their assets. Objectives Review diagnostic indications for anxiolytic/ sedative-hypnotics Review different classes of antianxiety and sedative-hypnotic agents in terms of their pharmacodynamics; pharmacokinetics; adverse effects; and potential for drug interactions. Review treatment strategies for anxiety and sleep disorders. Anxiety Natural human experience Subjective qualities of fear or related emotions Ensures survival and adaptation In excess, can cripple and destroy Anxiety Symptoms Anxiety symptoms are associated with numerous medical conditions: Cardiovascular disease Endocrine disease Gastrointestinal disease Neurologic disease Drug-induced Indications for Antianxiety/Sedative-Hypnotics Generalized anxiety disorder (GAD) Phobic disorders Psychological factors affecting medical condition Panic disorder Obsessive-compulsive disorder Posttraumatic stress disorder Sleep disorders (dyssomnias; parasomnias) GAD Represents up to 50% of anxious patients seen by physicians Increased annual medical expenses Often unnecessary medical consultations 55 million prescriptions for BZDs in 1989 Anxiolytic age