Alprazolam anxiety from

Rehfeld JF, Nielsen FC Molecular forms and regional distribution of cholecystokinin in the central nervous system, in Cholecystokinin and Anxiety From Neuron to Behavior. Edited by Bradwejn J, Vasar E. Austin, TX, RG Landes, 1995, pp 33-56 Rehm LP Behavior Therapy for Depression. New York, Academic Press, 1979 Reich JR, Yates W A pilot study of treatment of social phobia with alprazolam. Am J Psychiatry 145 590-594, 1988... 

Signs and symptoms of BZ withdrawal are similar to those of alcohol withdrawal, including muscle pain, anxiety, restlessness, confusion, irritability, hallucinations, delirium, seizures, and cardiovascular collapse. Withdrawal from short-acting BZs (e.g., oxazepam, lorazepani, alprazolam) has an onset within 12 to 24 hours of the last dose. Diazepam, chlordiazep-oxide, and clorazepate have elimination half-lives (or active metabolites with elimination half-lives) of 24 to greater than 100 hours. So, withdrawal may be delayed for several days after their discontinuation. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Benzodiazepines. These agents, particularly alprazolam and clonazepam, have been widely used in the treatment of PTSD, despite little evidence to demonstrate their effectiveness. The few studies exploring the effectiveness of benzodiazepines for PTSD suggest that they provide modest relief for anxiety in general but offer no benefit for the core symptoms of PTSD, namely, intrusive recollections and emotional numbing. Furthermore, a small controlled study investigating prophylactic treatment with a benzodiazepine in the immediate aftermath of trauma exposure failed to protect patients from the subsequent development of PTSD symptoms. Consequently, we do not recommend benzodiazepines for the routine management of PTSD. 

Kava should not be used with alcohol, benzodiazepines, barbiturates or other sedatives because of their additive effects. In one case, coma resulted from mixing alprazolam and kava. Patients have complained that kava, while relaxing the body, may be less effective for mental anxiety with obsessive or racing thoughts than are the benzodiazepines. 

Alprazolam (Xanax /Pharmacia), a benzodiazepine derivative is used for the treatment of both anxiety and panic disorder and buspirone (Buspar /Bristol-Myers Squibb) is indicated for the treatment of anxiety disorders. The mechanism of action of buspirone is distinct from that of the benzodiazepines and is believed to be mediated mainly through modulation of serotonergic neurotransmission via its interaction with the 5-HT1A serotonin receptor subtype. 

Abecarnil is a partial agonist at the benzodiazepine -GABA receptor complex, and is used in generalized anxiety disorder. Its pharmacology suggests that it may be less likely to produce sedation and tolerance, but data thus far have not shown clear differences in its adverse effects from those of classical benzodiazepines, such as alprazolam, diazepam, and lorazepam. As expected, both acute adverse effects and tolerance are dose-related. 

Benzodiazepines useful to treat anxiety generally have an intermediate to long elimination ty2 (alprazolam and diazepam), and those primarily used as anticonvulsants (clonazepam) have a long ty2. Elimination ty2 is clearly not the sole determinant of duration of action of benzodiazepines. In some cases, the rate of drug redistribution from the CNS may be an even more important factor. For instance, midazolam (b/2=l to 4 hours) and diazepam (fi/2 - 30 to 56 hours) were demonstrated to have equivalent recovery times for single-dose, short-term sedation. For this application, the distribution kinetics for diazepam are more significant than elimination fi/2. 

The CNS contains a wide variety of neurotransmitters and high concentrations of receptors. Mechanisms of action of many drugs are often complex combinations of receptor-based actions. Some of the most widely used (and abused) drugs are hypnotics/sedatives, for treatment of insonmia. Barbiturates such as amylo-barbitone have been used for many years, but suffer from side-effects and are addictive. Thiopentone sodium salt (sodium pentothal), however, is very useful as a short-acting intravenous anaesthetic. The benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax), are safer drags for insomnia and also can be used for treatment of anxiety and muscle spasms. Zolpidem (Ambien) is a newer and more selective hypnotic. 

In treatment-resistant cases, benzodiazepines, either long-acting (diazepam, clonazepam, and chlordiazepoxide) or short-acting (alprazolam, oxazepam, and lorazepam) may be used when the patient does not have a history of addictive behavior. Also, they can be combined with SNRIs/SSRIs in the first weeks of treatment before the onset of the therapeutic effects of the latter. Benzodiazepines as monotherapy may not be as robust as assumed. Among patients responding to treatment, less than two-thirds will go into remission, and a number of studies have indicated, despite early improvements in anxiety symptoms, that the effect of benzodiazepines may not be different from placebo after 4-6 weeks of treatment. 

A) Alprazolam is effective in the management of obsessive-compulsive disorders Clonazepam has effectiveness in patients who suffer from phobic anxiety states Diazepam is used for chronic management of bipolar affective disorder in patients who are unable to tolerate lithium Intravenous buspirone is usefiil in status epilepticus... 

A 28-year-old woman has sporadic attacks of intense anxiety, with marked physical symptoms including hyperventilation, tachycardia, and sweating. If she is diagnosed as suffering from a panic disorder, the most appropriate drug to use is (A) Alprazolam... 

Multihetero atom heterocycles are comparatively rare in nature, dendrodoine, a cytotoxic substance from a marine tunicate, is an example, however in medicinal chemistry they are of considerable significance Alprazolam is a major drug for the treatment of anxiety, Acetazolamide is an inhibitor of the enzyme carbonic anhydrase and is used principally for the treatment of glaucoma, and Fluconazole, is an antifungal agent. 

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