5. Anxiolytics and Hypnotics Flashcards
What is anxiety?
Unpleasant state of tension, apprehension, or uneasiness (of unknown source)
Anxiety is good for you
Negative reinforcer
Keeps us out of danger
Motivates escape and avoidance
Crucial for learning and memory hard wired neural circuitry
Amygdala is important for hardwired circuits in brain
Slide 5
What are the BENZODIAZEPINE anxiolytics?
What are the BARBITURATE anolytics?
BENZODIAZEPINES: Diazepam Flurazepam Oxazepam Temazepam Triazolam
BARBITURATES:
Phenobarbital
What is the benzodiazepine antagonist?
Flumazenil
What are the other hypnotic agents?
Ramelteon
Zaleplon
Zolpidem
What is the function of emotions?
What is emotions dysfunction in affective disorders?
Emotion reflects the survival significance of incoming sensory data, directs memory formation and reinforces survival directed behaviour
Affective disorders are characterized by pathological inappropriate emotions and behaviour, loss of contact with reality, inoperative reinforcement contingencies and the irrelevance of survival
What do we do if anxiety is inescapable or unavoidable?
What do we do about people with physiological abnormalities in the anxiety pathways in their brains?
Escape from anxiety by suppressing neural activity in the anxiety pathways
People with physiological abnormalities in the anxiety pathways are given anti-depressant drugs
Slide 7
What are the 7 anxiety disorders?
Generalized anxiety disorder Panic disorder Obsessive-compulsive disorder Post traumatic stress disorder Social phobia Social anxiety disorder Specific phobias
What are the pharmacological effects of benzodiazepines?
What are the neurochemical effects?
Pharmacological effects: Anxiolytic Hypnotic Anticonvulsant Muscle relax Amnesia
Neurochemical effects:
Increase GABA inhibition
Down regulate benzodiazepine receptors
Up regulate downstream receptors for NA, 5HT, etc
Overdose of benzodiazepines isn’t lethal but they do potentiate the lethal actions of other compounds like alcohol and drugs
Slide 10
How does tolerance and withdrawal work?
Rebound vs withdrawal
Altered receptor density produces tolerance
Effects of drug withdrawal after tolerance has developed is the exact opposite of the direct drug effects
Withdrawal lasts until enough receptors have returned to their pre drug state to maintain normal nerve impulse traffic
The withdrawal syndrome is more severe with short half life drugs because all active drug molecules are eliminated before any receptors can return to pre drug densities
Slide 12
What is benzodiazepine withdrawal?
It’s severe with short half life drugs like triazolam
It’s the opposite of the direct drug effect (anxiety, agitation, insomnia, convulsions, muscle tension, aches)
Withdrawal usually not a problem with long half life like diazepam
If someone needs to come off short life drug put them on a long half life drug and reduce amount given 10% a week
What are sleep disorders?
Pure insomnia is rare
Sleep is disrupted by environmental events, medical conditions, stresses, etc
Sleep deficit is usually made up in a couple of nights
Characteristic sleep anomalies is psychiatric disorders
Chemically induced sleep is not normal and not good long term but good for short term use
Look at case study slide 19
Okay
