Anti-Anxiety Drugs

Question 1

What are three characteristics of anxiety?

Answer 1

Adaptive
Pathological
Anticipatory

Question 2

3 main types of anxiety

Answer 2

Gen anxiety disorder
Panic disorder
Phobias

Question 3

What are 4 proposed treatments for GAD?

Answer 3

Antidepressants, especially SSRIs
Benzodiazepines (eg. Diazepam)
Beta blockers (propranolol) if somatic
Buspirone (5-HT1A partial agonist)

Question 4

What are 2 proposed treatments for Panic Disorder?

Answer 4

Benzodiazepines

Antidepressants

Question 5

What are the proposed treatments for social and specific phobias?

Answer 5

Social - beta blockers

Specific - Therapist sessions

Question 6

What is the comorbidity of GAD?

Answer 6

Other anxiety disorders and Major Depression

Question 7

Who gets GAD?

Answer 7

Everyone

Question 8

Diazepam has similar distribution patterns to which kind of receptor?

Answer 8

GABA-A

Question 9

Diazepam _____ GABA receptors’ affinity to GABA

Answer 9

Increases

Question 10

GABA and GABA agonists ______ Diazepam binding

Answer 10

Increase

Question 11

What three parameters describe GABA-A receptor activity?

Answer 11

Probability of opening
Open time
Conductance

Question 12

Benzodiazepines mainly do what to GABA receptors?

Answer 12

They increase the probability of the channel opening

Question 13

Barbiturates do what to GABA receptors?

Answer 13

Prolong channel opening

Question 14

True/False? GABA-A receptors have only one binding site

Answer 14

False

Question 15

True/False? All Benzodiazepines have roughly the same pharmacokinetics

Answer 15

False

Question 16

What properties to Benzodiazepines share? (4)

Answer 16

Rapid brain entry, slow redistribution (IV diazepam)
Active metabolites
Binding to plasma proteins
Enterohepatic recycling

Question 17

What is the main active metabolite in benzodiazepines?

Answer 17

Nordiazepam

Question 18

Why do Benzodiazepines have a long duration of action?

Answer 18

Clearance is reduced due to plasma protein binding

Question 19

What are the three main effects of benzodiazepines? What receptors are affected?

Answer 19

Sedation
Muscle relaxation
Anticonvulsant

GABA-A receptors presenting alpha 1 subunit

Question 20

Which receptors produce anxiolytic effects when affected?

Answer 20

Noradrenergic alpha 2 receptors

Question 21

What determines the anxiolytic action of diazepam?

Answer 21

alpha2-containing GABA-A receptors

Question 22

What is the difference in therapeutic delay for buspirone and Benzodiazepines?

Answer 22

Buspirone: 1-3 weeks
BZs: 15 min-2 hrs

Question 23

True/False? buspirone helps with panic attacks

Answer 23

False

Question 24

True/False? buspirone has hardly any side effects

Answer 24

True (slight sedation)

Question 25

Is Buspirone's effect on 5-HT transmission predictable? Why (not)?

Answer 25

No. - 5-HT1A receptors have opposing effects on 5-HT transmission (they inhibit 5-HT cell firing and release, but also mimic a postsynaptic action of 5-HT) - Partial agonists can have agonist-like or antagonist-like actions, depending on 5-HT tone

Question 26

What is the stereotypical beta blocker?

Answer 26

Propranolol

Question 27

What are the endogenous agonists at beta-adrinergic receptors? (2)

Answer 27

Noradrenaline and adrenaline

Question 28

Where are beta adrenergic receptors found?

Answer 28

Heart Blood vessels in muscle Bronchi Brain

Question 29

What does the effect of beta blockade depend on?

Answer 29

sympathetic tone

Question 30

What are 5 unwanted effects of Propranolol?

Answer 30

``` Bronchoconstriction in asthma Cardiac failure in heart disease Blocks signs of hypoglycemia in diabetic patients Physical fatigue Bad dreams ```

Question 31

True/False? Diazepam reduces somatic and psychic anxiety.

Answer 31

True

Question 32

True/False? Propranolol reduces somatic and psychic anxiety.

Answer 32

False, just somatic

Question 33

Which drugs work best for GAD?

Answer 33

Benzodiazepines ~ buspirone ~ SSRIs Choice of drugs depends need of rapid onset and adverse effects Beta blockers are widely used but not proven to work long term (considered second line)

Question 34

What are 2 examples of animal models?

Answer 34

Elevated plus maze | Fear-potentiated startle response

Question 35

True/False? Acute buspirone helped rats spend more time in the open arms of the elevated plus mase

Answer 35

False

Question 36

What is the fear-potentiated startle response?

Answer 36

0. Pavlovian conditioning to associate light with shock 1. startle in dark, measure response 2. startle in light, measure response 1. and 2. have different responses

Question 37

What are three advantages of the fear-potentiated startle response?

Answer 37

- Detects broad range of anxiolytics - Not only order drugs, but newer ones (buspirone) - Reveals brain mechanisms

Question 38

True/False? Anxiety has many components

Answer 38

True