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Pharm-Neuro > Anxiety and Insomnia > Flashcards

Anxiety and Insomnia Flashcards

1
Q

Generalized Anxiety Disorder

A

6 months or more of excessive worry or anxiety, generally with an unidentified cause

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2
Q

Panic Disorder

A

periods of sudden, intense fear or terror and feelings of impending doom

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3
Q

Obsessive-Compulsive Disorder

A

obsessive or intrusive thoughts that cannot be controlled and are repetitive. (e.g., washing hands, combing hair, cleaning house)

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4
Q

Posttraumatic Stress Disorder

A

follows a traumatic event, characterized by increased arousal and avoidance of stimuli that approximate the original traumatic event

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5
Q

Social Anxiety Disorder

A

persistent fear and anxiety in social or performance situations that are recognized as excessive or unreasonable.

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6
Q

RX group options for Anxiety disorders

A

1) Benzodiazepines
2) Non-Benzodiazepines
3) Antidepressants
4) Buspirone
5) Miscellaneous agents: beta blockers, MAOIs, antihistamines, barbiturates, antipsychotics

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7
Q

Sedatives

A
  • anxiolytic effect
  • calm
  • no CNS depression (no sleepiness)
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8
Q

Hypnotics

A
  • cause drowsiness

- depress CNS

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9
Q

Benzodiazapenes used in anxiet

A
  • alprazolam
  • clonazepam
  • diazepam
  • lorazepam
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10
Q

5 properties of benzodiazapenes

A

1) Anxiolytic
2) Hypnotic
3) Muscle relaxation
4) Anticonvulsant
5) Amnesic actions

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11
Q

MOA of Benzodiazapines

A

increase the frequency of opening chloride ion channels that are coupled to GABA-A receptors
act as agonists,
-increase GABA effect

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12
Q

where are benzos absorbed?

A

the gut

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13
Q

pharmocology of benzos

A

as plasma level decreases they leave the brain, metabolized by liver and turned into active metabolites

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14
Q

long lasting benzodiazapenes are (3)…

A

1) chlordiazepoxide
2) diazepam
3) flurazepam

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15
Q

Short acting Benzodiazapenes are (4)…

A

1) alprazolam
2) estazolam
3) midazolam
4) triazolam

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16
Q

What are 3 benzodiazepines not converted to active metabolites?

A

1) Oxazepam
2) Temazepam
3) lorazepam

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17
Q

What are issues with Benzodiazepenes?

A
  • tolarance and dependence to hypnotic issue develops quickly
  • physical dependence occurs within weeks to months
  • patient should only be on it for 4 months
  • tapper dose or withdrawl
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18
Q

What is the abuse potential in patients with generalized anxiety?

A

Abuse potential is low in patients with true generalized anxiety disorder and they usually do not continue to escalate their doses because tolerance

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19
Q

Do benzos effect fetus?

A

yes, can cross placenta and breast milk. sedates and depresses kid

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20
Q

what is the annecdote for benzos?

A

Flumazenil

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21
Q

What are 3 sedative - hypnotic drugs that are not benzos?

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

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22
Q

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

A
  • do not affect sleep architecture
  • decrease sleep latency
  • shorter half life than benzos
  • zaleplon- shortest 1/2 life
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23
Q

TCAs

A
  • used in panic dissorder and has anxiolytic effect
24
Q

SSRIs

A

used in anxiety disorders

25
Q

2 SNRIs used in general anxiety dissorder

A

Venlafraxine and Duloxetine

26
Q

Duloxetine

A

general anxiety dissorder and panic disorder

27
Q

How long does it take to see a response with antidepressants?

A

a couple weeks

28
Q

Buspirone (Buspar) MOA

A

5-HT1A (serotonin) & dopamine receptors agonist

29
Q

Buspirone (Buspar)

A
  • used in treatment of chronic anxiety

- takes 3-4 weeks to start working so do not use in acute anxiety

30
Q

Beta-blocker used in public speaking

A

Propranolol

-caution in asthmatic patients

31
Q

MAOIs

A

used for pts. with panic dissorder w/ atypical depression

32
Q

Antihistamine

A

sedating properties can reduce anxiety and often tried in patients with substance abuse issues

33
Q

What two antihistamines are used to reduce anxiety?

A

Hydroxzyzine (Atarax & Vistaril)

Diphenhydramine (Benadryl)

34
Q

Barbituates

A

-narrow theraputic window, lethal in overdose

35
Q

Treatment approach for generalized anxiety is…

A

benzodiazepines
limit to 4 months
-usualy no dose escalation

Antidepressants
take longer to work, great for chronic

Buspirone
good in drug seekers take 4 weeks

36
Q

Panic Disorder medications

A
  • alpazolam, clonazepam

- SSRIs

37
Q

Does Buspirone work in panic dissorder?

A

NO

38
Q

OCD treatment protocol is…

A

SSRIs
Paraxatine and Clomipramine
patients need cognitive therapy

39
Q

PTSD treatment

A

SSRI-Sertaline-firstline

Beta-blockers- second line

40
Q

Where are the sleep centers in the brain?

A

brain stem, basal forebrain, and hypothalamus

41
Q

What maintains wakefulness?

A

reticular activating system

42
Q

What neurotransmiters are involved in the sleep-wake cycle?

A

NE, 5-HT, acetylcholine, histamine, and neuropeptides

43
Q

Which transmiter is used during dreaming?

A

NE

44
Q

Which transmiter is used during non-dreaming sleep?

A

5-HT

45
Q

What is insomnia?

A
  • inability to maintain sleep
  • transient- acute stress drugs for a couple days
  • short term- acute stressor ongoing in nature (drugs for 10 days)
  • chronic- treat underlying cause
46
Q

What drug should be avoided in sleep apnea?

A

Ramelteon (Rozerem)

47
Q

What are 3 non-benzos used in insomnia

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

48
Q

Melatonin - insomnia

A

Reamelteon

receptor 1 and 2 agonis

49
Q

What three benzos are used in insomnia?

A
  • triazolam
  • temazepam
  • flurazepam
50
Q

Problems with benzos for insomnia

A 
-not indicated for chronic use
effective for 4 weeks
-tolerance
-daytime sedation
-rebound insomnia
-amnisia
-withdrawl
51
Q

Zolpidem (ambien) MOA

A

modulates the GABA-A receptor complex
½ life: 1.5-4 hours
-no repiratory effect

52
Q

Zaleplon (sonata)

A

similar to ambien

super short 1/2 life (1hour)

53
Q

Eszopiclone (Lunesta)

A

GABA-A agonist

54
Q

Ramelteon )Rozerem)

A

Melatonin receptor agonist

treats sleep onset insomnia

55
Q

Diphenhydramine

A

OTC

  • sedating and antichoinergic
  • regular use not recomended
  • dont use in elderly may worsen dementia
56
Q

TCAs and Trazadone

A

effective for insomnia and only need a much lower dose

Pharm-Neuro (6 decks)

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