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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
2 SNRIs used in general anxiety dissorder
Venlafraxine and Duloxetine
26
Duloxetine
general anxiety dissorder and panic disorder
27
How long does it take to see a response with antidepressants?
a couple weeks
28
Buspirone (Buspar) MOA
5-HT1A (serotonin) & dopamine receptors agonist
29
Buspirone (Buspar)
- used in treatment of chronic anxiety | - takes 3-4 weeks to start working so do not use in acute anxiety
30
Beta-blocker used in public speaking
Propranolol | -caution in asthmatic patients
31
MAOIs
used for pts. with panic dissorder w/ atypical depression
32
Antihistamine
sedating properties can reduce anxiety and often tried in patients with substance abuse issues
33
What two antihistamines are used to reduce anxiety?
Hydroxzyzine (Atarax & Vistaril) | Diphenhydramine (Benadryl)
34
Barbituates
-narrow theraputic window, lethal in overdose
35
Treatment approach for generalized anxiety is...
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
Panic Disorder medications
- alpazolam, clonazepam | - SSRIs
37
Does Buspirone work in panic dissorder?
NO
38
OCD treatment protocol is...
SSRIs Paraxatine and Clomipramine patients need cognitive therapy
39
PTSD treatment
SSRI-Sertaline-firstline | Beta-blockers- second line
40
Where are the sleep centers in the brain?
brain stem, basal forebrain, and hypothalamus
41
What maintains wakefulness?
reticular activating system
42
What neurotransmiters are involved in the sleep-wake cycle?
NE, 5-HT, acetylcholine, histamine, and neuropeptides
43
Which transmiter is used during dreaming?
NE
44
Which transmiter is used during non-dreaming sleep?
5-HT
45
What is insomnia?
- 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
What drug should be avoided in sleep apnea?
Ramelteon (Rozerem)
47
What are 3 non-benzos used in insomnia
Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta)
48
Melatonin - insomnia
Reamelteon | receptor 1 and 2 agonis
49
What three benzos are used in insomnia?
- triazolam - temazepam - flurazepam
50
Problems with benzos for insomnia
``` -not indicated for chronic use effective for 4 weeks -tolerance -daytime sedation -rebound insomnia -amnisia -withdrawl ```
51
Zolpidem (ambien) MOA
modulates the GABA-A receptor complex ½ life: 1.5-4 hours -no repiratory effect
52
Zaleplon (sonata)
similar to ambien | super short 1/2 life (1hour)
53
Eszopiclone (Lunesta)
GABA-A agonist
54
Ramelteon )Rozerem)
Melatonin receptor agonist | treats sleep onset insomnia
55
Diphenhydramine
OTC - sedating and antichoinergic - regular use not recomended - dont use in elderly may worsen dementia
56
TCAs and Trazadone
effective for insomnia and only need a much lower dose

Pharm-Neuro (6 decks)

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