Anxiety and Sleep

Question 1

GABA and anxiety

Answer 1

decreased GABA = increased anxiety

Question 2

Serotonin and anxiety

Answer 2

decreased serotonin = increased anxiety

Question 3

NE and anxiety

Answer 3

Decreased NE = increased anxiety

Question 4

Busiprone

Answer 4

tx for generalized anxiety disorder

useful in patients without comorbid depression or other anxiety disorders

Question 5

First line treatment for Generalized Anxiety Disorder

Answer 5

Benzodiazepines

Question 6

TCAs

Answer 6

tx for GAD

useful for patients with comorbid depression

Question 7

Examples of Benzodiazepines

Answer 7

short acting- triazolam, oxazepam, lorazepam

long acting- diazepam, flurazepam, clonazepam

Question 8

Flumazenil

Answer 8

blocks BZ1 and BZ2 receptors to rapidly reverse action of benzodiazepines

Question 9

MOA of Benzodiazepines

Answer 9

increase frequency of Cl channel opening
binds on BZ1- sedative
BZ2- antianxiety, anticonvulsant, muscle relaxant

Question 10

BZs not metabolized by the liver

Answer 10

Lorazepam and Oxazepam

better for elderly and those with hepatic dysfunction

Question 11

SE of BZs

Answer 11

CNS depression- drowsiness

anterograde amnesia

Question 12

Chronic BZ use leads to….

Answer 12

dependence and abuse

Question 13

Antidepressants for GAD

Answer 13

SSRIs

SNRIs

Question 14

Examples of SSRIs

Answer 14

Escitalopram

paroxetine

Question 15

MOA of SSRIs

Answer 15

block neuronal serotonin transporter (SERT)

inhibits reuptake of serotonin, prolonging its action

Question 16

SE of SSRIs

Answer 16

sexual dysfunction

Question 17

Drug Interactions of SSRIs

Answer 17

paroxetine with TCAs- cardiotoxicity

not CNS depressants- good if history of substance abuse

Question 18

MOA of SNRIs

Answer 18

block SERT and NET to inhibit reuptake of serotonin and NE

Question 19

SE of SNRIs

Answer 19

cardiac effect due to NE
nausea, headache, dry mouth
sexual dysfunction

Question 20

Examples of TCAs

Answer 20

imipramine

Question 21

MOA of TCAs

Answer 21

block SERT and NET to inhibit reuptake of serotonin and NE

Question 22

SE of TCAs

Answer 22

block of M receptors- dry mouth, tachycardia, sedation, weight gain
a1 receptor block- hypotension, tachycardia

Question 23

MOA of Buspirone

Answer 23

inhibits NET

Question 24

SE of Buspirone

Answer 24

nausea, headaches

not CNS depressant

Question 25

Immediate relief for panic attack

Answer 25

BZs

Question 26

Tx of Social Anxiety Disorder

Answer 26

antidepressants- SSRIs and SNRIs

B blockers

Question 27

BZs for Insomnia

Answer 27

Triazolam

Flurazepam

Question 28

Non-BZ GABA Agonists for Insomnia

Answer 28

Zolpidem

Zaleplon

Question 29

Advantages of Non-BZs over BZs

Answer 29

less withdrawal, tolerance, rebound insomnia

no BZ2 effect

Question 30

Melatonin Receptor Antagonists for Insomnia

Answer 30

Ramelteon

Question 31

Least effective Insomnia Drug

Answer 31

Melatonin Receptor Agonist