Anxiety and Sleep Disturbance

Question 1

how do you treat phobias

Answer 1

CBT

Question 2

how do you treat anxiety states:

panic disorders, OCD, acute stress disorder, PTSD

Answer 2

anti-depressants

Question 3

how do you treat generalised anxiety disorder?

Answer 3

anti-anxiolytics

Question 4

barbituates vs benzos:

therapeutic effect

Answer 4

Barbiturates-
Anxiolytic effects only at sedative doses

Benzodiazepines-
Anxiolytic effects at non-sedative doses

Question 5

barbituates vs benzos:

pharmacokinetic

Answer 5

Barbiturates-
Induces cytochrome P450 enzyme system, hence tolerance develops and dose has to be increased.

Benzo-
No induction of CP450 enzyme system, so no tolerance develops.

Question 6

barbituates vs benzos:

overdose toxicity

Answer 6

Barbiturates-
Significant risk of overdose – respiratory depression and coma

Benzo-
No respiratory depression, hence safe in overdose

Question 7

barbituates vs benzos:
Additive effects with other CNS depressants
(esp. alcohol)

Answer 7

barbituates- affected by alcohol

Question 8

barbituates vs benzos:

dependance

Answer 8

barb-
severe

benzo-
less severe

Question 9

Chloral Hydrate

Answer 9

anti-anxiolytic:

Metabolised to trichlorethanol but mechanism unknown

Question 10

use of chloral hydrate?

Answer 10

Sedative for children and elderly patients

Question 11

use of meprobramate?

Answer 11

Only as muscle relaxant (in MS) due to abuse and dependence as anti-anxiolytic

Question 12

Pentobarbitone
Phenobarbitone
Thiopentone

Answer 12

Barbiturates -
Augments binding of GABA at GABAa receptor to increase duration that Cl- channels are open.

At high concentrations, directly opens Cl- channel, independent of GABA.

Question 13

use of thiopentone?

Answer 13

anaesthesia induction

Question 14

Clonazepam
Diazepam
Lorazepam
Triazolam 
Midazolam

Answer 14

Benzodiazepines -
PAM/LAM- anxiety

Positive allosteric modulator of GABAa receptor to increase frequency at which Cl- opens

Question 15

use of clonazepam?

1/2 life?

Answer 15

Anti-convulsant (long-acting t1/2 = 55h for sustained anticonvulsant effect)

Question 16

use of diazepam?

1/2 life?

Answer 16

Anti-anxiolytic (medium-acting t1/2 = 32h to reduce risk of rebound anxiety)

Question 17

use of lorazepam?

1/2 life?

Answer 17

Anti-anxiolytic (medium-acting t1/2 = 10h to reduce risk of rebound anxiety)

Question 18

use of triazolam?

1/2 life?

Answer 18

Hypnotic (short-acting t1/2= 8h)

Question 19

use of midazolam?

1/2 life?

Answer 19

Dental Phobia (very short-acting t1/2 = 30 mins)

Question 20

antidote for benzo overdose?

Answer 20

flumazenil

Question 21

what are:

Zolpidem and Zopiclone

Answer 21

non-benzodiapzemine ligands for the benzodiazepine binding site.

Question 22

what is Beta-carboline?

Answer 22

endogenous inverse agonist of the benzodiazepine receptor i.e. causing anxiety.

Question 23

how does benzo move around the body?

Answer 23

it is hydrophobic- so can access BBB.

it has to be carried by proteins in plasma, since it is not very soluable (90% bound)