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Psychiatry-M2 > Anxiety and Sleep Pharm > Flashcards

Anxiety and Sleep Pharm Flashcards

1
Q

How would you classify if a patient is suffering from acute anxiety/panic disorder or generalized anxiety disorder?

A

General Anxiety Disorder
- At least 1 month duration, constant worry about self and others, not correlated with any specific symptoms that indicate panic disorder.

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2
Q

What are physical symptoms of anxiety?

A

Increased Sympathetic Stimulation

  • Sweating, Tachy, Palpitations
  • Dry Mouth
  • Frequent Urination
  • Jitteriness and inability to relax
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3
Q

What receptor is most important in Benzo binding and functionality?

A

GABA-A Receptor

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4
Q

How do Benzodiazepines affect GABA receptor function?

A

Benzodiazepines – bind to an allosteric binding site, which causes increased frequency/chance of opening of the GABA channel for the SAME amount of GABA
- sensitizes the channel to GABA

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5
Q

How do Barbiturates differ in function compared to Benzodiazepines?

A
  • Barbiturates bind to a different allosteric site inducing the channel to state open LONGER per stimulation per GABA molecule.
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6
Q

What should you give a patient if you suspect they have overdosed on Benzodiazepines?

A

Flumazenil – Benzo Receptor Antagonist

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7
Q

How does the GABA receptor typically function when activated by GABA?

A
  • Opens allowing in Cl- hyperpolarizing the membrane making it more difficult to depolarize the membrane
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8
Q

What drug that is used for general anxiety syndrome, but does not involve the GABA receptor, while its a partial agonist of the 5-HT1A receptor (inhibiting adenylate cyclase) opening K+ channels.

A

Buspirone

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9
Q

What Benzodiazepines are primarily used for hypontic agents?

A
  • Flurazepam
  • Triazolam
    (Lorazepam too, but not generally just for sleep)
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10
Q

What Benzodiazepam hypnotic agent is long acting agent?

A

-Flurazepam

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11
Q

What Benzodiazepam hypnotic agent is rapid acting with a very short half life primarily used to help fall asleep, not stay asleep?

A

Triazolam

- Alpha-Hydroxy-Triazolam active metabolite

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12
Q

How does Lorezepam and Flurazepam affect sleep, other than helping the patient sleep?

A
  • Decreases Sleep Latency
  • Increases Stage 1 / 2 Sleep, decreases Stage 3/4 Sleep
  • Decreases REM sleep
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13
Q

What happens when there is abrupt withdrawl of sleep aids (Lorazepam) for sleep?

A
  • REM Rebound
  • Rebound Insomnia
  • Deep Sleep Rebound
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14
Q

What are some adverse site effects of taking Hypnotic agents for sleep?

A
  • Daytime Sedation
  • Ataxia at night, increased risk of falls
  • Rebound Insomnia
  • Tolerance / Dependence
  • Increased Death Rate
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15
Q

What hypnotic drugs have minimal effect on REM Sleep and preserve normal Stage 3-4 Sleep?

A

Zolpidem

Zaleplon

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16
Q

How do the Non-benzodiazepine hypnotic agents work, compared to Lorezapam?

A

Trick Question!

– Both Bind the BDZ receptor of the GABA receptor, just Zolpidem/Zaleplon are not structurally related.

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17
Q

If you see a patient in the ED who consumed an entire bottle of Zolpidem intending on suicide, what can be given immediately to limited effects?

A
  • Flumazenil

BDZ Receptor Antagonist

18
Q

What hypontic agent affects Melatonin receptors and is primarily used to help patients who have difficulty falling asleep?

A
  • Ramelteon

Melatonin MT1/MT2 Receptor Agonist

19
Q

Which hypnotic agent acts in the same way as Zolpidem, but is thought to have limited likelihood of dependence and withdrawal?

A

Eszopiclone

20
Q

What is the fast acting Barbiturate?

A

Secobarbital

21
Q

How do Barbiturates illicit their effects?

A

They are lipid soluble, rapidly absorbed, that distribute to the brain quickly causing their effects, but terminated by redistribution.

22
Q

If a GABA channel increases the amount of time the channel is open per activation, what might be the drug the patient is taking?

A

Phenobarbital

Secobarbital

23
Q

What are the most concerning and worrisome side effects of Barbiturates?

A
  • General CNS Depression w/ Respiratory Depression
  • Cytochrome Induction changing metabolism
  • Physical Dependence
  • CV Effects in high doses
  • Exacerbate Acute Porphyria (increased delta-aminolevulinic acid synthase)
24
Q

What is the difference between Benzodiazepines and Barbiturates in regards to CNS Depression?

A

Barbiturates have a dose dependent action of CNS Depression and include Respiratory Depression

25
Q

What drug has a very pungent taste that does not effect sleep stages as Benzos or Barbiturates?

A

Chloral Hydrate

26
Q

What hypnotic drug antagonizes the Orexin Receptor (inhibits wakefulness usually stimulated by orexin)?

A

Suvorexant

27
Q

What agents are most commonly used for muscle spasticity and relaxation?

A
  • Diazepam

- Baclofen

28
Q

What agent acts at the GABA-B receptor preventing release of excitatory transmitters (Glu) in the spinal cord?

A

Baclofen

29
Q

How does diazepam work in the spinal cord to promote relaxation?

A
  • Promotes GABA-induced presynaptic inhibition in spinal cord
30
Q

What is the agent that agonizes Alpha-2 receptor in the spinal cord inhibiting presynaptic-post synaptic inhibition?

A

Tizanidine

  • drowsiness, hypotension, dry mouth, and inhibits CYP1A2
31
Q

How is Buspirone different from Benzodiazepines?

A
  • Less Sedating
  • No Cross Tolerance
  • Takes several weeks to illicit a response in the patient
32
Q

What might be a good pharmaceutical agent for occasional performance anxiety?

A

Beta-Blockers

33
Q

What is the best way to stop treatment with Benzodiazepines?

A
  • Gradual Dose Reduction

- Switch to longer acting Drugs

34
Q

Does either Diazepam or Lorazepam cause a faster action?

A

Diazepam – more lipid soluble

35
Q

Which has an active metabolite Lorazepam or Diazepam?

A

Diazepam – Oxazepam it is converted to for action

- rapid redistribution after single dose

36
Q

Which is more lipophilic Lorazepam or Diazepam?

A

Diazepam – faster absorption

37
Q

What is a unique characteristic with IV Lorazepam administration?

A
  • Retrograde Amnesia
38
Q

What is key in differing Benzodiazepines from other CNS Depressants?

A

Does not effect the Respiratory Drive or CV, however is additive with other depressants that do such as:

  • Ethanol
  • Barbiturates
  • Antihistamines
39
Q

What should be given an Alcoholic when they are attempting to stop drinking and need to manage withdraw symptoms?

A

Chlordiazepoxide

- prevents seizures and withdraw symptoms in alcholics

40
Q

What Benzodiazepine can be used to treat an ACUTE manic episode?

A
  • Clonazepam
41
Q

What is Alprazolam usually used for?

A

Fast Acting Effects

- Panic Disorder, etc

Psychiatry-M2 (14 decks)

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