anxiolytics

Question 1

what are the neurological causes of anxiety?

Answer 1

central and peripheral NA/A activation (depolarisation) which leads to the Fight or flight response
stress response leading to the HPA axis and secretion of stress hormones (cortisol)

Question 2

list the examples of benzodiazepines as anxiolytics, hypnotics and pre-anesthetics

Answer 2

anxiolytics: lorazepam, diazepam
hypnotics: triazolam, temazepam, diazepam
pre-anesthetics: midazolam, diazepam

Question 3

what is the MOA of benzos

Answer 3

binds to benzo site on GABA receptor to enhance binding of GABA and open Cl- channel easily for hyperpolarisation

Question 4

ADR of benzos

Answer 4

• acute toxicity/overdose can cause severe respiratory depression especially w concurrent alcohol use (treat w flumazenil)
• drowsiness, confusion, amnesia
• impaired muscle coordination
• tolerance and dependence

Question 5

what is the MOA and use of zolpidem

Answer 5

potentiate GABA mediated Cl- currents at the same site as benzodiazepines
- has good hypnotic effect, ineffective as anxiolytics

Question 6

MOA of buspirone

Answer 6

5-HT receptor partial agonist and also binds to dopamine receptors; indicated as anxiolytic but effect takes 1-2 weeks

Question 7

MOA of barbiturates

Answer 7

potentiates GABA mediated Cl- currents at barbiturate site; at higher doses can directly open channels and block Na+ channels

Question 8

DOA of barbiturates and examples

Answer 8

long acting (anticonvulsant): phenobarbital 
short acting (sedative & hypnotic): pentobarbital & amobarbital 
ultra-short acting (anesthesia): thiopental

Question 9

why has the use of barbiturates been replaced?

Answer 9

high tendency to develop tolerance and dependence with several withdrawal sx

Question 10

MOA of pregabalin

Answer 10

GABA analogue increasing synaptic GABA for hyperpolarisation and also acts on voltage-gated calcium channels

Question 11

ADR of pregabalin

Answer 11

associated w emergence of worsening suicidal thoughts

Question 12

MOA of hydroxyzine and what are its benefits?

Answer 12

anti-histamine with antagonistic effect on serotonergic and adrenergic receptors
low addictive potential compared to benzo and barbi

Question 13

propranolol

Answer 13

ß-blocker; used for performance anxiety and social phobias; reduces physical sx related to adrenergic activation