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PSY1201 > Anxiolytics > Flashcards

Anxiolytics Flashcards

1
Q

Anxiolytic

A

A drug that reduces anxiety without causing significant sedation

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2
Q

Depressant

A

General term for any drug that slows or reduces CNS activity, drugs can belong to different pharmacologic classes

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3
Q

Sedative

A

Drug used to relax, calm, or tranquilize

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4
Q

Hypnotic

A

Drug used to induce sleep

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5
Q

Barbiturate

A

Class of prescription drugs used to sedate, reduce anxiety and general anesthesia

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6
Q

Benzodiazepine

A

Class of prescription drugs used to sedate, reduce anxiety and reduce muscle tension

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7
Q

Non-barbiturate/Non-benzodiazepine

A

Prescription drugs from different classes used to sedate, promote sleep and reduce anxiety

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8
Q

Inhalants

A

Chemicals that depress CNS function via inhalation, many are household products

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9
Q

Barbiturate

A

High potential for abuse/dependence
Often paired with anphetamines in 1940s
Low therapeutic index
Several still in use today

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10
Q

Onset and Duration Barbiturate

A

Ultra Short(Methohexital) .2 min onset, .25 hour duration
Short(pentobarbital) 15 minute onset, 2-3 hours
Medium (Aprobarbital) 30 minute onset, 5-6 hour duration
Long, (mephobarbital) 60 minute onset, 6-10 hour duration

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11
Q

Mechanism of Action

A

Potentiate the effects of neurotransmitter GABA
Enhance binding to GABA receptor
Barbiturate binding sites are near GABA binding sites
Inhibits release of excitatory neurotransmitter
Higher doses mimic the effects of GABA
Lead to profound CNS depression and reduced respiration
Paradoxical stimulation of CNS at low doses due to suppression of inhibitory brain systems

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12
Q

Barbiturate Effect on CNS

A

Low dose: euphoria, sense of well being, greater self esteem, increased feelings of confidence, increased talking and social acceptability
Moderate Dose: Sedation and sleep
Higher Dose: Surgical Anesthesia
Overdose: Coma

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13
Q

Barbiturate Pattern of Use and Abuse (General)

A

Oral administration most common route
Pentobarbital (yellow) and secobarbital(red) are preferred
Older adults
Original contact may be via prescription for insomnia or anxiety
Patterns range from infrequent sprees of gross intoxication lasting a few days to prolonged compulsive daily use
- Hover around 19% of population
- Taken by opiate dependent individuals trying to boost heroine- use frequent enough to develop tolerance to both drugs which complicates treatment
Alcoholics use it to relieve from withdrawal

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14
Q

Barbiturate Use and Abuse Types

A

Adults
Obtain prescription for anxiety or insomnia
Develop tolerance, get higher dose–> physical dependence
Get prescription from multiple physicians to hide abuse
don’t refer to themselves as abusers
Young Adults
Diverted prescription meds to get high
Typically take at large doses with ethanol
Thriving black market
Frequency of use is episodic, so dependence does not always occur
Acute toxic reactions are frequent

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15
Q

Metabolic Tolerance- Barbiturate

A

Increase liver enzymes that metabolize barbiturates, shortens duration but does not induce need for higher doses

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16
Q

Pharmacologic Tolerance- Barbiturate

A

Reduced sensitivity to direct effects on neurons resulting in lowered CNS, respiratory and toxic effects, dose must be increased to achieve original response

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17
Q

Cross Tolerance- Barbiturate

A

Tolerance to lethal effects does not occur

Cross tolerance is complete with many CNS depressants, including alcohol

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18
Q

Dependence- Barbiturate

A

Like alcohol
Onset of withdrawal depends on half-life
Tremors, hallucinations, convulsions, delirium
Withdrawal can be fatal

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19
Q

Benzodiazepine Clinical Use

A 
Anxiety Disorder
GAD, acute anxiety, panic disorder, social phobia, PTSD, OCD
Anxiety Illness
cardiovascular, GI, chemotherapy
Insomnia
Convulsive, spastic, involuntary movement
Detoxification
Pre-surgical anesthetic
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20
Q

Benzodiazepine Half Lives

A 
Anxiolytics
Clorazepate- 2
Oxazepam- 8
Chlordiazepoxide-10
Alprazolam- 12
halazepam- 14

Anticonvulsant
clonazepam- 23

Hypnotic
midazolam-2 
triazolam- 3
estazolm- 10 
temazepam- 11

Preanesthetic
midazolam-3

21
Q

Benzodiazepine Mechanism of Action

A

Potentiate the effects of GABA
Binding sites near GABA binding sites
Self-limiting effect, so toxicity is low
Affect neurons at all levels, including CNS and muscles
Increases the flow of Cl- ions into the cell

22
Q

Benzo effect at different doses

A

Low- Reduces anxiety, not general depressant
Moderate- Light headedness, lassitude, increased reaction time, sedation
High- Motor incoordination, relaxed muscle tone, impaired mental function, confusion, sleep
Higher- anteretrograde, amnesia

23
Q

Benzo Use and Abuse

A

Similar to barbiturate
Only short acting alprazolam and highly lipophilic diazepam are abused
Taken with other drugs
Take the edge of the fear of trying other drugs
Animal models- Barbiturates more self administered than benzos
Most commonly mentioned in combination with another drug
Perceived as reinforcing, but generally only by experienced sedative users/abusers
naive subjects don’t like the effects
Schedule IV

24
Q

Benzo Tolerance

A

Similar to barbiturate, except benzo does not stimulate its own metabolism
Develops to all CNS effects except to memory disturbances
Tolerance to sedative effects quickly

25
Benzo Dependence
Similar to benzo but less severe Convulsions can occur, but are rare Withdrawal symptoms-- similar to anxiety so difficult to document Receptor antagonist can precipitate withdrawal
26
Anxiety
Cardinal symptom of many psychiatric disorders, but frequent component of medical/surgical procedures Emotion that allied with fear is adaptive Separate acute episode-dependent anxiety from non specific disease-driven anxiety, drugs better at treating the former Treatment should be limited in duration
27
Insomnia
Treated carelessly Prescribing drugs without knowing what causing the insomnia puts patient at risk for abuse Behavioral therapy, psychotherapy or nonhypnotic drugs may be superior to hypnotics when there is a specific cause If transient in nature, use may be satisfied - Administer no more than every third night to avoid abuse
28
Other Insomnia Agents
Ambien, Sonata and Lunesta Non benzo used for short term management for insomnia Little occurrence of tolerance or rebound insomnia Schedule IV
29
Inhalants: Definition and Type
Breathing in chemical vapors to get high Common Home or Workplace Products Adhesive, Aerosols, Anesthetics, Cleaning Agents, Volatile Solvents and gases, erosol whipped cream canisters, room deodorizers
30
Volatile Solvents
Gases or liquids that vaporize at room temperature | ex. paint thinners, nail polish removers, degreasers, felt tip markers, adhesives, glue
31
Aerosols
Sprays that contain solvents and propellants | spray paint, hair spray deodorant spray, fabric protector spray
32
Gases
Found in household/commercial products as well as anesthetics ex. butane lighters, propane tanks, refrigerant gases, ether, chloroform, halothane
33
Nitriles
``` Special class used primarily as sexual enhancers ex. Vasodilators, smooth muscle relaant Amyl nitrile packaged in ampules commonly known as "poppers" and are highly flammable Butyl nitrite found in video head cleaner, room odorizer, leather cleaner ```
34
Scope fo Abuse
Primarily abused by boys 10-15 adolescents between 12-17 Adults exposed at work place can also abuse Abuse increasing, especially among isolated Native American and Hispanic populations Products readily available and inexpensive Other countries now experiencing problems Most tried drug of abuse in 8th grade
35
Inhalant Use
Directly from container to nose From a soaked rag through the mouth From a soaked bag From inside a balloon Inhalation continues until desired effects, few minutes Leads to unconsciousness, relax grip on bag, and let fall away so that individual breaths again Both solo and group sniffing bags, bags are sometimes shared
36
Pattern of Abuse- Inhalant
Typically episodic in nature following fads "Huffing"- through mouth "Sniffing" through nose Semiliquid products placed in bags and held over mouth and nose, Heating increases the concentration Gas sprayed onto cloths , propellants separated from particulates
37
Access of Inhalant
- Products are widely available, accessible, inexpensive to use and legal Warning labels alert individuals to potentially new sources Isolated pockets of abuse can grow quickly if overreact in the media
38
Inhalant Pharmacology
General CNS depressant, but can stimulate at low doses | Onset of action and duration of action typically short
39
Effects- Inhalant
Immediate effects are euphoria, giddiness,, ataxia, slurred speech, perceptual distortions Effects last 15-45 minutes after sniffing ends Drowsiness and stupor last for 1-2 hrs
40
Tolerance- Inhalant
Many anecdotal reports exist | Unknown if cross tolerance exists
41
Dependence Inhalant
No evidence for physical dependence, unlikely because short duration of action - If exists, similar to barbiturates and ethanol
42
Treatment for Abuse
No accepted treatment plan Many centers refuse to treat because believe that abusers are resistant to treatment Complex psychosocial, economic and biophysical issue, longer time periods are needed for treatment - No support from insurance for treatment
43
Nitrous Oxide
Lauging gas Colorless, non-flammable gas with slight sweet odor Currently used in surgical procedures as well as minor dental procedures Thought of as a minor anesthetic reports of use on a small scale since 1971 Most used by inhaling from balloons or plastic bags Generally pleasant effects, but short lived Cognitive deficiencies were noted during high
44
Nitrous Oxide- Mechanism of Action
Not completely understood Most likely modulates ion channels Blocks NMDA and acetylcholine regulated channels May inhibit GABAc and 5-HT receptors May slightly potentiate GABAa and glycine receptors Anxiolytic effect- GABA a Analgesic Effect- endogenous opioids and noradrenergic Euphoria- mesolimbic pathway via antagonizing NMDA receptors that hten increase dopamine release in ventral tegmentum and nucleus accumbens
45
Nitrous Oxide Time Course
``` Effects perceived at 10% concentration Deprives brain of oxygen At 100%, experience sense of well-being, "high" Difficultly maintaining balance Slow to answer questions Low response to pain, noise and speech Lapse into unconsciousness Breathing reflex is surppressed for a few seconds Can be fatal very quickly ```
46
Nitrous Oxide Methods
Crackers: 2' metal or plastic cannisters filled with pure N2O Whip Its: Small cartridges used for dispensing whipped cream, discharged into a balloon and then inhaled Tanks; Either medical grade or autoracing grade tanks, 20 pounds Charging Bottles: similar to seltzer bottles
47
Nitrous Oxide- Long Term Toxicity
``` Nitrous oxide binds with oxygen in body Results in vitamin B12 deficiency RBC count is lowered anemia Nerve degeneration can occur, results in pain in arms and legs, unsteady gait, irritable, cognitive deterioration Severe headaches Rashes in nose and mouth Weight loss Red eyes, glassy eyes Menstrual disorders Night sweats ```
48
Inhalant Effects on Brain
Atrophy of cerebral, cerebellar and brainstem white matter, resulting in dementia Chronic use can lead to neuropsych deficits, such as impairments in processing speed, attention, memory retrieval, language and executive function Consisten with white matter pathology
49
Sudden Sniffing Death Syndrome
Most common form of acute death Can occur after only 1 use Precipitated when startled- causes a burst of epinephrine that can cause fatal cardiac arrythmia Death by aspiration, accidental trauma while under the influence, or suffocation

PSY1201 (22 decks)

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