Anxiolytics

Question 1

Fight or Flight response has a peripheral noradrenergic response mediated via ____ and a central adrenergic reaction mediated via ______.

Answer 1

1. NA/NE

2. adrenaline/epinephrine

Question 2

The stress response involves the ____ axis and secretion of ______

Answer 2

1. Hypothalamus-pituitary-adrenal(HPA)axis

2. cortisol (stress hormone)

Question 3

Therapeutic rationale of sedatives is to cause _____ and ______. (Patient is still conscious)

Answer 3

sedation

relaxation

Question 4

Therapeutic rationale of _____ is to induce drowsiness, sleep and may have amnestic effects.

Answer 4

Hypnotics

Question 5

Anxiolytics reduce _____.

Answer 5

anxiety

Question 6

The same anxiolytic can have more than one action depending on dose.

• Low dose = _______
• Higher doses = _______
• Even higher doses = ________

Answer 6

1. anxiolytic and sedative effects
2. hypnotic
3. can cause anesthesia, used for surgery

Question 7

Benzodiazepines can be used as anxiolytics/sedatives (i.e. ________).

Answer 7

diazepam, lorazepam

Question 8

Benzodiazepines that can be used as hypnotics (i.e. _________, _________, _________).

Answer 8

1. diazepam
2. triazolam
3. temazepam

Question 9

Benzodiazepines can be used as _______ (i.e. diazepam, midazolam).

Answer 9

pre-anaesthetics

Question 10

Benzodiazepines can have anti-convulsant effects (i.e. ______).

Answer 10

diazepam

Question 11

Benzodiazepines can have anti-convulsant effects (i.e. ______).

Answer 11

diazepam

Question 12

Non-BZDs include Barbiturates (eg _________), _______, ________ and Propranolol etc.

Answer 12

1. phenobarbital
2. Buspirone
3. Zolpidem

Question 13

BZD binding potentiates the binding of ______ receptor binding site, making GABA-A open more easily, Potentiates __________ leading to _______= neurons not firing

Answer 13

1. GABA to GABA-A
2. influx of Cl-ions
3. Hyperpolarization

Question 14

GABA binding, enhanced by BZDs leads to ______ (limbic system), ______ (reticular activating system) and ________ (motor cortex).

Answer 14

1. altered mood
2. drowsiness
3. relaxed muscles

Question 15

The longer acting BZDs are more appropriate for ______ to reduce dose frequency and have a duration of ______.

Answer 15

1. chronic conditions

2. 1-3 days

Question 16

The Short acting BZDs are more appropriate for ______ and can last ______.

Answer 16

1. General anesthesia induction

2. 3-8hrs

Question 17

The intermediate acting BZDs can last ______.

Answer 17

10-20hrs

Question 18

BZDs can cause _________, especially used concurrently with alcohol.

Answer 18

severe respiratory depression

Question 19

Treatment of BZD overdose is using ______, a benzodiazepine antagonist

Answer 19

flumazenil

Question 20

Side effects of BZDs are related to CNS depression and include: ______, _______, _______. and impaired muscle co-ordination (which is why we must counsel pts _______).

Answer 20

1. Drowsiness
2. confusion
3. amnesia
4. Not to operate heavy machinery

Question 21

BZD tolerance depends on ______ of use. Therefore, tolerance develops ______for epilepsy than use to induce sleep.

Answer 21

1. frequency

2. faster

Question 22

Dependence for BZDs can develop and BZDs have abuse potential. Withdrawal effects include: _____, rebound _____, tremor and ______.

Answer 22

1. disturbed sleep
2. anxiety
3. convulsions

Question 23

A key strategy to avoid BZD dependence is to ______.

Answer 23

Withdraw gradually

Question 24

Zolpidem has the ______ but different _____ compared to BZDs. It is ____effective than anxiolytics.

Answer 24

1. same MOA
2. structure
3. less

Question 25

Zolpidem has a good _____ effect and is primarily used to treat ________.

Answer 25

1. hypnotic | 2. insomnia

Question 26

Buspirone is a _____ receptor partial agonist that also binds _____ receptors.

Answer 26

1. 5-HT1A | 2. dopamine

Question 27

Buspirone is indicated for GAD but anxiolytic effects require ______. It also lacks anti-convulsant and _______ properties.

Answer 27

1. take 1-2 wks | 2. muscle relaxant

Question 28

Barbiturates have the same ______ but different _______ compared to BZDs. At anesthetic doses, barbiturates (i.e. phenobarbital) can _____________ as well as block Na+ channels.

Answer 28

1. MOA 2. binding site 3. directly open CL- channels (no longer potentiates)

Question 29

Barbiturate use as a sedative-hypnotic has largely been replaced by BZDs due to barbiturate's increased tendency to ________. Flumazenil is _____ in treating Barbiturate overdose.

Answer 29

1. develop tolerance and dependence | 2. not effective

Question 30

Barbiturates have _____ withdrawal symptoms.

Answer 30

severe

Question 31

Long acting barbiturates meant for anti-convulsant use have a duration of action of 1-2 _____. (i.e. _____)

Answer 31

1. days | 2. phenobarbital

Question 32

Short acting barbiturates meant for sedative and hypnotic use have a duration of action of 3-8 _____. (i.e. _____ and ______)

Answer 32

1. hrs 2. pentobarbital 3. amobarbital

Question 33

Ultra-short acting barbiturates meant for induction of anesthesia have a duration of action of 20 _____. (i.e. _____ )

Answer 33

1. mins | 2. thiopental

Question 34

BZDs are ____ likely to cause respiratory depression compared to barbiturates.

Answer 34

less

Question 35

At higher doses, barbiturates cause _____ depression and can even result in _____.

Answer 35

1. medullary | 2. coma

Question 36

Pregabalin acts by _______, resulting in hyperpolarization. It also acts on _____channels.

Answer 36

1. increasing synaptic GABA | 2. voltage gated Ca2+

Question 37

Pregabalin has ______effects and is used in treatment of _____ but may be associated with emergence or worsening of ______.

Answer 37

1. anticonvulsant 2. GAD 3. suicidal thoughts

Question 38

Hydroxyzine is a 1st gen anti-histamine with effects on _____ and ______ receptors. Its anxiolytic effects are due to antagonism of ______ receptors. It can also help with _____ due to its anti-histamine activity.

Answer 38

1. serotonergic 2. α-adrenergic 3. serotonergic 4. itching/nausea related anxiety

Question 39

Hydroxyzine has ____ addictive potential compared to BZDs and barbiturates.

Answer 39

lower

Question 40

Propranolol can be used for treating _________ and _____ phobias. It reduces the physical symptoms associated with adrenergic activation i.e. tachycardia and _______.

Answer 40

1. performance anxiety 2. social 3. muscle tremors

Question 41

Propranolol is Contraindicated in patients with _____ and ______ conditions. (including predisposition)

Answer 41

1. asthma | 2. heart

Question 42

Many other depressants also serve as anxiolytics as the 2 conditions may share the same chemical basis. They include _______ (NaSSA), _______ (TCA), Fluoxetine, citalopram, sertraline, paroxetine (____) and Venlafaxine, duloxetine (_____).

Answer 42

1. Mirtazapine 2. Clomipiramine 3. SSRI 4. SNRIs