Anxiolytics/Hypnotics

Question 1

what region of the brain is associated with anxiety?

Answer 1

amygdala

Question 2

what are the two endings for benzodiazepines?

Answer 2

pam and lam

Question 3

what is the one benzo that doesnt end in lam or pam?

Answer 3

chlordiazepoxide

Question 4

what is the MoA of benzos?

Answer 4

they bind the GABA channel and help GABA enter through the channel to increase inhibition

Question 5

what are the classic SEs of benzos?

Answer 5

drowsiness, dizziness, fatigue, memory loss, confusion

respiratory depression

Question 6

what can happen with benzos with continued use over time?

Answer 6

tolerance

Question 7

how does the body build tolerance to benzos?

Answer 7

increase glutamate presynaptice release and increase glutamate receptors on post synaptic

Question 8

so what happens if you withdrawal benzos quickly?

Answer 8

the increased glutamate and receptors will lead to stimulation and you get anxiety/panic, insomnia, tachycardia

Question 9

can benzos be addictive?

Answer 9

yes

Question 10

why are benzos addictive?

Answer 10

they stimulate dopamine release into the nucleus accumbens

Question 11

what is the nucleus accumbens also known as?

Answer 11

pleasure center/addictive center

Question 12

how do benzos cause dopamine release in the nucleus accumbens?

Answer 12

they inhibit the release of GABA so more excitation in the area with loss of GABA

Question 13

with chronic alcohol intake, what happens to glutamate?

Answer 13

glutamate amount and receptors increase to counterbalance the continued inhibitory effects of alcohol

Question 14

what can you give for alcohol withdrawal to help with glutamate overload?

Answer 14

benzos

Question 15

what are immediate symptoms of alcohol withdrawal?

Answer 15

anxiety, GI issues, tremors

Question 16

what are long term results of alcohol withdrawal?

Answer 16

seizures 2-5 days out

delirium tremen 3-7 days out

Question 17

what is the reversal agent for benzodiazepines?

Answer 17

Flumazenil

Question 18

what is the MoA of Flumazenil?

Answer 18

competitively inhibits the binding of benzos to GABA receptors

Question 19

what two drugs are benzos synergistic with that can lead to death?

Answer 19

alcohol and opiates

Question 20

what is the issue with benzo metabolism?

Answer 20

can lead to sedation through active metabolites

Question 21

which two benzos have significant active metabolites in breakdown?

Answer 21

chlordiazepoxide and diazepam

Question 22

which three benzos do not have any metabolites in breakdown? what does this mean about them?

Answer 22

Lorazepam
Oxazepam
Temazepam
means they have no sedation side effect

Question 23

what GABA receptor do benzos bind to be anxiolytics?

Answer 23

a2/5 GABA-R

Question 24

what GABA receptor do benzo metabolites bind to be sedative?

Answer 24

a1 GABA-R

Question 25

what is the MoA of Buspirone?

Answer 25

agonizes the inhibitory serotonin autoreceptor and decreases pre synaptic serotonin release

Question 26

what are SEs of buspirone?

Answer 26

not really any

Question 27

how do SSRI and SNRIs treat anxiety?

Answer 27

treat underlying depression

Question 28

what class of drugs stimulates the a1 GABA-R receptor?

Answer 28

Z drugs

Question 29

name the Z drugs

Answer 29

Zalepon
Zolpidem
Eszopiclone

Question 30

what is the MoA and effect of Zalepon, Zolpidem and Eszopiclone?

Answer 30

they bind the a1-GABA receptor and induce sedation

Question 31

what can Zalepon, Zolpidema and Eszopiclone cause?

Answer 31

sleep walking/eating/driving

Question 32

what is the drug to give for inducing sleep that is similar to melatonin?

Answer 32

Ramelteon

Question 33

when do you give ramelteon?

Answer 33

at night when sun goes down