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CPPS 306 > Chapter 17&19: Anxiolytics and Hypnotic Drugs > Flashcards

Chapter 17&19: Anxiolytics and Hypnotic Drugs Flashcards

1
Q

What is Anxiety?

A

An unpleasant state of tension, apprehension, or uneasiness of (unkown source).

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2
Q

What is the purpose of Anxiety?

A
  • Is good for you
  • Is a negative reinforcer
  • Keeps us out of danger
  • Motivates escape and avoidance
  • Crucial for learning and memory
  • Hard wired neural ciruitry
  • Innate, species specific, releasing stimuli.
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3
Q

How does anxiety affect performance?

A
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4
Q

What parts of the brain are involved in Anxiety?

A

Nucleus Accumbens
Amygdala

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5
Q

What are the functions of emotions?

A

Emotions reflect the survival significance of incoming sensory data, directs memory formation and reinforces survival directed behavior.

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6
Q

What are the different type of emotions?

A
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7
Q

How do emotions affect disorders?

A

Affective disorders are characterized by pathological inappropriate emotions and behavior, loss of contact with reality, inoperative reinforcement contingencies and the irrelevance of survival.

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8
Q

What are some anxiety disorders?

A
  • Generalized anxiety disorder.
  • Panic Disorder
  • OCD
  • PTSD
  • Social Phobia
  • Social anxiety disorder
  • Specific Phobias
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9
Q

What are the Pharmacological effects of Benzodiazepines?

A

Pharmacological Effects
- Anxiolytic
- Hypnotic
- Anticonvulsants
- Muscle Relaxant
- Amnesia

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10
Q

What are the neurochemical effects of benzodiazepines?

A
  • Increase GABA Inhibition
  • Down-Regulate Benzodiazepine Receptors
  • Up-Regulate downstream receptors for Na and 5HT. (GABA reduces release of these which cause downstream receptors to increase in number and sensitivity)
  • Overdose of benzodiazepines is not lethal but benzodiazepines do potentiate the lethal action of other compounds like alcohol and narcotics (Barbituates).

Lethal with other compounds by supressing breathing by too much inhib.

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11
Q

What are two benzodiazepines and their characteristics?

A

Diazepam
Triazolam

Diaz - Long Half Life; Less Potent Triaz - Short Half Life; High Potentcy
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12
Q

What produces tolerance?

A

Altered receptor density.

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13
Q

Explain benzodiazepine withdrawal?

A
  • Effects of drug withdrawal after tolerance has developed is the exact opposite of the direct drug effects. (Anxiety, insomnia, convulsions, muscle, tension and aches and pains).
  • Withdrawal lasts until enough receptors have returned to their pre-drug state to maintain normal nerve impulse traffic.
  • The withdrawal syndrome is more severe with short half life drugs because all active drug molecules are eliminated before any receptors can return to pre-drug densities.
  • Is severe with short half life drugs like Triazolam.
  • Withdrawal not usually a problem with long half life likes Diazepam.
  • To discontinue a short half-lfe drug, switch patient to a comparable dose of a long half life drug, and reduce the amount of drug given by 10% a week.
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14
Q

What are Atypical Anxiolytics?

A

Buspirone
Propranolol

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15
Q

Whar are the characteristics of Buspirone?

A
  • Is not a Benzodiazepine
  • Acts as a partial agonist at serotonin 5HT1A inhibitory presynaptic autoreceptors.
  • Seems to be a selective anti-anxiety drug
  • Lacks hypnotic, anti-convulsant or muscle relaxant effects
  • Does not potentiate the respiratory depressant actions of alcohol, narcotics.
  • Little or no withdrawal syndrome.

It takes 2-3 weeks for buspirone to have its antianxiety effects, most patients wont wait that long.

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16
Q

What are the characteristics of Propranolol?

A
  • B-Andrenergic Receptor antagonist (These receptors involved in fight or flight/anxiety)
  • Treat performance anxiety
  • Suppress sympathetically-mediated somatic and autonomic symptoms.
17
Q

What drug treats performance anxiety?

A

Propranolol

18
Q

Explain the Sleep Cycle.

A
19
Q

Explain Sleep disorder.

A
20
Q

What do hypnotic drugs help with?

A
  • Jet Lag
  • Shift Work
  • Bereavement
21
Q

How long should you use hypnotic drugs?

A

2 to 3 nights

22
Q

What are the characterisitcs of the ideal sleeping pill?

A
23
Q

What are the different hypnotic agents?

A
  • Triazolam (Benzodiazepine)
  • Zolpidem (Atypical; Binds to the ame site as the Benzodiazepien
  • Ramelteon (Atypical; Binds to Melatonin 1/2 receptors; No side effects long term)
  • **Melatonin ** (Best Option)
24
Q

What is Ramelteon?

A

Ramelteon, sold under the brand name Rozerem, is a melatonin receptor agonist used to treat insomnia, specifically for difficulty falling asleep. It works by selectively activating the MT1 and MT2 receptors, which regulate the sleep-wake cycle, but its overall clinical benefit is small. Unlike benzodiazepines or Z-drugs, it does not act on GABA receptors, making it non-addictive and not a controlled substance in most countries. Ramelteon has a longer half-life than melatonin, allowing for prolonged effects. It was first described in 2002 and approved for medical use in 2005. Common side effects include drowsiness, dizziness, nausea, fatigue, hormone level changes, and, in some cases, worsened insomnia. Despite these effects, it is considered safe for long-term use with no known misuse potential.

25
Q

What is Flumazenil?

A

Flumazenil (also known as flumazepil, code name Ro 15-1788) is a selective GABA_A receptor antagonist used as an antidote for benzodiazepine overdose and to reverse anesthesia through competitive inhibition. It is primarily administered intravenously, but can also be given intranasally, via otic insertion, or experimentally as a sublingual lozenge or topical cream. Flumazenil was first characterized in 1981, marketed in 1987 by Hoffmann-La Roche under the trade name Anexate, and FDA-approved on December 20, 1991. The drug’s patent expired in 2008, allowing the availability of generic formulations. While it rapidly reverses benzodiazepine effects, its short half-life means symptoms may return if the benzodiazepine is long-acting. Additionally, flumazenil can trigger seizures, particularly in individuals dependent on benzodiazepines.

26
Q

What is the major difference between Atypical drugs from benzodiazepines in sleep?

A

Atypical are reported to have less effects on sleep EEG than the benzodiazepines, but still do not produce normal sleep.

CPPS 306 (11 decks)

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