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Clinical Pharmacology Therapeutics and Prescribing > CPTP 3.5 - Hypnotics and Anxiolytics > Flashcards

CPTP 3.5 - Hypnotics and Anxiolytics Flashcards

1
Q

How many cycles exist within a typical 8 hour duration of sleep?

A

Five -
REM sleep (later half)
Slow wave sleep (stage 1 - 4)

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2
Q

In which brain regions is slow wave sleep mediated?

A

Hippocampus

Neocortex circulatory

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3
Q

Describe four features of slow wave sleep?

A

Increased amplitude
Slow frequency
Delta wavelength
Memory = reactivation of short-term memory which is integrated into long-term storage

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4
Q

In which brain regions is rapid eye movement sleep mediated?

A

Cortex

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5
Q

Describe four features of REM sleep?

A

Decreased amplitude
Increased frequency
Gamma (Y) wavelength
Memory = consolidation into long-term stores (synapses strengthened vis repeated activation)

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6
Q

What acts as the body’s clock pace-maker and where is this found?

A

Suprachiasmatic nucleus

Hypothalamus - receives inputs from the retina (photosensitive neurones)

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7
Q

What does the suprachiasmatic nucleus activate?

A

Dorsomedial hypothalamic nucleus

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8
Q

What does the dorsomedial hypothalamic nucleus activate?

A
  1. Tuberomammillary nucleus - Histamine
  2. Raphe nucleus - 5HT
  3. Locus coereleus - Nor Epi
    = Activated - project to cortex and facilitate arousal
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9
Q

Describe the two ways in which sleep is initiated?

A
  1. Pineal gland secretes melatonin (inhibits suprachiasmatic nucleus)
  2. Ventrolateral pre-optic nucleus secretes GABA and Galanine - inhibits tuberomammillary/raphe/locus corueleus nucleus
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10
Q

Why do elderly people suffer more insomnia?

A

With increased age melatonin secretion decreases

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11
Q

What are the three types of insomnia?

A

Initial insomnia = difficulty falling asleep
Middle insomnia = wake up repeatedly
Terminal insomnia = wake up too early

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12
Q

Name four causes for insomnia?

A

Stress
Psychiatric illness
Drugs (SSRI and MAOI - Increased monoamines)
Medical illness

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13
Q

How can stress lead to insomnia?

A

Active mind
Increased cortisol = interference between hippocampus and neocortex circuitry (SWS)
Increased cortisol also interferes with LTP (REM)

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14
Q

What is the association between anxiety and sleep?

A

Initial insomnia

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15
Q

What is the association between depression and sleep?

A

Terminal insomnia

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16
Q

What is the association between bipolar disorder and sleep?

A

Decreased slow wave sleep

17
Q

What is the association between PTSD and sleep?

A

Decreased REM sleep

18
Q

Define anxiety?

A

Physical and psychological response to perceived threat - if XS/prolonged = anxiety disorder

19
Q

Describe the relationship between neurotransmitters in the brain and anxiety?

A

Decreased GABA-A receptor binding = Increased anxiety
Increased 5HT = Increased anxiety
Increased Nor Epi = PTSD = Increased anxiety

20
Q

What is the relationship between hypnotics and anxiolytics?

A

Drugs have common range of activity - depends on DOSAGE used =
Low dose - anxiolysis
Middle dose - concious sedation
High dose - Hypnosis

21
Q

Name three non-specific CNS suppressants?

A

Alcohol
Barbituates
Benzodiazapines

22
Q

Name a benzodiazapine with a short half-life?

A

Temazepam
8-20 hours half-life
Used as a hypnotic

23
Q

Name two benzodiazapines with long half-lives?

A 
Chlorodiazepoxide = 6-28 hours (anxiolytic)
Diazepam = 20-70 hours (anxiolytic)
24
Q

Name four adverse effects associated with hypnotic/anxiolytic use?

A

Barbituates and benzodiazapines are potentated by alcohol
Poor motor co-ordination
Poor memory (decreased REM)
Tolerance and dependence

25
Q

What is the difference in mechanisms between barbituates and benzodiazepines?

A

Barbituates are non-selective and reduce the excitability of Na+ channels therefore reduce action potentials - can open Cl- channel on GABA-A receptors without the presence of GABA
Benzodiazepines and alcohol are both allosteric modulators of GABA-A receptor and therefore NEED the presence of GABA to have their effects

26
Q

What is the GABA-A structure in humans?

A

2 alpha
2 Beta
1 other (usually always Y-gamma 2)

27
Q

Which specific GABA-A subunits are found within the monoamine nuclei of the brain?

A

a3 subunits = anxiolysis

28
Q

Which specific GABA-A subunits are found within the corticle areas of the brain?

A

a1 subunits = sedation

29
Q

Which GABA-A receptors are alcohol and benzodiazepines selective for?

A

2 alpha
2 Beta
1 gamma (Y)
As this is commonly found right across the brain - alcohol and benzodiazepines are NOT selective to a particular brain region

Clinical Pharmacology Therapeutics and Prescribing (17 decks)

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