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PODA > Drugs for anxiety disorders > Flashcards

Drugs for anxiety disorders Flashcards

1
Q

Psychological components of anxiety:

A
  • Tension
  • Fears
  • Difficulty in concentration
  • Apprehension
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2
Q

Somatic components of anxiety:

A
  • Tachycardia
  • Hyperventilation
  • Apnea
  • Palpitations
  • Tremor
  • Sweating
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3
Q

Anxiety disorders incl:

A
  • GAD
  • Panic disorders
  • Phobia disorders
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4
Q

Most common anxiety disorder:

A

GAD

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5
Q

TorF: GAD rate tends to decrease with age?

A

False. Increase with age. Manifestations occur initially in 20-35 y/o

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6
Q

What effects does GAD have on the CVS?

A
  • Tachycardia

- HTN

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7
Q

What affects does GAD have on the GI system?

A

Increased acidity, nausea, epigastric pain

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8
Q

What affects does GAD have on the Neurologic Sys?

A

Headache, near-syncope

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9
Q

In GAD, abnormalities in the activities of norepinephrine, serotonin and benzodiazepine-binding systems incld:

A

Decreased α2-adrenoceptor receptor binding

Decreased serotonin levels in the CSF

Reduced benzodiazepine receptor binding in the LEFT
TEMPORAL LOBE.

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10
Q

In adults, anxiety is associated with what kind of activity in the brain?

A

ELEVATED cingulate cortex activity

(Cingulate cortex: A component of the limbic system, it is involved in processing emotions and behavior regulation. It also helps to regulate autonomic motor function. Furthermore, the cingulate cortex has many bilateral connections with the frontal, temporal, and occipital cortex of both hemispheres of the brain.)

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11
Q

In CHILDREN anxiety is associated with what activity in the brain?…..

A

Increased RIGHT amygdala activation

(Amygdala is the integrative center for emotions, emotional behavior, and motivation….. The amygdala may be best known as the part of the brain that drives the so-called “fight or flight” response……Amygdala, region of the brain primarily associated with emotional processes)

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12
Q

Which type of anxiety is defined as recurrent, unpredictable episodes of intense anxiety accompanied by marked physiologic manifestations?

A

Panic disorder: RECURRENT AND UNPREDICTABLE

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13
Q

What are the symptoms of panic disorders?

A

Symptoms include dyspnea, tachycardia, palpitations, headaches, dizziness, CHOKING, PARESTHESIA, nausea and bloating.

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14
Q

TorF: About 25% of pts w. Panic disorders also have OCD.

A

True

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15
Q

What are the panicogens(what causes the anxiety)?

A

Panicogens include:

CO2

Caffeine

Cholecystokinin(peptide hormone)

Sodium lactate

Yohimbine( a2 adrenergic antagonist commonly used for erectile dysfunction, athletic performance, weight loss, angina)

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16
Q

__________________ in the amygdala may play a role in generating FEARFUL PERCEPTIONS.

A

Increased pH sensitivity

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17
Q

Excessive activation of ______________ locus ceruleus neurons may also enhance symptoms of panic.

A

NOREPINEPHRINE

18
Q

Binding of GABA to the GABA receptor triggers the ____________

A

Binding of GABA to the receptor triggers the opening of channel leading to Cl- influx (and hyperpolarization)

19
Q

Binding of GABA is enhanced by BZD, resulting in ______

A

Binding of GABA is enhanced by BZD, resulting in a greater entry of Cl-

20
Q

MOA of BZDs:

A
  1. Modulate GABA by binding to a distinct site on the a subunit and gamma subunit of the GABAA receptor
  2. INCREASE FREQUENCY of channel openings produced by GABA
  3. INCREASE AFFINITY of GABA to the GABA binding site
21
Q

TorF: BZDs reduce anxiety at high doses by selectively enhancing GABAergic transmission in neurons
having the α2 subunit in their GABAA receptors.

A

False: BZDs reduce anxiety at LOW doses by selectively enhancing GABAergic transmission in neurons
having the a2 SUBUNIT in their GABAA receptors.

22
Q

TorF: Some benzodiazepines can produce hypnosis in high doses by mediating the α2 subunit of GABAA
receptors.

A

False: Hypnotic effects are mediated by α1 subunit of GABAA receptor

23
Q

How does BZDs mediate their muscle relaxant effects?

A

BZDs can relax spasticity of skeletal muscles in HIGH doses (by INCREASING PRESYNAPTIC INHIBITION in the spinal cord where α2 SUBUNIT of GABAA receptors are located)

24
Q

The a1 subunit of GABA receptors are also involved in these pharmacological effects:

A

Anticonvulsant actions:

 Effect is partially mediated by α1 subunit of GABAA receptors

Anterograde amnesia:

 Mediated by α1 subunit of GABAA receptors.

25
Q

What 2 mechanisms are involved in the tolerance of BZDs?

A
  1. Decreased expression of GABAA receptors at synapses.

2. Uncoupling of BZD binding site from the GABA site.

26
Q

What are the SE of alprazolam on the CNS?

A

CNS depression

fatigue

impaired coordination, memory impairment

changes in libido or appetite

paradoxical excitation (rebound excitement)

seizures

dysarthria (motor speech disorder)

27
Q

T or F: alprazolam can cause constipation?

A

True

28
Q

CNS depression can be enhanced with concurrent use of BZDs and what other class of medications?

A

alcohol, psychotropics, anticonvulsants, antihistamines

29
Q

TorF: alprazolam levels can be enhanced by drugs like cimetidine?

A

True. BZDs are potentiated by CYP3A inhibitors (e.g., cimetidine, nefazodone,
fluvoxamine, fluoxetine, paroxetine, nifedipine)

30
Q

Lorazepam SE:

A

CNS: sedation, dizziness, transient MEMORY IMPAIRMENT, confusion, disorientation, change in appetite, headache, SLEEP APNEA

GI: nausea

31
Q

Increased sedation, respiratory depression, coma and death with opioids is a SE of which BZD?

A

Lorazepam

32
Q

TorF: alprazolam may be potentiated by probenecid, or VPA?

A

False. LORAZEPAM may be potentiated by probenecid or valproic acid

 May be antagonized by theophylline, aminophylline

33
Q

TorF: clonazepam cause amnesia

A

True

34
Q

TorF: clonazepam can cause hyper-salivation

A

True

35
Q

Absence seizures with valproic acid is a SE of which BZD?

A

Clonazepam

36
Q

CNS: depression, ataxia, memory impairment, paradoxical excitement

 GI: salivation changes

 Neutropenia, jaundice

Are the SE of which BZD?

A

SE of diazepam

37
Q

Buspirone is a selective partial agonist at which receptor?

A

Selective partial agonist at 5-HT1A receptors.

Also displays affinity for dopamine D2 and 5-HT2A receptors.

38
Q

SE of Buspirone

A

dizziness,

headache,

nervousness,

tinnitus,

dream disturbances

Nonspecific chest pain

39
Q

TorF: Both SSRIs and SNRIs may produce some increases in anxiety in the short-term that will dissipate with time.

A

True

40
Q

Both SSRIs and SNRIs are beneficial in specific anxiety conditions such as

A

Generalized anxiety disorder

Phobic disorders

Obsessive-compulsive disorder (e.g., fluvoxamine)

Panic disorder (e.g., sertraline)

PODA (5 decks)

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