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Fall P2 > IDT - Anxiolytics & Sedatives, Ishmael > Flashcards

IDT - Anxiolytics & Sedatives, Ishmael Flashcards

1
Q

What do Anxiolytics do?

A

Reduce Anxiety

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2
Q

What do sedatives do?

A

Induce “sedation”, decrease activity, have a calming effect/reduce anxiety

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3
Q

What do Hypnotics do?

A

Induce drowsiness, cognitive performance decrease, and allow onset or allow maintenance of sleep

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4
Q

What is Fear?

A

reaction to immediate perceived threat/critical to survival

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5
Q

What is Conditioned fear?

A

Reaction to a stimulus that is associated with a threat

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6
Q

What is anxiety?

A

A normal human emotion, anticipatory response to an uncertain, potential threat

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7
Q

How do anxiety disorders occur?

A

Symptoms of anxiety interfere with normal life; no longer useful as a warning system; no focus to the fear or dread, where the scale of symptoms is not appropriate for the threat.

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8
Q

What region of brain is responsible for the expression of fight or flight motor response?

A

Striatum

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9
Q

Which region of the brain is responsible for the body’s autonomic response?

A

Brainstem

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10
Q

Which region of the brain produces hormonal stress response?

A

Hypothalamus

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11
Q

Which brain regions encompass the Limbic System?

A

Cortex, Hippocampus, Amygdala and Striatum

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12
Q

What is the role of GABA on arousal or sleep?

A

GABA deceases arousal in order to promote sleep (Inhibitory)

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13
Q

What Neurochemicals play a role in the regulation of sleep-wake cycles

A 
Glutamate
NE
ACh
5-HT
DA
GABA
Orexin/Hypocretin
Histamine
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14
Q

What is circadian rhythm?

A

24hr cycle of physical, mental and behavioral changes

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15
Q

What Biological clocks control circadian rhythms?

A

Pineal gland - releases melatonin
Suprachiasmatic Nucleus (SCN) - master clock
Retina - light

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16
Q

What are the subjective features of anxiety disorders

WHARDFIA

A 
Apprehension
Worry
Anticipation
Fear
Hypervigilance
Restlessness
Impaired Concentration
Depression
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17
Q

What physiological features accompany anxiety disorders?

NGRC

A

Neuromuscular (tension, fatigue)
Gastrointestinal (Dry mouth, swallowing issues)
Respiratory (Hyperventilation)
Cardiovascular (palpitations)

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18
Q

Type of anxiety where there is excessive anxiety and worry most of the time about life?

A

Generalized anxiety disorder

GAD

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19
Q

Type of anxiety where an irrational fear interferes with normal behavior?

A

Phobic Anxiety Disorders

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20
Q

Type of anxiety where there are discrete periods of intense fear?

A

Panic Disorder

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21
Q

Type of anxiety where it mostly occurs in situational or specific circumstances?

A

Social Anxiety Disorder

SAD

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22
Q

Persistent thoughts, ideas or images that intrude into conscious awarenss

A

Obsession

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23
Q

Urges or impulses for repetitive intentional behaviors

A

Compulsions

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24
Q

Type of anxiety which recurs and is precipated by exposure to an exceptionally stressful/horrific or life threatening event.

A

Post-traumatic stress disorder

PTSD

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25
Q

Anxiety where there is a reaction to a recent identifiable stress; lasts less than six months

A

Acute stress disorder

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26
Q

Disorder where depression and anxiety occur together at the same time in the same patient (SSRIs, SNRIs)

A

Comorbid Depression and Anxiety

27
Q

Drug where the anxiolytic effect is likely in the limbic system where high density of GABAa receptors control emotional behavior

A

Benzodiazepines (BZD)

28
Q

Advantages of BZDs Anxiolytics

A

Rapid Onset of action
High therapeutic index
Highly effective in acute forms

29
Q

Disadvantages of BZDs

A

Tolerance or Habituaton/dependence
CNS depressants/Sedative
Impair cognition/memory
additive danger w/ alcohol

30
Q

Short Acting Anxiolytics

A

Chlorazepate

Oxazepam

31
Q

Intermediate Acting Anxiolytics

A

Alpralozam
Lorazepam
Oxazepam

32
Q

Long acting Anxiolytics

A

Chlordiazepoxide
Diazepam
Clonazepam

33
Q

Effect of BZDs on GABA receptors

A

Enhance the affinity, increasing frequency of channel opening.

34
Q

What other drug classes can be used as Anxiolytic drugs?

A

SSRIs
SNRIs
5HT1A agonist
Beta-Blockers

35
Q

What is the disadvantage of SSRIs and SNRIs as anxiolytic drugs?

A

slow onset of action 2-6wks

36
Q

What are some disadvantages of 5-HT1A agonist as axiolytic drugs?

A

unsuitable for acute anxiety, slow onset of action

37
Q

What Beta-Blocker anxiolytic is used and how is it different than other anxiolytic medications?

A

Propanolol

Only treats physiological smptoms

38
Q

Mechanism of action for Buspirone

A

5-HT1A agonist (presynaptic receptors)

attenuates serotonergic transmission

39
Q

What are the primary indications of Sedative-Hypnotic drugs?

A 
Anxiolytic
Insomnia
Sedation/Amnesia
Anesthesia
Epilepsy
Muscle Relaxants
Withdrawal
40
Q

Which BZDs used for insomnia

QFETT

A 
Triazolam
Estazolam
Temazepam
Flurazepam
Quazepam
41
Q

What is the effect of Barbiturates on the GABA receptor?

A

Increase efficacy of GABA by increasing duration of opening

42
Q

Ultrashort acting Barbiturates for induction of anesthesia

A

Methohexital

Thiopental

43
Q

Short acting barbiturates for insomnia/preoperative sedation

A

Amobarbital
Pentobarbital
Secobarbital

44
Q

Long acting barbituates for treatment of seizures

A

Phenobarbital

45
Q

Which drug classes bind to GABAa receptors?

A 
BZD
BRB
Mep
ChH
Z-drugs
46
Q

What is the GABAa subunit composition?

A

2 alpha, 2 gamma, 1 beta

47
Q

What is the GABAb subunit composition?

A

2 alpha, 2 beta, 1 gamma

48
Q

What drug can be used to reverse overdose of BDZ drugs?

A

Flumazenil (BDZ antagonist)

no clinical effect alone

49
Q

What GABAa receptor subtypes do common BDZs bind to?

A

alpha 1, 2, 3, 5

not 4 or 6

50
Q

What GABAa subunit are Z-drugs specific for?

A

Alpha-1 subunit

51
Q

What is defined as a state with repeated difficulty in sleep initiation, duration, consolidation and circumstances for sleep?

A

Insomnia

52
Q

What is the most common complaint of insomnia?

A

Insomnia resulting in daytime impairment

53
Q

What is the longest stage of sleep?

A

Non-REM sleep (75-80%)

54
Q

How long does REM sleep generally last?

A

20-30min

55
Q

BDZ effect on Sleep stages

A

Decreases sleep latency, by decreasing light sleep/dozing, and increasing time of awareness disappearance, increasing TOTAL sleep time but decreasing REM and deep sleep time.

56
Q

Stages of Sleep

A 
1 - light sleep
2 - awareness disappears
3 - slow wave sleep
4 - slowest wave sleep
REM - Memorable dreaming 
(Cycle lasts 90-110min)
57
Q

Sleeping pills/alcohol effect on sleep

A

perception = deep refreshing sleep

Sleep not physiologically normal

58
Q

Where is the binding site for BDZ drug on GABA receptor?

A

between alpha and gamma subunits

59
Q

An alpha2 adrenergic agonist used for sedation and analgesia in intensive care patients and some procedures

A

Dexmedetomidine
8 times more potent than Clonidine
Preferred over BDZ and propofol

60
Q

What are the warnings/precautions of Z-drugs (Ambien)

A

May cause complex behaviors such as sleep-driving, or other sleep-activities

61
Q

Restless Legs Syndrome effect and treatment

A

Impacts sleep, must be treated with newer dopamine agonists

62
Q

OTC Sleep Aids action

A

contain antihistamine, target H1 receptor to cause sleepiness

63
Q

Disadvantages of Diphenhydramine

A

Long half-life = daytime grogginess

64
Q

Orexin receptor agonist effect on sleep

A

Belsomra
Bind OX1R and OX2R (GPCRs)
Improve sleep initiation and maintenance by lengthening deep sleep and REM

Fall P2 (13 decks)

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