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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
Anxiety where there is a reaction to a recent identifiable stress; lasts less than six months
Acute stress disorder
26
Disorder where depression and anxiety occur together at the same time in the same patient (SSRIs, SNRIs)
Comorbid Depression and Anxiety
27
Drug where the anxiolytic effect is likely in the limbic system where high density of GABAa receptors control emotional behavior
Benzodiazepines (BZD)
28
Advantages of BZDs Anxiolytics
Rapid Onset of action High therapeutic index Highly effective in acute forms
29
Disadvantages of BZDs
Tolerance or Habituaton/dependence CNS depressants/Sedative Impair cognition/memory additive danger w/ alcohol
30
Short Acting Anxiolytics
Chlorazepate | Oxazepam
31
Intermediate Acting Anxiolytics
Alpralozam Lorazepam Oxazepam
32
Long acting Anxiolytics
Chlordiazepoxide Diazepam Clonazepam
33
Effect of BZDs on GABA receptors
Enhance the affinity, increasing frequency of channel opening.
34
What other drug classes can be used as Anxiolytic drugs?
SSRIs SNRIs 5HT1A agonist Beta-Blockers
35
What is the disadvantage of SSRIs and SNRIs as anxiolytic drugs?
slow onset of action 2-6wks
36
What are some disadvantages of 5-HT1A agonist as axiolytic drugs?
unsuitable for acute anxiety, slow onset of action
37
What Beta-Blocker anxiolytic is used and how is it different than other anxiolytic medications?
Propanolol | Only treats physiological smptoms
38
Mechanism of action for Buspirone
5-HT1A agonist (presynaptic receptors) attenuates serotonergic transmission
39
What are the primary indications of Sedative-Hypnotic drugs?
``` Anxiolytic Insomnia Sedation/Amnesia Anesthesia Epilepsy Muscle Relaxants Withdrawal ```
40
Which BZDs used for insomnia | QFETT
``` Triazolam Estazolam Temazepam Flurazepam Quazepam ```
41
What is the effect of Barbiturates on the GABA receptor?
Increase efficacy of GABA by increasing duration of opening
42
Ultrashort acting Barbiturates for induction of anesthesia
Methohexital | Thiopental
43
Short acting barbiturates for insomnia/preoperative sedation
Amobarbital Pentobarbital Secobarbital
44
Long acting barbituates for treatment of seizures
Phenobarbital
45
Which drug classes bind to GABAa receptors?
``` BZD BRB Mep ChH Z-drugs ```
46
What is the GABAa subunit composition?
2 alpha, 2 gamma, 1 beta
47
What is the GABAb subunit composition?
2 alpha, 2 beta, 1 gamma
48
What drug can be used to reverse overdose of BDZ drugs?
Flumazenil (BDZ antagonist) | no clinical effect alone
49
What GABAa receptor subtypes do common BDZs bind to?
alpha 1, 2, 3, 5 | not 4 or 6
50
What GABAa subunit are Z-drugs specific for?
Alpha-1 subunit
51
What is defined as a state with repeated difficulty in sleep initiation, duration, consolidation and circumstances for sleep?
Insomnia
52
What is the most common complaint of insomnia?
Insomnia resulting in daytime impairment
53
What is the longest stage of sleep?
Non-REM sleep (75-80%)
54
How long does REM sleep generally last?
20-30min
55
BDZ effect on Sleep stages
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
Stages of Sleep
``` 1 - light sleep 2 - awareness disappears 3 - slow wave sleep 4 - slowest wave sleep REM - Memorable dreaming (Cycle lasts 90-110min) ```
57
Sleeping pills/alcohol effect on sleep
perception = deep refreshing sleep | Sleep not physiologically normal
58
Where is the binding site for BDZ drug on GABA receptor?
between alpha and gamma subunits
59
An alpha2 adrenergic agonist used for sedation and analgesia in intensive care patients and some procedures
Dexmedetomidine 8 times more potent than Clonidine Preferred over BDZ and propofol
60
What are the warnings/precautions of Z-drugs (Ambien)
May cause complex behaviors such as sleep-driving, or other sleep-activities
61
Restless Legs Syndrome effect and treatment
Impacts sleep, must be treated with newer dopamine agonists
62
OTC Sleep Aids action
contain antihistamine, target H1 receptor to cause sleepiness
63
Disadvantages of Diphenhydramine
Long half-life = daytime grogginess
64
Orexin receptor agonist effect on sleep
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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