Mock test for Anxiety Flashcards
2 Types of ion channels
- Voltage-gated channels
- Ligand-gated channels
2 types of neurotransmitter
Ionotropic receptors
Metabotropic receptors
EFFLUX OF K,
INFLUX OF CL-, CHANGE IN
CELLMEMBRANE POTENTIAL
HYPERPOLARIZATION
INFLUX OF NA AND CA–
CELL BECOMES POSITIVE
DEPOLARIZATION
EPSP stands for ?
Excitatory post-synaptic potential
IPSP stands for ?
Inhibitory postsynaptic potential
opens Na or Ca channels/ influx -> depolarization
(more positive) -> nerve impulse
Excitatory neurotransmitters
Excitatory neurotransmitters examples:
Norepinephrine, Dopamine, Acetylcholine,
Glutamate, Aspartate (NAGDA)
opens Cl channels -> hyperpolarization (more
negative) -> no nerve impulse
Inhibitory neurotransmitters
Inhibitory neurotransmitters examples:
glycine, gamma-aminobutyric acid (GABA)
Blocks Na channel from outside toxin?
source: Puffer fish
Tetrodotoxin (TTX)
Slows inactivation, shifts activation of Na channels?
source: Colombian frog
Batrachotoxin (BTX)
blocks “small Ca-activated” K channel
source: Honeybee
Apamin
blocks “big Ca- activated” K channel
source: Scorpion
Charybdotoxin
Blocks N-type channel in Ca+ channel
Source:Pacific cone snail
Omega conotoxin
(ω-CTX-GVIA)
Blocks P-type channel in Ca+ channels
Source: Funnel web spider
Agatoxin (ω-AGA-IVA)
The irreversible antagonist of Nicotinic ACh
receptor (Ligand-gated)
Source: Marine snake
α-Bungarotoxin
Blocks channel in GABA a receptor?
Source: South Pacific plant
Picrotoxin
Competitive antagonist in Glycine receptor
Source: Indian plant
Strychnine
Blocks channel in AMPA receptor
Source: Wasp
Philanthotoxin
AMPA stand for ?
a-Amino- 3- hydroxy- 5- methylisoxazole- 4 proprionic acid
is an emotional state commonly caused by the
perception of real or potential danger that
threatens the security of an individual
anxiety
recurrent unexpected panic
attacks that can occur with agoraphobia in which
patients fear places in which escape might be difficult.
Panic disorder
intense fear of particular objects
or situations (e.g. snakes, heights);most common
psychiatric disorder
Specific phobia
intense fear of being scrutinized in
social or public situations (e.g., giving a speech, speaking
in class).
Social phobia
intense pervasive
worry, over virtually every aspect of life
Generalized anxiety disorder
persistent reexperience of a trauma, efforts to avoid recollecting the trauma, and hyperarousal
Post-traumatic stress disorder
recurrent
obsessions and compulsions that cause significant
distress and occupy a significant portion of one’s life
Obsessive-compulsive disorder
usually, accompanied by symptoms of anxiety?
tachycardia, palpitations, tachypnea,
sweating, trembling and weakness
a. restlessness
b. fatigue
c. difficulty in concentrating
d. irritability
e. muscle tension
f. sleep disturbance
symptoms in ?
Generalized anxiety disorder (GAD)
Palpitations or tachycardia
Sweating
Trembling or shaking
Sensations of shortness of
breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal
distress
Dizziness, unsteadiness,
lightheadedness
Derealization or
depersonalization
Fear of losing control
Fear of dying
Paresthesia
Chills or hot flushes
Diagnostic criteria for ?
Panic disorder or Panic attack
At least ______ of the following symptoms
developed abruptly and reached a peak within
______
least four (1)
10 minutes (2)
Fear of losing control
Fear of dying or being detached from your environment.
Derealization or
depersonalization
Chills or hot flushes or burning sensation
Paresthesia
Goals of Therapy:
to reduce the severity, duration and
frequency of the anxiety symptoms
▪to improve the patient’s overall
functioning
▪to prevent anxiety symptoms
▪to improve quality of life
Nonpharmacologic Therapy
Short-term counseling
Stress management
Psychotherapy - for encouragement
Meditation
Exercise
Avoidance from caffeine, nonprescription
stimulants and diet pills
calming effect but did not induce sleep
Sedative drugs
Minor tranquilizers , induce drowsiness and sleep
Hypnotic drugs
most widely used anxiolytic and drug of choice in GAD
MOA: Increase frequency of chloride
channel opening enhancing
membrane hyperpolarization
benzodiazepines
Short-acting (2-8 hrs) BZD
Oxazepam (Serax)
Triazolam (Halcion)
Clonazepam (Klonopin, Rivotril)
Midazolam (Versed, Dormicum)
Temazepam (Restoril)
Intermediate-acting (10-20 hrs) BZD
Lorazepam (Ativan)
Alprazolam (Xanax, Xanor)
Temazepam (Restoril)
Flunitrazepam (Rohypnol)
Long-acting (1-3 days)
Diazepam (Valium, Anxionil)
Flurazepam(Dalmane)
Chlordiazepoxide (Librium)
Anxiety BZD
Alprazolam, diazepam
Seizures BZD
diazepam, clonazepam,
lorazepam
Insomnia BZD
flurazepam, midazolam
pre-operative sedation BZD
midazolam
metabolite of benzodiazepines ?
N-desmethyldiazepam (N-DMDZ),
active metabolite with a long elimination t1/2
of more than ____.
40 hours
ABSORPTION and DISTRIBUTION: BZD
§ Absorbed ____ following oral administration
§ Cross the___, ____ barrier
§ Secreted in ____
rapidly (1)
BBB (2)
placental (3)
milk (4)
for IV anesthesia BZD
Diazepam and lorazepam
Anticonvulsant BZD
Clonazepan, Nitrazepam,
Lorazepam, Diazepam
lost of coordination like muscle control, balance and trouble in walking
Ataxia
loss of the ability to
create new memories after the event that
caused the amnesia, leading to a partial or
complete inability to recall the recent past,
while long-term memories before the event
remain intact.
Anterograde amnesia
§ Decreased responsiveness to a drug following
repeated exposure
§ Result in the need for an increase in the dose
required to maintain symptomatic improvement
or to promote sleep
Tolerance
An altered physiologic state that requires
continuous drug administration to prevent
abstinence or withdrawal syndrome
Dependence
Treat for BZD withdrawal symptoms
Diazepam
▪ -can be initiated as loading dose (40% of daily
consumption), followed by a daily tapering of
10%.
§ Clonazepam
▪ -an alternative agent
§ Phenobarbital
▪ for mixed Bzd and alcohol dependence.
treatment for Benzodiazepine poisoning
A benzodiazepine antagonist
§ GABA receptor antagonist
Flumazenil (Anexate)
additive effect; lowers the therapeutic index
of BZD
Alcohol + BZD
Synergism of adverse sedative effects
CNS depressants + BZD
Respiratory suppression and death
Lorazepam + Clozapine
inhibition of BZ metabolism
Cimetidine + BZD
§ increased alprazolam concentrations.
Nefazodone/Fluvoxamine
§ increased alprazolam concentrations.
Nefazodone/Fluvoxamine
- former DOC for anxiety, insomnia
MOA:s increase the duration of GABA-mediated chloride ion channel opening
barbiturates
Ultra-short (20 min)
Thiopental (Pentothal)
Short-acting (3-8 h)
Pentobarbital (Nembutal)
Amobarbital (Amytal)
Long-acting (1-2 d):
phenobarbital (Luminal)
Intermediate-acting
amobarbital, butabarbital
induction of anesthesia BAR
Thiopental
seizures in children BAR
Phenobarbital
anxiety-BAR
Pentobarbital, Amobarbital
is capable of inducing
the hepatic microsomal drug-metabolizing enzyme system(P-450)
Phenobarbital
bind selectively to GABAA receptor isoforms that
contain α1 subunits to enhance
hyperpolarization
used in sleep disorders
Eszopiclone (Lunesta ™)
§ cyclopyrrolone
Zaleplon ( Sonata ™)
§ pyrazolopyrimidine
Zolpidem (Ambien™)
§ Imidazopyridine
Melatonin Receptor Agonist
MOA: Activates MT1 and MT2 receptors in
suprachiasmatic nuclei in the CNS
Rapid onset of effect with minimal rebound
insomnia
¡ Used with caution in patients with liver
dysfunction
Metabolized by CYP1A2
ramelteon (rozerem)
drug interaction of ramelteon :
CYP1A2 inhibitors
(Ciprofloxacin, Fluvoxamine, Tacrine, Zileuton)
and Rifampin
azapirone anxiolytic
§ Possess no anti-convulsant, muscle relaxant, hypnotic,
motor impairment and dependence properties
alternative for GAD
The agent of choice in the management of chronic, persistent
anxiety.
¡ It is not cross-tolerant with BZs and will not treat or prevent
symptoms of BZ withdrawal
It is an appropriate choice for anxious patients with a history
of alcohol or drug abuse
buspirone.
useful in patients with prominent
cardiovascular symptoms of anxiety
they are less effective anxiolytics than BZs,
Propranolol and other beta-blockers
Accumulate with the nightly administration of
the drug
Associated to MICKEY FINN
¡ Trichloroethanol – active metabolite
¡ Trichloroacetic acid – toxic metabolite
CHLORAL HYDRATE
Diphenhydramine (Benadryl), doxylamine (Unisom),
hydroxyzine (Atarax, Iterax)
Antihistamines
not a Bz but acts on Bz receptor
Zolpidem (Ambien, Stilnox)