PHARM - Anxiolytic and Hypnotic Drugs - Week 10

Question 1

What other condition do anxiety disorders often coexist with?

Answer 1

Depression

Question 2

What four aspects of life are anxiety disorders often associated with?

Answer 2

High degree of social and work impairment
Poor quality of life
Frequent relapses

Question 3

Briefly describe panic disorder.

Answer 3

Sudden episodes of overwhelming fear with somatic symptoms

Question 4

Briefly describe obsessive-compulsive disorder.

Answer 4

Compulsive and ritualistic behaviours as well as purposeless activities driven by irrational fears and thoughts

Question 5

Briefly describe post-traumatic stress disorder.

Answer 5

Anxiety triggered by recall of past traumatic and stressful experiences

Question 6

Briefly describe phobias.

Answer 6

Intense fear of objects or situations

Question 7

Briefly describe generalised anxiety disorder.

Answer 7

A feeling of nervousness, tension, or worry not associated with a specific event, situation, or object

Question 8

Briefly describe social anxiety disorder.

Answer 8

Fear of being with and interacting with people

Question 9

Anxiety is associated with a dysregulation of what four neurotransmitter systems?

Answer 9

GABA
Serotonin
Noradrenaline
Dopamine

Question 10

What do the most effective therapeutic agents for anxiety do (2)?

Answer 10

Potentiate GABA and serotonin neurotransmission

Question 11

Is GABA inhibitory or excitatory?

Answer 11

Inhibitory

Question 12

Is glutamate inhibitory or excitatory?

Answer 12

Excitatory

Question 13

Is serotonin widely used in the CNS or only very specific parts?

Answer 13

Widely used

Question 14

What do anxiolytics do (3)?

Answer 14

Relieve anxiety and tension without notably impairing consciousness

Question 15

What do hypnotics do?

Answer 15

Produce drowsiness, encouraging the onset of a state of sleep

Question 16

Is insomnia a disease entity?

Answer 16

No

Question 17

How are insomnia and anxiety related?

Answer 17

Insomnia is a common clinical manifestation of anxiety

Question 18

Name three non-pharmacological interventions for insomnia.

Answer 18

Diet
Exercise
Routine change

Question 19

What two things may be responsible for insomnia?

Answer 19

Disease and environmental factors

Question 20

What kind of drugs are benzodiazepines and what is its mechanism of action? In what way does it bind to receptors?

Answer 20

They are anxiolytics.

They potentiate the effects of GABA on GABAa receptors by binding allosterically.

Question 21

How are benzodiazepines classified?

Answer 21

By the duration of their half-life.

Question 22

Do benzodiazepines have predictable or unpredictable side effects?

Answer 22

Common and predictable

Question 23

Name 5 side effects of benzodiazepines.

Answer 23

Confusion
Drowsiness/impaired coordination
Long-lasting hangover effects
Tolerance and dependence
Supression of REM sleep

Question 24

Do benzodiazepines have a wide or narrow therapeutic margin? What does this indicate about its safety?

Answer 24

Wide window - good safety margin

Question 25

When can benzodiazepines be lethal?

Answer 25

If taken in excess with alcohol or other CNS depressants like opioids and anticonvulsants

Question 26

Do benzodiazepines have good absoprtion orally? What is this determined by?

Answer 26

Good absorption after oral administration. | Determined by lipophilicity.

Question 27

What happens to benzodiazepines in the body metabolically for its clearance to occur? What system is critical for this to occur and what function should be checked as a result when administering benzodiazepines?

Answer 27

Transformation or biotransformation to hydrophilic metabolites. The microsomal liver system is critical for this. Liver function should be checked.

Question 28

Many benzodiazepines have active metabolites. Are agents with or without them preferred for older patients?

Answer 28

Agents without active metabolites are preferred for older patients.

Question 29

Are drug interactions common or rare with benzodiazepines? Give one example.

Answer 29

They are common | Mood stabilisers - reduce the elimination of benzodiazepines

Question 30

What should benzodiazepines never be taken with and why? What can occur as a result?

Answer 30

Do not mix with alcohol. | It causes additive CNS depression, possibly leading to death.

Question 31

Are benzodiazepines addictive? Compare it to heroin.

Answer 31

It is addictive - more difficult to stop than heroin.

Question 32

What do benzodiazepines increase the risk of in older patients and why?

Answer 32

Risk of falling due to possible drowsiness.

Question 33

Describe what the dosage should be like with benzodiazepines (2).

Answer 33

Start low and increase the dose gradually. | Decrease the dose if drowsiness and confusion occur.

Question 34

Can benzodiazepines cross the placenta?

Answer 34

Yes, it accumulates in foetal circulation

Question 35

Can benzodiazepines cross into breast milk?

Answer 35

Yesd

Question 36

Are benzodiazepines teratogenic (2)?

Answer 36

Yes, cleft palate occurs

Question 37

How long does it take to gain tolerance/dependence to benzodiazepines?

Answer 37

A couple of weeks.

Question 38

What happens if sudden discontinuation of benzodiazepines occur?

Answer 38

Withdrawal symptoms

Question 39

List 7 typical withdrawal symptoms of benzodiazepines.

Answer 39

``` Anxiety Restlessness Shakes Rebound insomnia (worse than pre-treatment) Weakness Orthostatic hypotension Generalised seizures ```

Question 40

What is the recommendation to prevent benzodiazepine withdrawal symptoms?

Answer 40

Gradual dose reduction over 2 months.

Question 41

Name a non-benzodiazepine anxiolytic and briefly describe what it does. Compare it to benzodiazepines (3).

Answer 41

Buspirone Relieves anxiety without causing marked sedative/hypnotic effects Lacks muscle relaxant and anticonvulsant properties

Question 42

Briefly describe how buspirone works (2) and whether it acts on GABAa directly.

Answer 42

No direct effects on GABAa | Is a partial agonist of 5HT1a and some affinity for D2 receptors.

Question 43

Does busiprone have abuse liability? Is there a risk of rebound anxiety or withdrawal symptoms?

Answer 43

Has minimal abuse liability | No rebound anxiety or withdrawal symptoms

Question 44

How long does buspirone take to have an effect? Is it useful for acute anxiety states?

Answer 44

May take 3-4 weeks to take effect. | Not useful for acute anxiety states.

Question 45

Does buspirone affect driving?

Answer 45

No

Question 46

List 4 adverse effects of buspirone.

Answer 46

Less psychomotor impairment than benzodiazepines Dizziness Headache GI disturbances

Question 47

Does buspirone have rapid oral absorption?

Answer 47

Yes

Question 48

Should liver function be checked when administering buspirone?

Answer 48

Yes

Question 49

Can benzodiazepines act as a hypnotic?

Answer 49

Yes

Question 50

How do benzodiazepines act as hypnotics?

Answer 50

They enhance GABA transmission.

Question 51

Name three side effects of using benzodiazepines as hypnotics.

Answer 51

Broken sleep Supression of REM sleep Rebound insomnia (abrupt cessation)

Question 52

Name 2 benzodiazepine-related drugs that can be used as hypnotics and describe briefly how they work. Do they cause REM sleep suppression?

Answer 52

Zopiclone Zolpidem Increases GABA transmission by selectively binding to BZ1 Dont cause REM sleep suppression

Question 53

Do antidepressants carry a risk of dependence like benzodiazepines?

Answer 53

No