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Block 16 Psychiatry Module 7 > Psychopharmacology of Anxiolytics > Flashcards

Psychopharmacology of Anxiolytics Flashcards

1
Q

Enumerate structures modulating fear

A
  1. Amygdala
  2. Anterior cingulate cortex
  3. Orbitofrontal cortex
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2
Q

Avoidance, a primarily motor response, is regulated by which structures?

A

Reciprocal connections between the amygdala and periaqueductal gray (PAG)

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3
Q

Which hormone is secreted in the fear response?

A

Cortisol

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4
Q

What are the physiologic responses to fear?

A
  1. Changes in respiration (regulated by parabrachial nucleus)
  2. Increases in HR and BP (regulated by connections between amygdala and locus ceruleus)
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5
Q

What is re-experiencing?

A

Traumatic memory stored in the hippocampus triggering the amygdala to initiate a fear response

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6
Q

Neurotransmitters involved in symptoms of anxiety and fear associated with malfunctioning of amygdala-centred circuits

A
  1. Serotonin (5HT)
  2. GABA
  3. Corticotropin releasing factor
  4. norepinephrine
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7
Q

Structure associated with symptoms of worry

A

Cortico-striato-thalamic-cortical (CSTC) loop

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8
Q

Drug treatments for Anxiety

A
  1. GABAergic anxiolytics/Benzodiazepines
  2. Serotonergic anxiolytics
  3. Noradrenergic anxiolytics
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9
Q

Most widely used anxiolytics

A

Benzodiazepines

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10
Q

Principal inhibitory neurotransmitter

A

GABA

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11
Q

Benzodiazepine mode of action

A

Enhancement of GABA action at amygdala and prefrontal cortex within CSTC loops

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12
Q

Types of GABA receptors

A
  1. GABAa: gatekeepers of chloride channel, allosterically modulated
  2. GABAb: Not allosterically modulated, binds exclusively to Baclofen
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13
Q

Benzodiazepine receptors

A
  1. Omega 1 (cerebellum: anxiolytic, sedative-hypnotic.)
  2. Omega 2: (spinal cord and striatum: muscle relaxant)
  3. Omega 3: peripheral
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14
Q

Actions of benzodiazepines

A
  1. Anxiolytic
  2. Anticonvulsant
  3. Muscle relaxation
  4. Hypnosis and stupour in high doses

NOT

  1. Analgesia
  2. Anaesthesia
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15
Q

Clinical uses of benzodiazepines

A
  1. Anxiety disorders
  2. Muscle relaxation
  3. Anticonvulsant
  4. Alcohol withdrawal
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16
Q

Adverse effects of benzodiazepines

A
  1. Drowsiness
  2. Confusio
  3. Ataxia
  4. Amnesia
17
Q

Benzodiazepines not metabolised in the liver, thus safe to give in liver disease

A
  1. Oxazepam
  2. Temazepam
  3. Lorazepam
18
Q

Benzodiazepine antagonist given for poisoning, reverses the effect of benzodiazepines

A

Flumazenil

19
Q

Neurotransmitter innervating the amygdala and CSTC, which regulates fear and worry

A

Serotonin

20
Q

Serotonergic anxiolytics

A
  1. Buspirone
  2. Gepirone
  3. Tandospirone
21
Q

Identify:
Serotonin 1A partial agonist, a generalised anxiolytic used as an augmenting agent to antidepressants which does not interact with alcohol, benzodiazepines, or sedatives; has no dependence or withdrawal symptoms even with long term use

A

Buspirone

22
Q

Clinical uses for Buspirone

A
  1. Chronic and persistent anxiety
  2. Comorbid substance abuse
  3. Elderly
23
Q

Neurotransmitter with important regulatory output to the amygdala, prefrontal cortex, and thalamus in CSTC circuits

A

Norepinephrine

24
Q

Noradrenergic anxiolytic that is an alpha 2 agonist (stimulates alpha-2 receptors) effective at decreasing tachycardia, dilated pupils, sweating, and tremors, but not at blocking subjective and emotional aspects of anxiety

A

Clonidine

25
Q

Anxiolytics useful in cases of social phobia

A

Beta blockers

26
Q

Novel approaches to treatment of anxiety disorders

A
  1. Fear extinction

2. Reconsolidation

27
Q

Benzodiazepine advantages

A
  1. Rapid-onset
  2. Effective
  3. Well-tolerated
  4. General anti-anxiety effects
  5. Safe in overdose
28
Q

Benzodiazepine disadvantages

A
  1. Withdrawal reaction
  2. Sedation
  3. Multiple daily dosing may be required
  4. Abuse potential
  5. Poor antidepressant
29
Q

SSRI advantages

A
  1. Effective
  2. Benign side effects
  3. No dependence issue
  4. Once a day dosing
30
Q

Tricyclic antidepressant (TCA) advantages

A
  1. Single daily dose
  2. Antidepressant effect
  3. No abuse potential
  4. Well-studied
  5. Effective
  6. Generics available
31
Q

TCA disadvantages

A
  1. Delayed-onset
  2. Anticholinergic side effects
  3. Postural hypotension
  4. Weight gain
  5. Dangerous in overdose
32
Q

Pharmacotherapeutic agents for insomnia

A
  1. Nonbenzodiazepine short-acting hypnotics (e.g. Zateplon, Zolpidem, Zopiclone)
  2. Benzodiazepines (decrease sleep latency, diminish wakenings, increase duration of sleep)
  3. Melatonergic hypnotics
  4. Sedative-hypnotic antidepressants
  5. Sedating antihistamines
  6. OTC agents
  7. Older sedative hypnotics e.g. Chloral hydrate

Block 16 Psychiatry Module 7 (8 decks)

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