Test 4: Anxiety Flashcards
What percentage of Americans suffer from anxiety?
18
__% of patients with MDD display anxiety disorders
58
[fear/anxiety] is a stress response from immediate danger
fear
[fear/anxiety] is a stress response from your thoughts
anxiety
structure deep within temporal lobes, major component of emotional processing neural circuitry including limbic cortices, hypothalamus, and hippocampus
amygdala
anxiety circuitry evaluates stimuli then directs appropriate response via ___
amygdala
What is the function of the lateral nucleus in the amygdala?
processes information
What is the function of the central nucleus in the amygdala?
orchestrating response
__ cells in the dorsal pons contact the limbic system to increase anxiety and panic
norepinephrine
[increased/decreased] firing of LC NE neurons in response to anxiety provoking stimuli, electrical stimulation of LC, or application of NE inhibitory autoreceptor antagonist increases fear and panic behavior
increased
panic disorder and PTSD patients have [increased/decreased] NE
increased
therapeutic agents that reduce anxiety (BDZ, SSRI, TC) [increase/reduce] LC firing and NE function
reduce
GABA A receptor is a __ channel and causes __
chloride, hyperpolarization
sedatives/hypnotics [enhance/decrease] GABA A function to cause sedation and reduce anxiety
enhance
[BDZ/BAR or ETOH/neurosteroids] bind to modulatory sites on receptor (not GABA site)
BDZ/BAR
[BDZ/BAR or ETOH/neurosteroids] binds to distinct area of GABA A receptor (not GABA site)
ETOH/neurosteroids
BDZ, BAR, ETOH, and neurosteroids are all positive ____ modulators for GABA
allosteric
Which GABA modulating drug is the most clinically useful?
BDZ
BDZ sites are widely distributed in the brain with a high concentration in __, __, and __
amygdala, limbic areas, PFC
BDZ agonists [increase/decrease] Cl- current
increase
BDZ agonists [increase/decrease] anxiety, arousal, seizures
decrease
BDZ antagonists cause cellular [excitation/inhibition]
excitation
BDZ inverse agonists uncouple GABA receptors from __ channels so GABA is less effective in causing entry of __ into cells - increases [excitation/inhibition]
Cl-, excitation
GABA or GABA agonist in which brain area reduces anxiety?
amygdala
many anxiolytics are CNS depressants of the __ class
sedative-hypnotic
anxiolytics function to [increase/decrease] neuronal excitations
decrease
4 side effects of anxiolytics
drowsiness/sedation, mental clouding, incoordination, prolonged reaction time
GABA A receptors are __ channels
Cl-
GABA agonists produce __, create [EPSP/IPSP] and [excite/inhibit] cell firing
hyperpolarization, IPSP, inhibit
BAR [can/cannot] directly open GABA A channels without GABA
can
Differences in structure complexity of BAR due to ___
side chain
differences in complexity of BAR responsible for differences in ___
lipid solubility
differences in BAR lipid solubility determine __ and __ of action
onset and duration
three classes of BAR
ultrashort acting, short/intermediate acting, long acting
ultrashort acting BAR is __ lipid soluble
highly
short/intermediate acting BAR are __ lipid soluble
moderately
long acting BAR have __ lipid solubility
poor
4 side effects of BAR
non restful sleep, cognitive side effects, physical dependence and abuse, pharmacokinetic increase in liver enzymes
first BDZ
librium
BDZ increases __ of receptor for __
affinity, GABA
BDZ [can/cannot] directly open GABA A channels without GABA
cannot
BDZ binding to ___ receptor modulates clinical efficacy of drug
GABA A
BDZ that require lower doses to displace Diazepam have [higher/lower] clinical efficacy
higher
differences in BDZ structure responsible for differences in ___
lipid solubility
differences in BDZ lipid solubility determine __ and __ of action
onset and duration
two classes of BDZ
short acting, long acting
Which class of BDZ uses Phase II metabolism in one step to inactive metabolites?
short acting
Which class of BDZ uses Phase I to active metabolites and Phase II to inactive metabolites?
long acting
2 BDZ therapeutic effects
conscious sedation and anxiety relief
T or F: BDZ have higher therapeutic index than BAR
true
T or F: BDZ produce pharmacokinetic increase in liver enzymes
F
Best known 2nd generation anxiolytic
Buspirone (Buspar)
T or F: buspirone enhances GABA function
false
Buspirone is a partial __ agonist acting in limbic system, amygdala, and PFC, raphe
5HT1A
Postsynaptic heteroreceptors of 5HT1A are located in __, __, and __
limbic system, amygdala, PFC
Somatodendritic 5HT1A autoreceptors are located in __
raphe
Anxiolytic action of buspirone may be due to [up/downregulation] of 5HT1A autoreceptors
down
buspirone [increases/decreases] 5HT function postsynaptically
increases
SSRIs relieve anxiety by enhancing 5HT function by blocking 5HT ___ postsynaptically
reuptake
SERT blockers are [more/less] effective than NERT blockers in reducing anxiety symptoms
more