Week 4 Flashcards
What are the symptoms of anxiety disorders?
Tense
Irritable
Distracted
What is the typically treatment for chronic, mild anxiety?
Not pharmacological
Relaxing activities like yoga help
What are the symptoms of chronic moderately severe anxiety disorders?
Must have symptoms for over 6 months. May come and go a little but doesn’t completely go away.
Poor concentration
General tense feeling for no reason
Is chronic moderately severe anxiety genetic or environmental?
Both
What is the treatment for chronic moderately severe anxiety?
Anxiolytics - many are sedatives
Other therapy is also necessary - behavior modification and exercise.
What are benzodiazepines?
They are sedative/hypnotics
Agonists on BDZ receptors (allosteric modulators of GABA A receptors)
Benzodiazepines arent the direct agonists, they are allosteric, which means they dont directly activate the receptor but they heighten the affinity of the receptor for its natural ligand.
Binds to chloride channels which allow them to open up which causes inhibition.
Benzodiazepines have ___ effect on respiration. They are the ___ popular CNS depressants.
Little
Most
Name six therapeutic actions of benzodiazepines
Anxiolytic
Treat seizures (because of increased GABA activity)
Diminish alcohol withdrawal
Treat insomnia (hypotonic - short acting)
Muscle relaxation
Often used a couple hours before surgical procedures for dental anxiety
Are the sedative effects of benzodiazepines short acting or long acting?
Short acting (its a hypnotic)
Hypnotics - short acting
Sedative - long acting
Although benzodiazepines are generally well tolerated, tolerance ___with long term use which can lead to ___ and withdrawal. Benzodiazepines act ___ with other depressants. It can cause ___, ___, and ____..
Increases
Addiction
Synergistically
Drowsiness
Motor impairment
Decreased cognition
Some people (especially ___) have a ____ reaction to benzodiazepines. The ___ population, however, is more sensitive to the depressant effects. Don’t use benzodiazepines on people with ___ because it may lead to suicide.
Children
Paradoxical - This means that they anxiety is heightened and can make the children hyper.
Elderly
Intellectually disabilities or major depression
Name two sedative benzodiazepines. What are their half lives?
Diazepam (Valium) - 20-100 hours
Alprazolam (xanax) - 6-12 hours
Name two hypnotic benzodiazepines. What are their half lives?
Lorazepam (Ativan) - 6 hours
Triazolam (halcion) - 2 hours
These are used for sleeping medication.
Name one benzo-like drug and describe it.
Zolpidem (ambien) - sleep aid. Short 2 hour half life. Less hangover effect. Doesn’t cause depression and abuse is not a concern.
Other than benzodiazepines, what is another sedative/hypnotic drug used for the treatment of anxiety? How do these work?
Barbiturates
Enhance GABA
Barbiturates are used ___-term for anesthesia induction (pentobarbital) and ___-term for seizures (phenobarbital). It can cause major ___ of respiration and tolerance. It can cause ___ addiction/dependence/withdrawal. It is not frequently used due to its ___ margin of safety. It has major interactions with the ___ and ___.
Short
Long
Depression
Major
Narrow
Liver
Drug interactions (tends to stimulate CYP450)
What is propofol?
It is a barbiturate.
Used for general anesthesia (IV)
Fast induction and recover (short half life)
What kind of a drug is buspirone (buspar)? What are its indications?
Barbiturate
Used for anxiety or tension associated with everyday stress.
Useful for treating anxiety with depression. Other anxiety drugs may make depression worse
Usually for short-term use
Name four side effects of buspirone
Not particularly addicting
Rare movement problems or seizures
Irregular heart beat (rare)
Interacts with MAO-inhibitors or antiseizure medicines.
What are the symptoms of a severe acute anxiety-panic attack?
Increased sympathetics
HR goes up
BP remains stable
Rapid breathing
Feels like a heart attack or in the middle of a fight or flight response.
True or false… CNS sedatives/depressants have a strong effect with panic attacks
False
What two drugs are effective in treating panic attacks?
SSRIs
Antidepressants with mixed effects (velafaxin)
What drugs are used to treat phobic disorders?
SSRIs (Zoloft)
About __% of people retain ADHD throughout adult hood. Others grow out of it.
50%
About __% of children have ADHD. The M:F is __
10%
2:1 (M:F)
What are the symptoms of ADHD? (Predominantly hyperactive - impulsive
Difficulty with other children
Act out
Very impulsive
cant focus
What are the symptoms of ADD? (Predominantly inattentive)
Less likely to act out
May sit still but dont pay attention
Name two different drugs that are used to treat ADHD/ADD.
Amphetamines (adderall)
Methylphenidate (Ritalin)
Interestingly, these drugs are stimulants. Since ADHD kids’ brains are wired differently, giving them these stimulants actually calms them down and allows them to focus.
Remember that behavior modification is necessary. Drugs are just a crutch
Medication usually starts when the child starts school
Name one non-stimulant used to treat ADHD?
Modafinil
It’s actually a minor stimulant
What are some properties and side effects of modafinil?
Fewer side effects (compared to ampethatmines and methylphenidate)
Better tolerated
Little abuse problem
Side effects: minor headache, upset stomach, alters sleep
What is the mechanism for modafinil?
Perhaps DAT and/or NET blocker
Children with autism have problems with what three things?
Problems with social interaction
Verbal or nonverbal communication
Repetitive behavior
When is autism usually diagnosed? Is it caused by genetics, environment or both?
2-3 years of age.
It is likely caused by both genetics and environment.
What are some potential causes for autism?
Children are born with a susceptibility to autism. No single trigger that causes it to develop
Cluster of unstable genes interfere with brain development
Problems during pregnancy or delivery
What gender is autism more prevalent in?
Males
True or false… treating autism early will lead to maximum benefit
True
___ or ___ may help with psychotic, aggressive or repetitive behavior associated with autism, however it doesn’t affect the progression of the disease
Atypical antipsychotics
SSRIs
What are the behavioral interventions that are necessary for autism?
Social skills
Language
Communication
Play skills
Daily living
Motor skills
Eating disorders typically affect ___. ___% of adolescents have eating disorders
Females
1-2%
What are the symptoms of anorexia nervosa?
Relentless pursuit to thinness, Distorted body image, extreme restriction of eating.
Osteoporosis
Muscle wasting
Damage to heart
Infertility (messes up their endocrine system)
Dry yellow skin
Other symptoms of malnutrition
Pts often use laxatives to get be lighter weight
What are the symptoms of bulimia?
Frequent bingeing and purging
Usually normal weight (instead of trying to get skinny, they are trying to prevent getting overweight)
Damage to esophagus
Tooth damage
Acid reflux and other GI problems
Dehydration from purging
Emotional turmoil/shame
What is the treatment and medication for bulimia?
Must get the behavior under control for treatment to be effective
Supportive psychotherapy - (image counseling_
Medication: antidepressants such as fluoxetine
This can be very difficult to treat
Define dependence
Persistent use resulting in adaptations typically accompanied by accommodation or tolerance (causing compensatory escalation) and withdrawal
Define drug addiction (substance abuse disorder)
A disorder of pathologic decision making. Expression of compulsive destructive behavior despite extreme negative consequences
We know that despite their many differences, virtually all abused substances enhance ____ activity in the ___ (particularly related to ___, ___, and ___ function). Other pathways also involved such as ___ and ___
Dopamine (neurotransmitter)
Nucleus accumbens
Pleasure, motor, and cognitive
Glutamate and GABA
What are the functions that dopamine drugs affect?
Reward (motivation)
Pleasure/euphoria
Motor function
Compulsion
Perseveration
Decision making
True or false.. drugs that affect dopamine pathways often also have a serotonin component
True
What are the functions that are affected by drugs that affect serotonin pathways?
Mood
Memory
Processing
Sleep
Cognition
Amphetamine alters dendrites and increases synaptic connections __fold
Two
There are thousands of contacts along axons that interact with other axons. These blebs increase with drug activity. This will give the dopamine reward system a bigger role in decision making.
Describe the effect that the following drugs have and how they cause dopamine release..
Opioid narcotics Nicotine Marijuana Caffeine Alcohol/sedative/hypnotics
Opioids - activate opioid receptors
Nicotine - activate nicotinic receptors
Marijuana - activate cannabinoid receptors
Caffeine - blocks adenosine receptors
Alcohol/sedative/hypnotics - activate GABA receptors; an inhibitory transmitter
How does cocaine and Ritalin work?
Blocks DA transporters so DA is not pumped back into the neuron. Leads to excess DA in the extraneuronal space
How do ampethamines, methamphetamines, MDMA (ecstasy), ephedrine, and bath salts affect DA?
They release DA from vesicles by reversing VMAT
Reverse the DA transporter to pump DA out of the neuron into the extraneuonal space.
Which drugs have much greater activity than any other drug of abuse? (Causes neurotoxicity)
Amphetamines
Amphetamines disrupt the control and maintenance of DA and kills the neurons, leading to increased chance of parkinsons
What are the 6 things that contribute to an effective anesthesia?
Hypnosis
Analgesia
Amnesia
Autonomic stability
Anxiolysis
Describe responsiveness of for the following levels of sedation..
Minimal sedation anxiolysis
Moderate sedation/analgesia (conscious sedation)
Deep sedation/analgesia
General anesthesia
Minimal sedation anxiolysis: normal response to verbal stimulation
Moderate sedation: purposeful response to verbal or tactile stimulation
Deep sedation: purposeful response following repeated or painful stimulation
General anesthesia: unarousable even with painful stimulus
Ether provides hypnosis, amnesia, and immobility, but lacks ___ and ___
Analgesia
Autonomic stability
Describe stage 2 of anesthesia
Lack of inhibition. Everything kinda goes haywire, the patient squirms and moans. Patient wont be able to remember anything in stage 2.
Once they reach stage 3, they are under anesthetic influence
For minor superficial surgery/biopsy, the patient should be put under ___ sedation by using ___ and ___. This provides…
Moderate
Oral/parenteral sedatives and local anesthetics
This provides conscious sedation… good anesthesia, relaxation, retain essential reflexes, responds to commands, quick recovery
___ is the most common induction agent in modern practice
Propofol
What are the mechanisms of CNS depressants?
Enhance GABA
Decrease glutamate
Elimination of sedatives is dependent on…
Water solubility of hepatic bioactive metabolites
What is the difference between volatile and gaseous inhaled anesthesia in regards to vapor pressure and boiling points.
Volatile: low vapor pressure and high boiling points
Gaseous: high vapor pressure and low boiling point
Describe the relationship between an inhaled anesthetic’s solubility in blood and its ability to cross the BBB.
If it not very soluble in the blood it goes to the brain quicker.
Nitrous has __ solubility - ___ blood compartment
Halothan has ___ solubility - ___ blood compartment
Low, small
High, large
Define drug abuse.
Purposefuly taking illicit or illegal drugs. Includes using prescription of drugs given to you earlier for a different reason
DA is inhibitory with __ receptors and excitatory with ___ receptors. ___ recpetors do most of the reward part of it.
D1
D2
D2
Amphetamines can increase extraneuronal DA __ fold. Cocaine ___ fold. Nicotine __ fold. Alcohol __ fold.
Amphetamines 10-50 fold
Cocaine 3 fold
Nicotine 2 fold
Alcohol 2 fold
Amphateamine users have a ___ fold increase in the incidence of parkinsons
3-10
~___% of people are prone to addiction across all drugs
10%
GWAS studies show that there is a genetic vulnerability for addiction. __-__% risk for drug abuse comes from genetics.
40-60%
Overlap of addiction and mental illness-difference in pattern dependent on age: youth more likely to have ___, older adults more likely to have depression
Conduct disorder
Depression
Describe stage one of anesthesia
Light, antianxiety, reflexes OK and awake
Describe stage 2 of anesthesia
Moderate, conscious sedation, drowsy, respond to commands, quick recovery
Describe stage 3 of anesthesia
Pre-operative (BDZ)
Induction with IV propofol or thiopentathol
Maintenance with inhaled (volatile agents or NO2) or IV drugs (propofol or opioid analgesics or combined
___ is a benzodiazepine antagonist. It reverses effects for emergency or quick recovery after a procedure
Flumazenil
Volatile inhaled anesthetics are ___ at room temperature and sea level. Name some types of volatiles.
Liquids
Halothane Enflurane Isoflurane NO2 Ether
Nitrous has a __ gas partition coefficient. Halothane has a ___ partition coefficient.
Low
High
Which has a more rapid induction and recovery, nitrous or enflurane?
Nitrous because it has a lower coefficient
Most modern inhaled anesthetics are eliminated by ___ not ___. What is an exception to this rule?
Ventilation
Metabolism
*although halothane does have hepatotoxic metabolites, so dont use in patients with liver damage
True or false… propofol can be used for sedation at lower doses or induction for general anesthesia
True
True or false. Propofol is an analgesic.
False. It is a hypnotic.
Propofol is used for __ duration procedures. It increases ___ activity. It ___ respiration.
Short
GABA
Depresses
Thipental is a short acting ____. It doesn’t provide ___. It is anti-___. It causes ___ respiration. Avoid in intermittent ____. It is rapid induction and short-acting
Barbiturate
Analgesia
Antiseizure
Reduced
Porphyria
Benzodiazepines such as ___, ___, and ___, have a __ onset. They are ___ injections. They are given preoperatively for sedation. They provide good ___ but not good ___.
Midazolam, lorazepam, diazepam
Rapid
Painful
Amnesia but not good analgesia
Ketamine is a dissociative ___. It is a ___ antagonist and causes some DAT inhibition. It has a ___ onset. Increases ___ blood flow. Causes nightmares in adults.
Analgesic
NMDA
Rapid
CNS
