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NURS 7310 > Anxiety disorders and agents used to treat them > Flashcards

Anxiety disorders and agents used to treat them Flashcards

1
Q

What regions of the brain does most research point to as being involved with anxiety?

A

prefrontal cortex, amygdala, hippocampus, and HPA axis

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2
Q

Kulver Bucy Syndrome

A

Role of temporal structures on emotions and temperament, but especially the amygdala (monkeys that had removed temporal lobe segments made them docile and unable to learn from negative experience)

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3
Q

The removal of just the amygdala is enough to

A

cause Kluver-Bucy Syndrome

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4
Q

What is the amygdala responsible for?

A

recognition and management of fear

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5
Q

How do we recognize danger

A

Thalamus projects auditory and visual information to the amygdala that is perceived as threatening BEFORE sending it to the cortex to be processed.

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6
Q

Where is brain activity during anticipatory anxiety?

A

Activity in the amygdala, hippocampus, and insula

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7
Q

What memory changes occur due to fear?

A

Structural changes in the amygdala in reaction to fearful circumstances

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8
Q

Feelings of fear are regulated by an OVERACTIVE reciprocal connections between

A

the amygdala and the anterior cingulate cortex and the amygdala and the orbitofrontal cortex

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9
Q

One of the central components of anxiety is the feeling

A

that one is not in control

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10
Q

What is the metaphorical brakes for the amygdala?

A

the mPFC (medial prefrontal cortex)

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11
Q

Patients with PTSD have demonstrated that their pre frontal cortex is

A

insufficiently powered and unable to turn down the “alarm” in the amygdala

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12
Q

What interaction between nature and nurture can be considered responsible for the development of PTSD?

A

A small hippocampus and exposure to trauma

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13
Q

Which neurotransmitters have been implicated in the anxiety response?

A

GABA, NE, BDNF

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14
Q

Activating GABA neurons

A

calms the brain down

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15
Q

Too much GABA activation causes

A

sluggishness and even coma

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16
Q

Stressed rates show increases in

A

NE release

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17
Q

Peripheral NE causes

A

somatic symptoms of anxiety

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18
Q

What is essential for the acquisition and extinction of anxiety?

A

BDNF

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19
Q

What is the relationship of breastfeeding and anxiety?

A

A recent study saw that children whose parents separated or divorced when the children were between the age of 5 and 10 were more resilient and less anxious if they had been breastfed.

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20
Q

What specific part of the brain is affected in OCD?

A

Basal Ganglia

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21
Q

Serotonin is the key neurotransmitter in

A

the amygdala and in elements of the CSTC circuits

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22
Q

Which medication is a general anxiolytic but not approved for anxiety disorder subtypes?

A

Buspar

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23
Q

What types of antidepressants are effective in reducing symptoms of anxiety and fear?

A

Antidepressants that increase serotonin SSRIs and SNRIs

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24
Q

Which neurotransmitter subtype is the target of benzodiazepines?

A

GABA-A receptors

25
Q

A GABA A subunit alpha 1 when activated induce

A

sedative and amnestic effects

26
Q

A GABA-A subunit alpha 2 when activated induce

A

anxiolytic effects

27
Q

The only GABA A receptors that are sensitive to benzodiazepines are those with

A

benzodiazepine isoform known as benzodiazepine-sensitive GABA A receptors

28
Q

How do benzodiazepine theoretically treat anxiety?

A

By reducing the amygdala output and enhancing the actions of inhibitory interneurons in CSTC circuits

29
Q

All beneficial effects and most adverse effects result from what benzodiazepine function?

A

Depression of the CNS

30
Q

How do benzodiazepines affect the limbic system?

A

reduce anxiety

31
Q

How do benzodiazepines affect the cortical areas?

A

they promote sleep

32
Q

How do benzodiazepines affect the supraspinal motor areas including the cerebellum?

A

muscle relaxation

33
Q

How do benzodiazepines affect the hippocampus and cerebral cortex?

A

retrograde amnesia and confusion

34
Q

What is the cardiovascular effects of benzodiazepines when taken orally? when taken IV?

A

Orally almost no effect. IV profound hypotension and cardiac arrest

35
Q

In patients with normal respiratory function benzodiazepines cause respiratory issues when combined with

A

other CNS depressants

36
Q

In patients with liver disease what are the preferred benzodiazepines?

A

oxazepam, temazepam, and lorazepam

37
Q

What half life caution is important to know with benzodiazepines?

A

Some of those medications have a short half life but are converted into active metabolites with an extremely long half life

38
Q

For a patient who needs help falling asleep what type of benzodiazepine would you prescribe?

A

one with a rapid onset like triazolam

39
Q

For a patient who needs something because they wake up later in the night what type of benzodiazepine would you prescribe?

A

one with a slower onset estazolam

40
Q

For a patient who is older what benzodiazepine is preferred?

A

one which is unlikely to accumulate with repeated dosing such as lorazepam

41
Q

What are the major adverse effects of benzodiazepines?

A

CNS depression, anterograde amnesia, sleep driving, paradoxical effects, respiratory depression, abuse (lower potential), use in pregnancy/lactation (category D and X)

42
Q

Death from overdose with oral benzodiazepines alone

A

has never been documented

43
Q

What should NEVER be taken with benzodiazepines?

A

other CNS depressants

44
Q

Discontinuation of a benzodiazepine?

A

Can cause withdrawal. Good practice includes tapering over weeks and/or months, replacing a long half life with a short half life. Monitor patients for three weeks after cessation for recurrence or withdrawal.

45
Q

What are the indications of an oral benzodiazepine overdose?

A

drowsiness, lethargy, confusion

46
Q

What are the indications of IV toxicity of benzodiazepines?

A

life threatening reactions, profound hypotension, respiratory arrest, and cardiac arrest

47
Q

What would the general treatment measures for an oral overdose of benzodiazepines?

A

gastric lavage, activated charcoal, saline cathartic, and dialysis

48
Q

What reversal agent is used for benzodiazepines?

A

Flumazenil

49
Q

For patients who do not respond to SSRIs/SNRIs or benzodiazepines what is great option either singly or in combination with these other medications?

A

Alpha 2 delta ligands (Gabapentin/Neurontin and Pregabalin/Lyrica)

50
Q

Which medication category is used for GAD but not specific anxiety disorders?

A

benzodiazepines

51
Q

Which medications are utilized for all anxiety disorders?

A

SSRIs

52
Q

What is a useful way to incorporate benzodiazepines into treatment of those with GAD?

A

When initiating SSRI/SNRI since they have a delayed onset, top up an SSRI/SNRI with those with only partial relief, and intermittent use when symptoms surge and sudden relief is needed

53
Q

What are the first line treatments for Panic disorder?

A

SSRIs, SNRIs, buspirone, alpha 2 delta ligands

54
Q

What are the second line treatments for Panic disorder?

A

benzodiazepines and tricyclic antidepressants

55
Q

How many tablets do you give for rescue benzodiazepines?

A

only 3-5 tablets

56
Q

What is the first line treatment for social anxiety disorder?

A

First line SSRIs, SNRIs, and alpha 2 delta ligands

57
Q

What can be used for performance anxiety?

A

beta blockers

58
Q

What is the first line treatment with post traumatic stress disorder?

A

SSRIs and SNRIs

59
Q

What can be used to treat PTSD nightmares?

A

alpha 1 antagonist at night

NURS 7310 (15 decks)

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