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Health.2 > Anxiety and Anxiolytics JB 🧠 > Flashcards

Anxiety and Anxiolytics JB 🧠 Flashcards

1
Q

physical symptoms of anxiety

A 
heart pounding 
face flushing
fast breathing
pupils dilating
tense muscles
slow digestion
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2
Q

different types of anxiety disorders

A

short term(natural rrepsonse, drives performance and increases alertness)

or prolonged- becomes distressing and disabling

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3
Q

what is anxiety?

define

A

normal, protective, psychological response to an unpleasant or threatening situation.

Mild to
moderate anxiety can improve performance and ensure
appropriate action is taken

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4
Q

main function of anxiety?

A

act as signal for danger

trigger appropriate adaptive response (fight/flight)

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5
Q

what is the acute stress response?

A

fight/flight response

physiological resonse to stress.

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6
Q

how does brain and body systems respond to anxiety? what happens when stressed?

A
  1. amygdala reacts to threat
  2. hypothalamus activates SNS, Ad released
  3. Cortisol released from adrenal cortex for continued alertness
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7
Q

what 3 transmitters have an inter-relationship to affect behaviours during anxiety?

A

Nad
Dopamine
Serotonin

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8
Q

hen does anxiety occur?

A

when arousal systems in brain are disturbed

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9
Q

main inhib transmitter in CNS?

A

GABA

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10
Q

what does biochemical theory of MH conditions centre around?

A

neurotransmitters in areas of the brain

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11
Q

affects of GABA?

A

anti-seizure and anti-anxiety effects

tranquility and wellbeing

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12
Q

Strong associations have been identified

between anxiety disorders and ?

A

physical health

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13
Q

Risk Factors for anxiety?

A
  • Family history
  • Childhood adversity (trauma) even if not direct. just witnessed
  • Stressful life events
  • Certain personality traits
  • Parenting styles(overprotective)
  • Younger age
  • Female, Unmarried or unemployed (societal expectations)
  • Poor physical and/or mental health
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14
Q

Physical symptoms of anxiety
disorders
(part of fight/flight as body cant differentiate actual and mental)

A

SOB, sweaty palms,

palpitations, nausea, dizziness, hot flushes

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15
Q

Behaviour Symptoms of anxiety.

A

Coping strategies eg:
avoidance strategies, engaging in risky behaviour,
escaping anxiety producing situations

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16
Q

Emotional Symptoms of anxiety.

A

Worry, apprehension,

distress, nervousness, panic, feeling uneasy

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17
Q

Cognitive symptoms of anxiety.

A

Thoughts that we have
when we are anxious eg: “ What if….happens?”,
“People will laugh at me”,

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18
Q

6 Types of anxiety disorders

A 
BDD body dysmorphic disorder
GAD generalised anxiety
Social anxiety
PTSD 
Panic disorder
OCD
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19
Q

diagnosis of anxiety

A

scale of severity of symptoms and duration- varies for individual disorder types

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20
Q

what to consider when making

diagnosis of anxiety?

A

physical conditions that mimic some symptoms e.g. thyrotoxicosis, stimulant drugs

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21
Q

GAD-2 scale: what score = anxiety likely?

A

usually 3 or more

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22
Q

how is anxiety treated? (2)

A

CBT- changing perceptions

or pharmacological therapy

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23
Q

Pharmacological treatment of anxiety- what does drug choice depend on?

A

diagnosis and

severity of symptoms

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24
Q

what drugs prescribed for physical symptoms?

A

beta blockers- tachycardia, sweating, tremor…

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25
Q

what drugs prescribed to increase GABA levels?

A

benzodiazepines
- give rapid relief of acute anxiety but have SEs

or pregabalin
- option in GAD

26
Q

what drugs prescribed to increase Serotonin levels?

A

SSRIs, SNRI, TCAs, Buspirone

27
Q

whats first line drug class for most anxiety disorders?

A

SSRIS- delay in effect

28
Q

mechanism of action of benzodiazepines?

A
  • interact w specific binding sites associated with GABA receptors in brain
  • potentiate inhibitory action of GABA
  • Cl channels open- allows Cl to enter cell = hyperpolarisation (inhibition) of neuron
29
Q

whats the most important NT in CNS?

A

GABA

30
Q

whats neural activity in CNS regulated by? (2)

A

inhibitory activity- GABA

and excitatory NTs e.g. glutamate

31
Q

whats are GABAa receptors and what do they control?

A

multimolec. complexes- control a Cl ion channel link and control specific binding sites for GABA

32
Q

how many subtypes of rec do benzodiazepines bind to?

A

2 or more.
combo of alpha 2 containing subtype mediates their antiepileptic effect
alpha 1: antiamnesic effect

33
Q

how are benzodiazepine receptors diff in patients with anxiety?

A

reduced receptors in key areas that regulate anxiety response

34
Q

all benzodiazepines undergo heptic metabolism via… (2)

A

oxidation/ conjugation

35
Q

the diff benzodiazepines available differ in… (2)

A

potency and rate of elimination

36
Q

whats the absorption and membrane permeability of benzodiazepines like?

A

most: well absorbed orally and rapidly penetrate brain

37
Q

how long does it take to get clinical effect of benzodiazepines via penetration in brain post oral admin?

A

within 30 mins

38
Q

what patients is the oxidation of benzodiazepines increased in? why?

A

elderly
patients w hepatic impairment
DDIs
alcohol

39
Q

how are benzodiazepines metabolised?

A

in liver, CYP450

40
Q

what may reduce levels of benzodiazepines?

A

enzyme inducers e.g. carbamazepine

41
Q

what may increase levels of benzodiazepines?

A

enzyme inhibitors e.g. erythromycin, ciprofloxacin

42
Q

clinical uses of benzodiazepines (actions)?

A

= immediate symptoms relief

CNS depressants- sedative, anxiolytic, amnesic, musclar relaxant, anticonvulsant actions

43
Q

when are benzodiazepines most useful?

A

short term anxiety- fight/flight

need alternatives for long term

44
Q

concerns with benzodiazepines and long term use?

A

dependance and tolerance.

restrict use to short term

45
Q

most common benzodiazepines and action?

A

Diazepam- rapid onset of action
slow elimination
= steady blood concs

46
Q

side effects of benzodiazepines

A

CNS depression

respiratory depression

47
Q

Examples of benzodiazepines?

A 
Alprazolam
Chlordiazepoxide
Clonazepam
Diazepam
Lorazepam
Oxazepam
Temazepam
48
Q

what is pregabalin and its effect at GABA a and GABA b receptors?

A

structural analogue of GABA

no clinical effect at GABAa or b

49
Q

how does pregabalin exert its effect?

A

Binds in a state-dependent manner to subunit of voltage-gated ca channels of ‘over excited’ pre-synaptic neurones
changes conformation of the channel

Reduces release of excitatory
neurotransmitters (glutamate,
substance P)

50
Q

what anxiety is pregabalin useful in?

A

Useful in GAD as a more long term option

than benzodiazepines.

51
Q

whats responsible for pregabalins long term: anxiolytic, anticonvulsant, analgesic effects?

A

reduction in stimulation of post synaptic neurones

52
Q

SSRIs: Role in what type of Anxiety

A

Long term treatment option for anxiety disorders

53
Q

how does response of SSRIs vary with use in anxiety vs depression

A

Response varies and less predictable than
when used for depression
Have broader anxiolytic effects

thus take care with licenced indications

54
Q

SSRIs mechanism of action

A

Increase serotonin by limiting its reabsorption
into the presynaptic cell

Low levels of serotonin are associated with
anxiety (and depression)

55
Q

examples of SSRIs?

A 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)
56
Q

Beta blockers: Role in Anxiety…

A

Used to manage/alleviate the physical symptoms eg:

palpitations, tremor, sweating, SOB

57
Q

Betablockers mechanism of action in anxiety

A

Reduce adrenaline which is produced as part
of the fight or flight response
 Useful in combination with CBT

help w rapid heart rate etc

58
Q

beta blockers- take care in parients with..?

A

Care in people with cardiac conditions as will
lower BP and HR

Can precipitate bronchospasm

59
Q

whats the recommended therapy for anxiety?

A

A combination of psychological and

pharmacological therapy is recommended

60
Q

when may benzodiazepines only be used?

A

only be used for

short term immediate relief of symptoms

61
Q

role of beta blockers in

A

Health.2 (19 decks)

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