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Health.2 > Anxiety and Anxiolytics JB 🧠 > Flashcards

Anxiety and Anxiolytics JB 🧠 Flashcards

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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
what drugs prescribed to increase GABA levels?
benzodiazepines - give rapid relief of acute anxiety but have SEs or pregabalin - option in GAD
26
what drugs prescribed to increase Serotonin levels?
SSRIs, SNRI, TCAs, Buspirone
27
whats first line drug class for most anxiety disorders?
SSRIS- delay in effect
28
mechanism of action of benzodiazepines?
- 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
whats the most important NT in CNS?
GABA
30
whats neural activity in CNS regulated by? (2)
inhibitory activity- GABA | and excitatory NTs e.g. glutamate
31
whats are GABAa receptors and what do they control?
multimolec. complexes- control a Cl ion channel link and control specific binding sites for GABA
32
how many subtypes of rec do benzodiazepines bind to?
2 or more. combo of alpha 2 containing subtype mediates their antiepileptic effect alpha 1: antiamnesic effect
33
how are benzodiazepine receptors diff in patients with anxiety?
reduced receptors in key areas that regulate anxiety response
34
all benzodiazepines undergo heptic metabolism via... (2)
oxidation/ conjugation
35
the diff benzodiazepines available differ in... (2)
potency and rate of elimination
36
whats the absorption and membrane permeability of benzodiazepines like?
most: well absorbed orally and rapidly penetrate brain
37
how long does it take to get clinical effect of benzodiazepines via penetration in brain post oral admin?
within 30 mins
38
what patients is the oxidation of benzodiazepines increased in? why?
elderly patients w hepatic impairment DDIs alcohol
39
how are benzodiazepines metabolised?
in liver, CYP450
40
what may reduce levels of benzodiazepines?
enzyme inducers e.g. carbamazepine
41
what may increase levels of benzodiazepines?
enzyme inhibitors e.g. erythromycin, ciprofloxacin
42
clinical uses of benzodiazepines (actions)?
= immediate symptoms relief | CNS depressants- sedative, anxiolytic, amnesic, musclar relaxant, anticonvulsant actions
43
when are benzodiazepines most useful?
short term anxiety- fight/flight | need alternatives for long term
44
concerns with benzodiazepines and long term use?
dependance and tolerance. | restrict use to short term
45
most common benzodiazepines and action?
Diazepam- rapid onset of action slow elimination = steady blood concs
46
side effects of benzodiazepines
CNS depression | respiratory depression
47
Examples of benzodiazepines?
``` Alprazolam Chlordiazepoxide Clonazepam Diazepam Lorazepam Oxazepam Temazepam ```
48
what is pregabalin and its effect at GABA a and GABA b receptors?
structural analogue of GABA no clinical effect at GABAa or b
49
how does pregabalin exert its effect?
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
what anxiety is pregabalin useful in?
Useful in GAD as a more long term option | than benzodiazepines.
51
whats responsible for pregabalins long term: anxiolytic, anticonvulsant, analgesic effects?
reduction in stimulation of post synaptic neurones
52
SSRIs: Role in what type of Anxiety
Long term treatment option for anxiety disorders
53
how does response of SSRIs vary with use in anxiety vs depression
Response varies and less predictable than when used for depression Have broader anxiolytic effects thus take care with licenced indications
54
SSRIs mechanism of action
Increase serotonin by limiting its reabsorption into the presynaptic cell Low levels of serotonin are associated with anxiety (and depression)
55
examples of SSRIs?
``` Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil, Pexeva) Sertraline (Zoloft) ```
56
Beta blockers: Role in Anxiety...
Used to manage/alleviate the physical symptoms eg: | palpitations, tremor, sweating, SOB
57
Betablockers mechanism of action in anxiety
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
beta blockers- take care in parients with..?
Care in people with cardiac conditions as will lower BP and HR Can precipitate bronchospasm
59
whats the recommended therapy for anxiety?
A combination of psychological and | pharmacological therapy is recommended
60
when may benzodiazepines only be used?
only be used for | short term immediate relief of symptoms
61
role of beta blockers in

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