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Psychiatry-M2 > Anxiety and Sleep Pharm > Flashcards

Flashcards in Anxiety and Sleep Pharm Deck (41):
1

How would you classify if a patient is suffering from acute anxiety/panic disorder or generalized anxiety disorder?

General Anxiety Disorder
- At least 1 month duration, constant worry about self and others, not correlated with any specific symptoms that indicate panic disorder.

2

What are physical symptoms of anxiety?

Increased Sympathetic Stimulation
- Sweating, Tachy, Palpitations
- Dry Mouth
- Frequent Urination
- Jitteriness and inability to relax

3

What receptor is most important in Benzo binding and functionality?

GABA-A Receptor

4

How do Benzodiazepines affect GABA receptor function?

Benzodiazepines -- bind to an allosteric binding site, which causes increased frequency/chance of opening of the GABA channel for the SAME amount of GABA
- sensitizes the channel to GABA

5

How do Barbiturates differ in function compared to Benzodiazepines?

- Barbiturates bind to a different allosteric site inducing the channel to state open LONGER per stimulation per GABA molecule.

6

What should you give a patient if you suspect they have overdosed on Benzodiazepines?

Flumazenil -- Benzo Receptor Antagonist

7

How does the GABA receptor typically function when activated by GABA?

- Opens allowing in Cl- hyperpolarizing the membrane making it more difficult to depolarize the membrane

8

What drug that is used for general anxiety syndrome, but does not involve the GABA receptor, while its a partial agonist of the 5-HT1A receptor (inhibiting adenylate cyclase) opening K+ channels.

Buspirone

9

What Benzodiazepines are primarily used for hypontic agents?

- Flurazepam
- Triazolam
(Lorazepam too, but not generally just for sleep)

10

What Benzodiazepam hypnotic agent is long acting agent?

-Flurazepam

11

What Benzodiazepam hypnotic agent is rapid acting with a very short half life primarily used to help fall asleep, not stay asleep?

Triazolam
- Alpha-Hydroxy-Triazolam active metabolite

12

How does Lorezepam and Flurazepam affect sleep, other than helping the patient sleep?

- Decreases Sleep Latency
- Increases Stage 1 / 2 Sleep, decreases Stage 3/4 Sleep
- Decreases REM sleep

13

What happens when there is abrupt withdrawl of sleep aids (Lorazepam) for sleep?

- REM Rebound
- Rebound Insomnia
- Deep Sleep Rebound

14

What are some adverse site effects of taking Hypnotic agents for sleep?

- Daytime Sedation
- Ataxia at night, increased risk of falls
- Rebound Insomnia
- Tolerance / Dependence
- Increased Death Rate

15

What hypnotic drugs have minimal effect on REM Sleep and preserve normal Stage 3-4 Sleep?

Zolpidem
Zaleplon

16

How do the Non-benzodiazepine hypnotic agents work, compared to Lorezapam?

Trick Question!
-- Both Bind the BDZ receptor of the GABA receptor, just Zolpidem/Zaleplon are not structurally related.

17

If you see a patient in the ED who consumed an entire bottle of Zolpidem intending on suicide, what can be given immediately to limited effects?

- Flumazenil
(BDZ Receptor Antagonist)

18

What hypontic agent affects Melatonin receptors and is primarily used to help patients who have difficulty falling asleep?

- Ramelteon
Melatonin MT1/MT2 Receptor Agonist

19

Which hypnotic agent acts in the same way as Zolpidem, but is thought to have limited likelihood of dependence and withdrawal?

Eszopiclone

20

What is the fast acting Barbiturate?

Secobarbital

21

How do Barbiturates illicit their effects?

They are lipid soluble, rapidly absorbed, that distribute to the brain quickly causing their effects, but terminated by redistribution.

22

If a GABA channel increases the amount of time the channel is open per activation, what might be the drug the patient is taking?

Phenobarbital
Secobarbital

23

What are the most concerning and worrisome side effects of Barbiturates?

- General CNS Depression w/ Respiratory Depression
- Cytochrome Induction changing metabolism
- Physical Dependence
- CV Effects in high doses
- Exacerbate Acute Porphyria (increased delta-aminolevulinic acid synthase)

24

What is the difference between Benzodiazepines and Barbiturates in regards to CNS Depression?

Barbiturates have a dose dependent action of CNS Depression and include Respiratory Depression

25

What drug has a very pungent taste that does not effect sleep stages as Benzos or Barbiturates?

Chloral Hydrate

26

What hypnotic drug antagonizes the Orexin Receptor (inhibits wakefulness usually stimulated by orexin)?

Suvorexant

27

What agents are most commonly used for muscle spasticity and relaxation?

- Diazepam
- Baclofen

28

What agent acts at the GABA-B receptor preventing release of excitatory transmitters (Glu) in the spinal cord?

Baclofen

29

How does diazepam work in the spinal cord to promote relaxation?

- Promotes GABA-induced presynaptic inhibition in spinal cord

30

What is the agent that agonizes Alpha-2 receptor in the spinal cord inhibiting presynaptic-post synaptic inhibition?

Tizanidine

- drowsiness, hypotension, dry mouth, and inhibits CYP1A2

31

How is Buspirone different from Benzodiazepines?

- Less Sedating
- No Cross Tolerance
- Takes several weeks to illicit a response in the patient

32

What might be a good pharmaceutical agent for occasional performance anxiety?

Beta-Blockers

33

What is the best way to stop treatment with Benzodiazepines?

- Gradual Dose Reduction
- Switch to longer acting Drugs

34

Does either Diazepam or Lorazepam cause a faster action?

Diazepam -- more lipid soluble

35

Which has an active metabolite Lorazepam or Diazepam?

Diazepam -- Oxazepam it is converted to for action
- rapid redistribution after single dose

36

Which is more lipophilic Lorazepam or Diazepam?

Diazepam -- faster absorption

37

What is a unique characteristic with IV Lorazepam administration?

- Retrograde Amnesia

38

What is key in differing Benzodiazepines from other CNS Depressants?

Does not effect the Respiratory Drive or CV, however is additive with other depressants that do such as:
- Ethanol
- Barbiturates
- Antihistamines

39

What should be given an Alcoholic when they are attempting to stop drinking and need to manage withdraw symptoms?

Chlordiazepoxide
- prevents seizures and withdraw symptoms in alcholics

40

What Benzodiazepine can be used to treat an ACUTE manic episode?

- Clonazepam

41

What is Alprazolam usually used for?

Fast Acting Effects
- Panic Disorder, etc