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

Anxiety disorders and agents used to treat them Flashcards

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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?

Study These Flashcards
A

GABA-A receptors

25
A GABA A subunit alpha 1 when activated induce
sedative and amnestic effects
26
A GABA-A subunit alpha 2 when activated induce
anxiolytic effects
27
The only GABA A receptors that are sensitive to benzodiazepines are those with
benzodiazepine isoform known as benzodiazepine-sensitive GABA A receptors
28
How do benzodiazepine theoretically treat anxiety?
By reducing the amygdala output and enhancing the actions of inhibitory interneurons in CSTC circuits
29
All beneficial effects and most adverse effects result from what benzodiazepine function?
Depression of the CNS
30
How do benzodiazepines affect the limbic system?
reduce anxiety
31
How do benzodiazepines affect the cortical areas?
they promote sleep
32
How do benzodiazepines affect the supraspinal motor areas including the cerebellum?
muscle relaxation
33
How do benzodiazepines affect the hippocampus and cerebral cortex?
retrograde amnesia and confusion
34
What is the cardiovascular effects of benzodiazepines when taken orally? when taken IV?
Orally almost no effect. IV profound hypotension and cardiac arrest
35
In patients with normal respiratory function benzodiazepines cause respiratory issues when combined with
other CNS depressants
36
In patients with liver disease what are the preferred benzodiazepines?
oxazepam, temazepam, and lorazepam
37
What half life caution is important to know with benzodiazepines?
Some of those medications have a short half life but are converted into active metabolites with an extremely long half life
38
For a patient who needs help falling asleep what type of benzodiazepine would you prescribe?
one with a rapid onset like triazolam
39
For a patient who needs something because they wake up later in the night what type of benzodiazepine would you prescribe?
one with a slower onset estazolam
40
For a patient who is older what benzodiazepine is preferred?
one which is unlikely to accumulate with repeated dosing such as lorazepam
41
What are the major adverse effects of benzodiazepines?
CNS depression, anterograde amnesia, sleep driving, paradoxical effects, respiratory depression, abuse (lower potential), use in pregnancy/lactation (category D and X)
42
Death from overdose with oral benzodiazepines alone
has never been documented
43
What should NEVER be taken with benzodiazepines?
other CNS depressants
44
Discontinuation of a benzodiazepine?
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
What are the indications of an oral benzodiazepine overdose?
drowsiness, lethargy, confusion
46
What are the indications of IV toxicity of benzodiazepines?
life threatening reactions, profound hypotension, respiratory arrest, and cardiac arrest
47
What would the general treatment measures for an oral overdose of benzodiazepines?
gastric lavage, activated charcoal, saline cathartic, and dialysis
48
What reversal agent is used for benzodiazepines?
Flumazenil
49
For patients who do not respond to SSRIs/SNRIs or benzodiazepines what is great option either singly or in combination with these other medications?
Alpha 2 delta ligands (Gabapentin/Neurontin and Pregabalin/Lyrica)
50
Which medication category is used for GAD but not specific anxiety disorders?
benzodiazepines
51
Which medications are utilized for all anxiety disorders?
SSRIs
52
What is a useful way to incorporate benzodiazepines into treatment of those with GAD?
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
What are the first line treatments for Panic disorder?
SSRIs, SNRIs, buspirone, alpha 2 delta ligands
54
What are the second line treatments for Panic disorder?
benzodiazepines and tricyclic antidepressants
55
How many tablets do you give for rescue benzodiazepines?
only 3-5 tablets
56
What is the first line treatment for social anxiety disorder?
First line SSRIs, SNRIs, and alpha 2 delta ligands
57
What can be used for performance anxiety?
beta blockers
58
What is the first line treatment with post traumatic stress disorder?
SSRIs and SNRIs
59
What can be used to treat PTSD nightmares?
alpha 1 antagonist at night

NURS 7310 (15 decks)

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