Anxiolytics and Hypnotics

Question 1

Anxiety disorders types

Answer 1

Panic disorders
Phobias
Social anxiety disorder
Generalised anxiety disorder

Question 2

Stress disorder

Answer 2

PTSD

Question 3

OCD symptoms

Answer 3

Thoughts a terrible event will occur, need for perfection with repetitive ritualistic behaviour

Question 4

Sleep disorder types

Answer 4

Insomnia:
transient - noise/shift work/jet lag
Intermediate - illness/emotional episode
Chronic - psychiatric disorder

Question 5

Anxiety and stress disorder treatments aim to

Answer 5

increase inhibition in limbic system as these are associated with increased glutamatergic activity

Question 6

BDZ MOA

Answer 6

Binds to BDZ receptor on GABA-A receptors, potentiates GABA action and more chloride passing through

Question 7

BDZ SE

Answer 7

Drowsiness
Agitation
Ataxia
Addiction
Interact with depressants

Question 8

BDZ uses

Answer 8

Short term anxiety e.g. bereavement

Sedation/amnesia so traumatic awake surgical procedures

Question 9

BDZ antagonist

Answer 9

Flumazenil short duration of action, used to reverse benzo activity

Question 10

Midazolam duration and uses

Answer 10

4 hr

Amnesic, pre-med surgery e.g. endoscopy

Question 11

Lorazepam, oxazepam, temazepam duration and uses

Answer 11

15 hr

Anxiolytic, hypnotic

Question 12

Alprazolam, nitrazepam duration and uses

Answer 12

24 hr

Anxiolytic, panic attacks

Question 13

Chlordiazepoxide, diazepam duration and uses

Answer 13

48 hr
Anxiolytic, muscle relaxant
Diazepam is anticonvulsant

Question 14

Clonazepam, Flurazepam duration and uses

Answer 14

60 hr

Anticonvulsant, anxiolytic

Question 15

flunitrazepam use

Answer 15

Roofies, rohypnol

Question 16

Z drugs use

Answer 16

Zolpidem, zopiclone, zaleplon and eszopiclone preferred as hypnotics
Pagoclone, suproclone used as anxiolytic

Question 17

Z drugs MOA

Answer 17

Zolpidem, zopiclone, zaleplon act at BDZ binding site but not BDZ

Question 18

Natural anxiolytics

Answer 18

Neurosteroids derived from progesterone/corticosterone such as allopregnanolone made in neurones and GABA cells
Diazepam binding inhibitor protein, binds at BDZ site in thalamic reticular nucleus

Question 19

Serotonergic system and anxiety

Answer 19

5HT1A receptors are inhibitory auto receptors, when activated reduces 5HT and increases anxiety

Question 20

Buspirone treatment MOA

Answer 20

Partial 5HT1A agonist, acutely causes less 5HT release but eventually desensitises receptors and lots of 5HT released after a few weeks

Question 21

Beta blockers MOA

Answer 21

Propranolol reduces physical manifestations of anxiety e.g. sweating, tremor, tachycardia by blocking beta-2

Question 22

Anti-depressants used in anxiety

Answer 22

SSRIs (fluoxetine, paroxetine) and SNRIs (venlafaxine, duloxetine) used in GAD, SAD, PTSD, phobias

Question 23

Anti-convulsants used in anxiety

Answer 23

Ca channel blockers (gabapentin, pregabalin), GABA uptake blocker (tiagabine) and GABA metaboliser (valproate) used for GAD

Question 24

Anti-psychotics used in anxiety

Answer 24

D2 antagonist (olazapine, linked to Gi so inhibits adenylate cyclase) and risperidone used for GAD, PTSD

Question 25

Chlormethiazole use

Answer 25

Hypnotic which potentiates GABA receptors, used for elderly as no hangover effect which could cause confusion/falls Is a barbiturate

Question 26

Advice for hypnotic use

Answer 26

short term treatment preferred tolerance develops over 2 weeks withdrawal over a few weeks, rebound insomnia, vivid dreams

Question 27

Barbiturates MOA

Answer 27

Thiopental, amylobarbitone, secobarbital, butobarbital, phenobarbitone, clomethiazole acts via GABA-A receptor even in absence of GABA

Question 28

Barbiturates use

Answer 28

no longer used, except sometimes as anticonvulsants (phenobarbital) and even more rarely as anaesthetic (thiopental)

Question 29

Barbiturates SE

Answer 29

Resp depression Easy to OD so natural antagonists Dependence

Question 30

Meprobamate use

Answer 30

No longer used as less potent than BDZ but more toxic

Question 31

Non-prescription anxiolytics/sedatives

Answer 31

Antihistamines (diphenhydramine, promethazine) | Valarian extract potentiates GABA receptor function