Block 2 Lecture 3 -- Anxiolytic and Hypnotic Drugs Flashcards Preview

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Flashcards in Block 2 Lecture 3 -- Anxiolytic and Hypnotic Drugs Deck (87)
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1

What is anxiety?

inappropriate worry in absence of a true threat that significantly impairs QoL.

2

Sxs of OCDs.

obsession
thoughts of murder + sex
hallucinations
fear to use public toilets

3

Sxs of social phobias.

fear of excessive humiliation
" public speaking
" public toilets

4

Sxs of mixed anxiety and depressive disorder.

-- anxiety
-- inner tension, depression
-- aggressiveness

5

Sxs of panic disorder.

-- fear of dying
-- fear of going
-- chest pain + SOB

6

How is GAD treated?

1st: CBT
2nd: anti-depressant
3rd: anti-depressant combos

7

What are the FDA-approved anti-depressants available for GAD treatment?

1st: SSRIs
-- es/citalopram, paroxetine, fluoxetine
-- +NET: duloxetine, venlafaxine
2nd: buspirone
also: hydroxyzine
also: combos, anti-convulsants
short-term: BZDs

8

What is hydroxyzine?

h1 antagonist

9

When is buspirone used in GAD?

2nd line as adjunct to SSRI or as monotherapy

10

Describe the onset of SSRIs

2-4 weeks

11

What happens if a GAD patient fails the 1st-line anti-depressant?

try another anti-depressant

12

What is agoraphobia?

avoidance of triggers evoking panic

13

How are agoraphobia and other anxiety disorders treated?

similar to GAD when chronic
-- anti-depressants (1+), buspar, combos
-- BZDs for exacerbations or agoraphobia
-- beta-blockers for acute panic

14

What drugs may cause secondary anxiety disorders?

1) NET/DAT-active anti-depressants
2) sympathomimetics
3) thyroid hormone
4) stimulants

15

What might anxiety disorders be secondary to?

1) medical conditions
2) drugs
3) drug withdrawal

16

For what conditions are barbs indicated?

1) induction of anesthesia
2) epilepsy
3) severe tension/migraine HA

17

MoA of barbs:

APLs of GABAa
-- increase duration of channel opening
-- synergistic with EtOH, BZDs, Z drugs, opioids

18

How does one become tolerant to barbs?

1) rapid PK (1a2, 2c9, 2c19, 3a4)
2) slow PD (decrease GABA # and change composition)

19

Why are barb withdrawals life-threatening?

convulsions

20

How are barbs categorized?

duration of action

21

ultra-short acting barbs:

methohexital
thiopental

22

What are ultra-short-acting barbs indicated for?

1) induction of anesthesia
2) terminal anesthesia

23

What are the intermediate-acting barbs?

1) pentobarbital
2) butalbital

24

What are the long-acting barbs?

phenobarbital

25

How is phenobarb used?

long-acting barb for anti-convulsant

26

How is butalbital used?

included with ASA/APAP and caffeine
-- w/ codeine for tension HA

27

What is the old lethal injection cocktail?

sodium thiopental, pancuronium br, KCl

28

What is the newer lethal injection cocktail?

hi-dose Na thiopental or pentobarbital

29

Where are alpha-1 containing GABAa receptors located?

most abundant, most widely distributed
-- also in VTA and HT
(hypnotic, anticonvulsant, amnestic, addiction)

30

Where are alpha-2 containing GABAa receptors located?

limbic, cortex, striatum (anxiolytic properties when agonized)