Mock test for Anxiety Flashcards by Zeigh Inoue

2 Types of ion channels

Voltage-gated channels
Ligand-gated channels

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2 types of neurotransmitter

Ionotropic receptors
Metabotropic receptors

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EFFLUX OF K,
INFLUX OF CL-, CHANGE IN
CELLMEMBRANE POTENTIAL

HYPERPOLARIZATION

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INFLUX OF NA AND CA–
CELL BECOMES POSITIVE

DEPOLARIZATION

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EPSP stands for ?

Excitatory post-synaptic potential

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IPSP stands for ?

Inhibitory postsynaptic potential

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opens Na or Ca channels/ influx -> depolarization
(more positive) -> nerve impulse

Excitatory neurotransmitters

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Excitatory neurotransmitters examples:

Norepinephrine, Dopamine, Acetylcholine,
Glutamate, Aspartate (NAGDA)

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opens Cl channels -> hyperpolarization (more
negative) -> no nerve impulse

Inhibitory neurotransmitters

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Inhibitory neurotransmitters examples:

glycine, gamma-aminobutyric acid (GABA)

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Blocks Na channel from outside toxin?
source: Puffer fish

Tetrodotoxin (TTX)

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Slows inactivation, shifts activation of Na channels?
source: Colombian frog

Batrachotoxin (BTX)

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blocks “small Ca-activated” K channel
source: Honeybee

Apamin

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blocks “big Ca- activated” K channel
source: Scorpion

Charybdotoxin

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Blocks N-type channel in Ca+ channel
Source:Pacific cone snail

Omega conotoxin
(ω-CTX-GVIA)

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Blocks P-type channel in Ca+ channels
Source: Funnel web spider

Agatoxin (ω-AGA-IVA)

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The irreversible antagonist of Nicotinic ACh
receptor (Ligand-gated)
Source: Marine snake

α-Bungarotoxin

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Blocks channel in GABA a receptor?
Source: South Pacific plant

Picrotoxin

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Competitive antagonist in Glycine receptor
Source: Indian plant

Strychnine

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Blocks channel in AMPA receptor
Source: Wasp

Philanthotoxin

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AMPA stand for ?

a-Amino- 3- hydroxy- 5- methylisoxazole- 4 proprionic acid

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is an emotional state commonly caused by the
perception of real or potential danger that
threatens the security of an individual

anxiety

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recurrent unexpected panic
attacks that can occur with agoraphobia in which
patients fear places in which escape might be difficult.

Panic disorder

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intense fear of particular objects
or situations (e.g. snakes, heights);most common
psychiatric disorder

Specific phobia

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intense fear of being scrutinized in social or public situations (e.g., giving a speech, speaking in class).

Social phobia

intense pervasive worry, over virtually every aspect of life

Generalized anxiety disorder

persistent reexperience of a trauma, efforts to avoid recollecting the trauma, and hyperarousal

Post-traumatic stress disorder

recurrent obsessions and compulsions that cause significant distress and occupy a significant portion of one’s life

Obsessive-compulsive disorder

usually, accompanied by symptoms of anxiety?

tachycardia, palpitations, tachypnea, sweating, trembling and weakness

a. restlessness b. fatigue c. difficulty in concentrating d. irritability e. muscle tension f. sleep disturbance symptoms in ?

Generalized anxiety disorder (GAD)

Palpitations or tachycardia Sweating Trembling or shaking Sensations of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distress Dizziness, unsteadiness, lightheadedness Derealization or depersonalization Fear of losing control Fear of dying Paresthesia Chills or hot flushes Diagnostic criteria for ?

Panic disorder or Panic attack

At least ______ of the following symptoms developed abruptly and reached a peak within ______

least four (1) 10 minutes (2)

Fear of losing control Fear of dying or being detached from your environment.

Derealization or depersonalization

Chills or hot flushes or burning sensation

Paresthesia

Goals of Therapy:

to reduce the severity, duration and frequency of the anxiety symptoms ▪to improve the patient’s overall functioning ▪to prevent anxiety symptoms ▪to improve quality of life

Nonpharmacologic Therapy

Short-term counseling Stress management Psychotherapy - for encouragement Meditation Exercise Avoidance from caffeine, nonprescription stimulants and diet pills

calming effect but did not induce sleep

Sedative drugs

Minor tranquilizers , induce drowsiness and sleep

Hypnotic drugs

most widely used anxiolytic and drug of choice in GAD MOA: Increase frequency of chloride channel opening enhancing membrane hyperpolarization

benzodiazepines

Short-acting (2-8 hrs) BZD

Oxazepam (Serax) Triazolam (Halcion) Clonazepam (Klonopin, Rivotril) Midazolam (Versed, Dormicum) Temazepam (Restoril)

Intermediate-acting (10-20 hrs) BZD

Lorazepam (Ativan) Alprazolam (Xanax, Xanor) Temazepam (Restoril) Flunitrazepam (Rohypnol)

Long-acting (1-3 days)

Diazepam (Valium, Anxionil) Flurazepam(Dalmane) Chlordiazepoxide (Librium)

Anxiety BZD

Alprazolam, diazepam

Seizures BZD

diazepam, clonazepam, lorazepam

Insomnia BZD

flurazepam, midazolam

pre-operative sedation BZD

midazolam

metabolite of benzodiazepines ?

N-desmethyldiazepam (N-DMDZ),

active metabolite with a long elimination t1/2 of more than ____.

40 hours

ABSORPTION and DISTRIBUTION: BZD § Absorbed ____ following oral administration § Cross the___, ____ barrier § Secreted in ____

rapidly (1) BBB (2) placental (3) milk (4)

for IV anesthesia BZD

Diazepam and lorazepam

Anticonvulsant BZD

Clonazepan, Nitrazepam, Lorazepam, Diazepam

lost of coordination like muscle control, balance and trouble in walking

Ataxia

loss of the ability to create new memories after the event that caused the amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories before the event remain intact.

Anterograde amnesia

§ Decreased responsiveness to a drug following repeated exposure § Result in the need for an increase in the dose required to maintain symptomatic improvement or to promote sleep

Tolerance

An altered physiologic state that requires continuous drug administration to prevent abstinence or withdrawal syndrome

Dependence

Treat for BZD withdrawal symptoms

Diazepam ▪ -can be initiated as loading dose (40% of daily consumption), followed by a daily tapering of 10%. § Clonazepam ▪ -an alternative agent § Phenobarbital ▪ for mixed Bzd and alcohol dependence.

treatment for Benzodiazepine poisoning A benzodiazepine antagonist § GABA receptor antagonist

Flumazenil (Anexate)

additive effect; lowers the therapeutic index of BZD

Alcohol + BZD

Synergism of adverse sedative effects

CNS depressants + BZD

Respiratory suppression and death

Lorazepam + Clozapine

inhibition of BZ metabolism

Cimetidine + BZD

§ increased alprazolam concentrations.

Nefazodone/Fluvoxamine

§ increased alprazolam concentrations.

Nefazodone/Fluvoxamine

- former DOC for anxiety, insomnia MOA:s increase the duration of GABA-mediated chloride ion channel opening

barbiturates

Ultra-short (20 min)

Thiopental (Pentothal)

Short-acting (3-8 h)

Pentobarbital (Nembutal) Amobarbital (Amytal)

Long-acting (1-2 d):

phenobarbital (Luminal)

Intermediate-acting

amobarbital, butabarbital

induction of anesthesia BAR

Thiopental

seizures in children BAR

Phenobarbital

anxiety-BAR

Pentobarbital, Amobarbital

is capable of inducing the hepatic microsomal drug-metabolizing enzyme system(P-450)

Phenobarbital

bind selectively to GABAA receptor isoforms that contain α1 subunits to enhance hyperpolarization used in sleep disorders

Eszopiclone (Lunesta ™) § cyclopyrrolone Zaleplon ( Sonata ™) § pyrazolopyrimidine Zolpidem (Ambien™) § Imidazopyridine

Melatonin Receptor Agonist MOA: Activates MT1 and MT2 receptors in suprachiasmatic nuclei in the CNS Rapid onset of effect with minimal rebound insomnia ¡ Used with caution in patients with liver dysfunction Metabolized by CYP1A2

ramelteon (rozerem)

drug interaction of ramelteon :

CYP1A2 inhibitors (Ciprofloxacin, Fluvoxamine, Tacrine, Zileuton) and Rifampin

azapirone anxiolytic § Possess no anti-convulsant, muscle relaxant, hypnotic, motor impairment and dependence properties alternative for GAD The agent of choice in the management of chronic, persistent anxiety. ¡ It is not cross-tolerant with BZs and will not treat or prevent symptoms of BZ withdrawal It is an appropriate choice for anxious patients with a history of alcohol or drug abuse

buspirone.

useful in patients with prominent cardiovascular symptoms of anxiety they are less effective anxiolytics than BZs,

Propranolol and other beta-blockers

Accumulate with the nightly administration of the drug Associated to MICKEY FINN ¡ Trichloroethanol – active metabolite ¡ Trichloroacetic acid – toxic metabolite

CHLORAL HYDRATE

Diphenhydramine (Benadryl), doxylamine (Unisom), hydroxyzine (Atarax, Iterax)

Antihistamines

not a Bz but acts on Bz receptor

Zolpidem (Ambien, Stilnox)