Week 4 Flashcards by Ryan Davis

What are the symptoms of anxiety disorders?

Tense

Irritable

Distracted

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What is the typically treatment for chronic, mild anxiety?

Not pharmacological

Relaxing activities like yoga help

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What are the symptoms of chronic moderately severe anxiety disorders?

Must have symptoms for over 6 months. May come and go a little but doesn’t completely go away.

Poor concentration

General tense feeling for no reason

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Is chronic moderately severe anxiety genetic or environmental?

Both

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What is the treatment for chronic moderately severe anxiety?

Anxiolytics - many are sedatives

Other therapy is also necessary - behavior modification and exercise.

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What are benzodiazepines?

They are sedative/hypnotics

Agonists on BDZ receptors (allosteric modulators of GABA A receptors)

Benzodiazepines arent the direct agonists, they are allosteric, which means they dont directly activate the receptor but they heighten the affinity of the receptor for its natural ligand.

Binds to chloride channels which allow them to open up which causes inhibition.

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Benzodiazepines have ___ effect on respiration. They are the ___ popular CNS depressants.

Little

Most

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Name six therapeutic actions of benzodiazepines

Anxiolytic

Treat seizures (because of increased GABA activity)

Diminish alcohol withdrawal

Treat insomnia (hypotonic - short acting)

Muscle relaxation

Often used a couple hours before surgical procedures for dental anxiety

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Are the sedative effects of benzodiazepines short acting or long acting?

Short acting (its a hypnotic)

Hypnotics - short acting

Sedative - long acting

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Although benzodiazepines are generally well tolerated, tolerance ___with long term use which can lead to ___ and withdrawal. Benzodiazepines act ___ with other depressants. It can cause ___, ___, and ____..

Increases

Addiction

Synergistically

Drowsiness

Motor impairment

Decreased cognition

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Some people (especially ___) have a ____ reaction to benzodiazepines. The ___ population, however, is more sensitive to the depressant effects. Don’t use benzodiazepines on people with ___ because it may lead to suicide.

Children

Paradoxical - This means that they anxiety is heightened and can make the children hyper.

Elderly

Intellectually disabilities or major depression

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Name two sedative benzodiazepines. What are their half lives?

Diazepam (Valium) - 20-100 hours

Alprazolam (xanax) - 6-12 hours

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Name two hypnotic benzodiazepines. What are their half lives?

Lorazepam (Ativan) - 6 hours

Triazolam (halcion) - 2 hours

These are used for sleeping medication.

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Name one benzo-like drug and describe it.

Zolpidem (ambien) - sleep aid. Short 2 hour half life. Less hangover effect. Doesn’t cause depression and abuse is not a concern.

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Other than benzodiazepines, what is another sedative/hypnotic drug used for the treatment of anxiety? How do these work?

Barbiturates

Enhance GABA

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Barbiturates are used ___-term for anesthesia induction (pentobarbital) and ___-term for seizures (phenobarbital). It can cause major ___ of respiration and tolerance. It can cause ___ addiction/dependence/withdrawal. It is not frequently used due to its ___ margin of safety. It has major interactions with the ___ and ___.

Short

Long

Depression

Major

Narrow

Liver

Drug interactions (tends to stimulate CYP450)

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What is propofol?

It is a barbiturate.

Used for general anesthesia (IV)

Fast induction and recover (short half life)

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What kind of a drug is buspirone (buspar)? What are its indications?

Barbiturate

Used for anxiety or tension associated with everyday stress.

Useful for treating anxiety with depression. Other anxiety drugs may make depression worse

Usually for short-term use

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Name four side effects of buspirone

Not particularly addicting

Rare movement problems or seizures

Irregular heart beat (rare)

Interacts with MAO-inhibitors or antiseizure medicines.

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What are the symptoms of a severe acute anxiety-panic attack?

Increased sympathetics

HR goes up

BP remains stable

Rapid breathing

Feels like a heart attack or in the middle of a fight or flight response.

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True or false… CNS sedatives/depressants have a strong effect with panic attacks

False

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What two drugs are effective in treating panic attacks?

SSRIs

Antidepressants with mixed effects (velafaxin)

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What drugs are used to treat phobic disorders?

SSRIs (Zoloft)

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About __% of people retain ADHD throughout adult hood. Others grow out of it.

50%

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About __% of children have ADHD. The M:F is __

10% 2:1 (M:F)

What are the symptoms of ADHD? (Predominantly hyperactive - impulsive

Difficulty with other children Act out Very impulsive cant focus

What are the symptoms of ADD? (Predominantly inattentive)

Less likely to act out May sit still but dont pay attention

Name two different drugs that are used to treat ADHD/ADD.

Amphetamines (adderall) Methylphenidate (Ritalin) Interestingly, these drugs are stimulants. Since ADHD kids' brains are wired differently, giving them these stimulants actually calms them down and allows them to focus. Remember that behavior modification is necessary. Drugs are just a crutch Medication usually starts when the child starts school

Name one non-stimulant used to treat ADHD?

Modafinil It's actually a minor stimulant

What are some properties and side effects of modafinil?

Fewer side effects (compared to ampethatmines and methylphenidate) Better tolerated Little abuse problem Side effects: minor headache, upset stomach, alters sleep

What is the mechanism for modafinil?

Perhaps DAT and/or NET blocker

Children with autism have problems with what three things?

Problems with social interaction Verbal or nonverbal communication Repetitive behavior

When is autism usually diagnosed? Is it caused by genetics, environment or both?

2-3 years of age. It is likely caused by both genetics and environment.

What are some potential causes for autism?

Children are born with a susceptibility to autism. No single trigger that causes it to develop Cluster of unstable genes interfere with brain development Problems during pregnancy or delivery

What gender is autism more prevalent in?

Males

True or false... treating autism early will lead to maximum benefit

True

___ or ___ may help with psychotic, aggressive or repetitive behavior associated with autism, however it doesn't affect the progression of the disease

Atypical antipsychotics SSRIs

What are the behavioral interventions that are necessary for autism?

Social skills Language Communication Play skills Daily living Motor skills

Eating disorders typically affect ___. ___% of adolescents have eating disorders

Females 1-2%

What are the symptoms of anorexia nervosa?

Relentless pursuit to thinness, Distorted body image, extreme restriction of eating. Osteoporosis Muscle wasting Damage to heart Infertility (messes up their endocrine system) Dry yellow skin Other symptoms of malnutrition Pts often use laxatives to get be lighter weight

What are the symptoms of bulimia?

Frequent bingeing and purging Usually normal weight (instead of trying to get skinny, they are trying to prevent getting overweight) Damage to esophagus Tooth damage Acid reflux and other GI problems Dehydration from purging Emotional turmoil/shame

What is the treatment and medication for bulimia?

Must get the behavior under control for treatment to be effective Supportive psychotherapy - (image counseling_ Medication: antidepressants such as fluoxetine This can be very difficult to treat

Define dependence

Persistent use resulting in adaptations typically accompanied by accommodation or tolerance (causing compensatory escalation) and withdrawal

Define drug addiction (substance abuse disorder)

A disorder of pathologic decision making. Expression of compulsive destructive behavior despite extreme negative consequences

We know that despite their many differences, virtually all abused substances enhance ____ activity in the ___ (particularly related to ___, ___, and ___ function). Other pathways also involved such as ___ and ___

Dopamine (neurotransmitter) Nucleus accumbens Pleasure, motor, and cognitive Glutamate and GABA

What are the functions that dopamine drugs affect?

Reward (motivation) Pleasure/euphoria Motor function Compulsion Perseveration Decision making

True or false.. drugs that affect dopamine pathways often also have a serotonin component

True

What are the functions that are affected by drugs that affect serotonin pathways?

Mood Memory Processing Sleep Cognition

Amphetamine alters dendrites and increases synaptic connections __fold

Two There are thousands of contacts along axons that interact with other axons. These blebs increase with drug activity. This will give the dopamine reward system a bigger role in decision making.

Describe the effect that the following drugs have and how they cause dopamine release.. ``` Opioid narcotics Nicotine Marijuana Caffeine Alcohol/sedative/hypnotics ```

Opioids - activate opioid receptors Nicotine - activate nicotinic receptors Marijuana - activate cannabinoid receptors Caffeine - blocks adenosine receptors Alcohol/sedative/hypnotics - activate GABA receptors; an inhibitory transmitter

How does cocaine and Ritalin work?

Blocks DA transporters so DA is not pumped back into the neuron. Leads to excess DA in the extraneuronal space

How do ampethamines, methamphetamines, MDMA (ecstasy), ephedrine, and bath salts affect DA?

They release DA from vesicles by reversing VMAT Reverse the DA transporter to pump DA out of the neuron into the extraneuonal space.

Which drugs have much greater activity than any other drug of abuse? (Causes neurotoxicity)

Amphetamines Amphetamines disrupt the control and maintenance of DA and kills the neurons, leading to increased chance of parkinsons

What are the 6 things that contribute to an effective anesthesia?

Hypnosis Analgesia Amnesia Autonomic stability Anxiolysis

Describe responsiveness of for the following levels of sedation.. Minimal sedation anxiolysis Moderate sedation/analgesia (conscious sedation) Deep sedation/analgesia General anesthesia

Minimal sedation anxiolysis: normal response to verbal stimulation Moderate sedation: purposeful response to verbal or tactile stimulation Deep sedation: purposeful response following repeated or painful stimulation General anesthesia: unarousable even with painful stimulus

Ether provides hypnosis, amnesia, and immobility, but lacks ___ and ___

Analgesia Autonomic stability

Describe stage 2 of anesthesia

Lack of inhibition. Everything kinda goes haywire, the patient squirms and moans. Patient wont be able to remember anything in stage 2. Once they reach stage 3, they are under anesthetic influence

For minor superficial surgery/biopsy, the patient should be put under ___ sedation by using ___ and ___. This provides...

Moderate Oral/parenteral sedatives and local anesthetics This provides conscious sedation... good anesthesia, relaxation, retain essential reflexes, responds to commands, quick recovery

___ is the most common induction agent in modern practice

Propofol

What are the mechanisms of CNS depressants?

Enhance GABA Decrease glutamate

Elimination of sedatives is dependent on...

Water solubility of hepatic bioactive metabolites

What is the difference between volatile and gaseous inhaled anesthesia in regards to vapor pressure and boiling points.

Volatile: low vapor pressure and high boiling points Gaseous: high vapor pressure and low boiling point

Describe the relationship between an inhaled anesthetic's solubility in blood and its ability to cross the BBB.

If it not very soluble in the blood it goes to the brain quicker.

Nitrous has __ solubility - ___ blood compartment Halothan has ___ solubility - ___ blood compartment

Low, small High, large

Define drug abuse.

Purposefuly taking illicit or illegal drugs. Includes using prescription of drugs given to you earlier for a different reason

DA is inhibitory with __ receptors and excitatory with ___ receptors. ___ recpetors do most of the reward part of it.

D1 D2 D2

Amphetamines can increase extraneuronal DA __ fold. Cocaine ___ fold. Nicotine __ fold. Alcohol __ fold.

Amphetamines 10-50 fold Cocaine 3 fold Nicotine 2 fold Alcohol 2 fold

Amphateamine users have a ___ fold increase in the incidence of parkinsons

3-10

~___% of people are prone to addiction across all drugs

10%

GWAS studies show that there is a genetic vulnerability for addiction. __-__% risk for drug abuse comes from genetics.

40-60%

Overlap of addiction and mental illness-difference in pattern dependent on age: youth more likely to have ___, older adults more likely to have depression

Conduct disorder Depression

Describe stage one of anesthesia

Light, antianxiety, reflexes OK and awake

Describe stage 2 of anesthesia

Moderate, conscious sedation, drowsy, respond to commands, quick recovery

Describe stage 3 of anesthesia

Pre-operative (BDZ) Induction with IV propofol or thiopentathol Maintenance with inhaled (volatile agents or NO2) or IV drugs (propofol or opioid analgesics or combined

___ is a benzodiazepine antagonist. It reverses effects for emergency or quick recovery after a procedure

Flumazenil

Volatile inhaled anesthetics are ___ at room temperature and sea level. Name some types of volatiles.

Liquids ``` Halothane Enflurane Isoflurane NO2 Ether ```

Nitrous has a __ gas partition coefficient. Halothane has a ___ partition coefficient.

Low High

Which has a more rapid induction and recovery, nitrous or enflurane?

Nitrous because it has a lower coefficient

Most modern inhaled anesthetics are eliminated by ___ not ___. What is an exception to this rule?

Ventilation Metabolism *although halothane does have hepatotoxic metabolites, so dont use in patients with liver damage

True or false... propofol can be used for sedation at lower doses or induction for general anesthesia

True

True or false. Propofol is an analgesic.

False. It is a hypnotic.

Propofol is used for __ duration procedures. It increases ___ activity. It ___ respiration.

Short GABA Depresses

Thipental is a short acting ____. It doesn't provide ___. It is anti-___. It causes ___ respiration. Avoid in intermittent ____. It is rapid induction and short-acting

Barbiturate Analgesia Antiseizure Reduced Porphyria

Benzodiazepines such as ___, ___, and ___, have a __ onset. They are ___ injections. They are given preoperatively for sedation. They provide good ___ but not good ___.

Midazolam, lorazepam, diazepam Rapid Painful Amnesia but not good analgesia

Ketamine is a dissociative ___. It is a ___ antagonist and causes some DAT inhibition. It has a ___ onset. Increases ___ blood flow. Causes nightmares in adults.

Analgesic NMDA Rapid CNS

Week 4 Flashcards

(85 cards)