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PT2 Psych 7-12 > anxiety and sleep disorder pharmacology > Flashcards

anxiety and sleep disorder pharmacology Flashcards

1
Q

fear

A

distressing emotional state aroused by current events perceived as dangerous and threatening, and aimed at immediate avoidance

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2
Q

anxiety

A

emotional state associated with apprehension in relation to anticipated events perceived as dangerous and threatening

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3
Q

anatomical pathway of fear generation

A

thalamus takes projections of what we see and relates them to potential dangers or threats, gets sent to amygdala, then lateral hypothalamus PAG resulting in manifestation of fear

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4
Q

2 neurotransmitters that regulate fear circuitry

A
  • serotonin from raphe nuclei

- NE from locus coeruleus

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5
Q

hypothalamus organizes hormonal changes to control

A
  • ANS
  • emotional and behavioral patterns
  • regulate eating and drinking
  • control body temp
  • regulate circadian rhythm and consciousness
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6
Q

region of hypothalamus that is a relay station for reflexes related to smell

A

mammillary region

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7
Q

region of hypothalamus that connects pituitary gland to hypothalamus

A

tubular region

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8
Q

region of hypthalamus that is superior to optic chiasm

A

supraoptic region

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9
Q

region of hypothalamus that is anterior to supraoptic region

A

preoptic region

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10
Q

function of periaqueductal gray

A

organizes autonomic and visceral responses related to fear and other processes such as pain

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11
Q

pathological anxiety

A

unrealistic, irrational fear or apprehension leading to function impairment based on cognitive bias to interpretation of environment

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12
Q

psychological symptoms of anxiety

A
  • restlessness
  • fatigue
  • sleep disturbances
  • difficulty concentrating
  • fixation on danger
  • decreased sex drive
  • irritability
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13
Q

physical symptoms of anxiety

A
  • dizziness
  • muscle tension
  • rapid breathing
  • heart palpitations
  • sweating
  • chest pain
  • N/D
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14
Q

generalized anxiety disorder definition

A

excessive and recurring anxiety for at least 6 months about various events and activities

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15
Q

GAD onset

A

> 20 typically

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16
Q

GAD symptoms

A
  • restlessness
  • fatigue
  • irritability and muscle tension
  • sleep disturbances
  • difficulty concentrating
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17
Q

panic disorder definition

A

characterized by recurrent panic attacks with persistent concern about panic attacks and their implications

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18
Q

how long must panic attack recur to be panic disorder

A

at least one month

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19
Q

agoraphobia

A

anxiety about being in places or situations form which escape might be difficult or in which help may not be available

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20
Q

panic disorder is often accompanied by

A

agoraphobia

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21
Q

specific phobias

A

clinically significant anxiety in response to specific objects or situations, for at least 6 months

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22
Q

specific phobias typical onset

A

early in life up to mid 20’s

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23
Q

social phobia

A

clinically significant anxiety in response to social performance, for at least 6 months (ex. public speaking)

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24
Q

social phobia typical onset

A

mid teens

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25
Q

obsessions

A

persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness and cause marked anxiety

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26
Q

examples of obsessions

A
  • contaminations
  • safety
  • doubting one’s memory
  • scrupulosity (fear of sinning)
  • need for order
  • unwanted, intrusive sexual/aggressive thoughts
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27
Q

compulsions

A

repetitive and rigid behavior or mental act that a person feels compelled to perform to reduce distress or anxiety

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28
Q

examples of compulsions

A
  • verbal/repetition compulsions
  • touching rituals
  • counting/repeating
  • cleaning/washing
  • checking
  • arranging objects
  • hoarding
  • seeking reassurance
  • list making
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29
Q

obsessive-compulsive disorder onset

A

6-15 in males

20-29 in females

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30
Q

obsessions are primarily due to alterations in

A

prefrontal cortex

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31
Q

compulsions are secondary to

A

striatal and accumbal activation which reduces the severity of obsession via indirect activation of the thalamus

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32
Q

management of OCD

A

serotonergic antidepressants

  • SSRI
  • clomipramine
  • possibly SNRI
  • behavior therapy
  • education
  • neurosurgery
  • deep brain stimulation
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33
Q

drug to avoid in treating OCD

A

bupropion because its lack and serotonin action and its pro dopamine action with make the OCD worse

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34
Q

post-traumatic stress disorder

A

maladaptive re-experiencing of an extremely traumatic event accompanied by avoidance of stimuli associated with the trauma

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35
Q

symptoms of increased arousal in PTSD

A
  • nightmares
  • anger outbursts
  • excessive startle
  • detachment and regressive behavior
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36
Q

cutoff for acute/chronic PTSD

A

3 months

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37
Q

acute stress disorder

A

symptoms similar to PTSD experienced during or immediately after the trauma (2 days up to 4 weeks)

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38
Q

symptoms of acute stress disorder

A
  • depersonalization and derealization
  • dissociative amnesia
  • sense of numbing, detachment, emotional unresponsiveness
  • persistent re-experiencing of trauma
  • marked symptoms of anxiety or increased arousal
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39
Q

stages of sleep

A

4 stages of sleep, one cycle from stage 1 to 4 and back to 1 ends with REM sleep;
About 4-6 cycles each night lasting about 90 minutes

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40
Q

non-rapid eye movement sleep

A

makes up about 75% of sleep and is divided into 4 stages
characterized by: decreased HR, BP, RR, temperature and tone
SLOW WAVE SLEEP

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41
Q

rapid eye movement sleep

A

make sup about 25% of sleep and is characterized by high frequency EEG, muscle atonia and dreams
FAST WAVE SLEEP

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42
Q

3 processes that regulate sleep

A
  • homeostatic
  • circadian
  • ultradian
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43
Q

homeostatic process in sleep

A

responsible for rise of sleep propensity during waking and its dissipation during sleep

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44
Q

circadian process in sleep

A

responsible for alteration of periods with high and low sleep propensity

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45
Q

ultradian process in sleep

A

alteration of the two basic sleep states NREM and REM during sleep

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46
Q

functions of sleep

A
  • evolutionary defense (amount is proportional to predatory pressure)
  • energy conservation
  • thermal regulation
  • detoxification/regeneration (neural connections in REM, anabolic processes to resupply)
  • consolidation of memory
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47
Q

who has the most slow wave sleep

A

people with high metabolic rates during the day, specifically infants

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48
Q

stages of REM sleep

A
  • tonic stage (muscle atonia)

- phasic stage (rapid eye movements, dreams)

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49
Q

dreams are fundamental for

A

retention and consolidation of affective memories or threat rehearsal (REM sleep is essential in maladaptive learning in depression and anxiety)

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50
Q

drugs that ablate REM sleep

A

antidepressants, especially MAOIs

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51
Q

4 parts of hypothalamus involved in sleep

A
  • suprachiasmatic nucleus
  • tuberomammillary nucleus
  • lateral hypothalamus
  • ventrolateral preoptic area
52
Q

suprachiasmatic nucleus role in sleep

A

works as switch for sleep/wake;

activated by light and melatonin

53
Q

tuberomammillary nucleus role in sleep

A

promotes wakefulness;

histaminergic neurons activated by glutamate, inhibited by GABA

54
Q

lateral hypothalamus role in sleep

A

promotes wakefulness through orexin neurons

55
Q

ventrolateral preoptic area role in sleep

A

promotes sleep through GABA neurons that inhibit tuberomammillary nucleus neurons

56
Q

melatonin and its role

A
  • serotonin derivative produced in pineal gland during darkness
  • enables action of suprachiasmatic nucleus
  • facilitates sleep through MT1 and MT2 receptors
57
Q

endogenous pacemaker for circadian rhythm

A

suprachiasmatic nucleus

58
Q

histamine in sleep

A
  • located in tuberomammillary nucleus
  • projects to most areas in brain
  • promotes wakefulness
59
Q

orexin

A
  • peptide that regulates arousal, wakefulness and appetite

- inhibits REM sleep

60
Q

location of orexinergic neurons

A

lateral hypothalamus and project to the cortex and most monoaminergic/cholinergic/histaminergic neurons

61
Q

orexin receptors are what type of receptor

A

GPCR

62
Q

dyssomnias

A

disorders of initiating or maintaining sleep, or excessive sleepiness and are characterized by the disturbance in the amount, quality or timing of sleep

63
Q

parasomnias

A

undesirable physical, experiential, or behavioral phenomena that occur only during sleep onset, during sleep, or during arrousals from sleep

64
Q

types of dyssomnias

A
  • insomnia disorder
  • hypersomnolence
  • narcolepsy
  • circadian rhythm sleep-wake disorders
  • restless legs syndrome
65
Q

insomnia

A

difficulty in initiating sleep or staying asleep, or waking up earlier

  • primary: due to high cortisol at night
  • secondary: due to anxiety or mental disorders
66
Q

symptoms of insomnia

A
  • nonrefreshing sleep
  • fatigue
  • mood disturbances, lack of motivation
  • daytime sleepiness
  • tension headache
67
Q

insomnia prevalence

A

33%

68
Q

insomnia male vs female

A

1:1.4 ratio

69
Q

nonpharm treatment for insomnia

A
  • normalize circadian rhythm through behavior
  • sleep hygiene
  • CBT
  • sleep restriction therapy
70
Q

narcolepsy

A

characterized by:

  • excessive daytime sleepiness with sufferers falling rapidly into 10-20 min episodes several times a day
  • night time wakefulness
  • cataplexy
  • hypnagogic and hypnopompic hallucinations
  • sleep paralysis
71
Q

treatments for narcolepsy

A

stimulants

modafinil

72
Q

neurobiology of narcolepsy

A
  • genetic alterations of HLA-DQB1 gene
  • reduction in orexin producing neurons, reducing REM sleep
  • emergence of REM sleep during wake period
73
Q

sedative drugs can also be used to treat

A

anxiety

74
Q

sedative drug general definition

A

drug that reduces nervousness, excitability and irritability

75
Q

hypnotic drug general definition

A

dug that calms or soothes the CNS to the point of causing sleep

76
Q

effects of hypnotic drugs on REM

A

initially shortens REM phases, but after repeated ingestion of hypnotics the proportion of REM vs NREM returns to normal

77
Q

benzos can be used for

A

sleep and anxiety

78
Q

barbiturates can be used for

A

sleep and anxiety

79
Q

z-drugs can be used for

A

sleep

80
Q

melatonergics can be used for

A

sleep

81
Q

orexin antagonists can be used for

A

sleep

82
Q

buspirone can be used for

A

anxiety

83
Q

benzodiazepines MoA

A

bind to a site between alpha and gamma subunits of GABA-A receptor, increasing the opening frequency

  • positive allosteric modulator*
  • GABA still required to open the channel*
84
Q

binding to alpha subunits in GABA-A in the amygdala causes what

A

alpha2 and 3 have anxiolytic/sedative action

85
Q

binding to alpha subunit in GABA-A in tuberomammillary nucleus and lateral hypothalamus causes what

A

alpha1 have hypnotic action

86
Q

3 benzos that do not form active metabolites

A

oxazepam
temazepam
lorazepam
safe for those with hepatic problems

87
Q

2-ketoBDZ drug features

A
  • long half life
  • pro drugs
  • oxidized in liver; slow metabolism
88
Q

2-ketoBDZ drugs

A

chlordiazepoxide
clonazepam
diazepam
flurazepam

89
Q

3-hydroxylBDZ drug features

A
  • short to intermediate half life

- does not form active metabolites; udnergoes rapid metabolism

90
Q

3-hydroxylBDZ drugs

A

lorazepam
oxazepam
temazepam

91
Q

triazoloBDZ drug features

A
  • shortest half lives (except alprazolam)

- oxidized in liver but limited active metabolites

92
Q

triazoloBDZ drugs

A

alprazolam
estazolam
triazolam

93
Q

benzo with longest duration

A

chlordiazepoxide

94
Q

benzo used in anesthesia

A

midazolam

95
Q

benzos used in anxiety

A

diazepam
clonazepam
alprazolam
lorazepam

96
Q

benzos used for sedation

A

lorazepam
temazepam
flurazepam

97
Q

benzo used for alcohol withdrawal

A

chlordiazepoxide

98
Q

long acting benzos

A

diazepam
flurazepam
clonazepam
chlordiazepoxide

99
Q

benzodiazepine side effects

A
  • CNS (sedation, drowsiness)
  • GI (dry mouth, constipation)
  • CV (hypotension/hypertension, arrhythmias)
  • hematologic (anemia)
  • GU (urinary retention, loss of libido)
100
Q

Benzo acute overdose

A
  • safe up to 30 times normal daily dose

- however, respiratory depression when using other CNS depressants like alochol

101
Q

benzo acute overdose couteraction

A

flumazenil and gastric lavage

102
Q

benzo dependence

A

alpha 1, 2, 3, 5 subunits in synapse all mediate phasic inhibition which predisposes for dependence

103
Q

common symptoms of benzo withdrawal

A 
jitteriness
anxiety
nightmares/insomnia
sweating
palpitations
nausea
confusion
104
Q

most worrisome symptom of benzo withdrawal

A

seizures which occur 5-7 days after abruptly stopping

105
Q

intensity of withdrawal symptoms is determined by

A

binding affinity of the benzo (lorazepam and alprazolam are high)

106
Q

benzos in pregnancy

A

they freely cross placental barrier; avoid in 1st trimester due to fetal abnormalities

107
Q

benzos in lactation

A

they are excreted in milk

108
Q

GABA-A anxiolytic drugs MoA

A

partial agonists of alpha 2 or 3 subunits in GABA-A causing sedation w/o dependence

109
Q

barbiturates MoA

A

binds to beta subunits of GABA-A; increasing duration of channel opening

110
Q

barbiturates side effects

A
  • CNS (somnolence, vertigo, anxiety)
  • GI (N, V, D)
  • CV (bradycardia, hypotension)
  • respiratory (respiratory depression)
111
Q

tolerance of barbiturates

A

-strongly induce synthesis and activity of CPY450 increasing rate of degradation of other drugs

112
Q

dependence of barbiturates

A

not frequently used as anxiolytic and hypnotic drug

113
Q

barbiturate overdose symptoms

A
  • consciousness change
  • respiratory depression
  • areflexia
  • low CO
  • paralysis of intestine
114
Q

barbiturate acute overdose treatment

A

there isn’t one

115
Q

zolpidem MoA

A

partial agonist of alpha-1 benzo site of GABA-A (also activates orexin causing hunger in the night)

116
Q

zolpidem tolerance

A

some risk but lower than benzo

117
Q

zolpidem antagnoist

A

flumazenil

118
Q

zaleplon and eszopiclone MoA

A

similar to zolpidem but less potent

119
Q

zaleplon half life

A

short so higher risk of early awakening

120
Q

eszopiclone half life

A

longer so higher risk of hangover effects

121
Q

ramelteon MoA

A
  • agonist of MT1 and MT2 receptors

- no GABA effects

122
Q

ramelteon side effects

A
  • dizziness
  • somnolence
  • fatigue
  • decreased testosterone
123
Q

buspirone MoA

A

potent partial agonist of 5HT1A

124
Q

buspirone use

A

anxiety only, not for panic attacks

125
Q

buspirone side effects

A
  • chest pain
  • tachycardia
  • palpitations
  • dizziness
  • GI distress
126
Q

suvorexant MoA

A

reversible dual antagonist of orexin receptors OX1 and OX2

127
Q

suvorexant use

A

insomnia, alteras REM sleep

PT2 Psych 7-12 (5 decks)

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