3. Anxiety/intro

Front 1

What is the duration of symptoms required for diagnosing generalized anxiety disorder?

Back 1

1 month

Front 2

What are 3 relatively common complications of anxiety disorders?

Back 2

-Alcohol abuse
-Sedative abuse
-Anti-anxiety med abuse

Front 3

What is the term Insomnia used to describe?

Back 3

Disorders of initiating and maintaining sleep.

Front 4

How many stages of sleep are there, and what is the normal order in which they occur?

Back 4

1, 2, 3, 4, 3, 2, REM

Front 5

What stages predominate
-Earlier in the night
-Later in the night

Back 5

Earlier = 3/4
Later = more REM

Front 6

What is the amplitude/duration of waves during the Awake state?

Back 6

-Low amplitude
-Rapid waves

Front 7

What is the lightest stage of sleep? What amplitude of waves is seen on EEG in this stage?

Back 7

Stage 1 - REM sleep
-Low amplitude

Front 8

What happens to the EEG waves' amplitude/speed as sleep progresses through deeper stages?

Back 8

Amplitude increases
Speed increases

Front 9

What are Stages 3/4 referred to collectively?

Back 9

Delta wave sleep

Front 10

How do drugs treat insomnia?

Back 10

By normalizing abnormal sleep patterns

Front 11

What NT is more important in slow wave sleep and NREM?

Back 11

Serotonin

Front 12

What NT's are more important in REM sleep?

Back 12

NE/ACh

Front 13

So what is Insomnia?

Back 13

A disorder of initiating and maintaining sleep

Front 14

What is hypersomnia? What is a common term for it?

Back 14

Excessive sleep/sleepiness
-Narcolepsy

Front 15

What type of receptor is the GABA-A receptor?

Back 15

Ligand gated ion (Cl) channel

Front 16

What type of receptor is the GABA-B receptor?

Back 16

A GPCR receptor

Front 17

What drug targets the GABA-B receptor?

Back 17

Baclofen

Front 18

What type of NT is GABA?

Back 18

An inhibitory neurotransmitter

Front 19

How is the action of GABA terminated?

Back 19

1. By active uptake mechanisms
2. By GABA transaminase

Front 20

What drugs act on the Ligand gated Cl channels that are GABA-A receptors?

Back 20

Benzodiazepines
Barbiturates

Front 21

What is the bottom line of the mechanism of Benzodiazepines?

Back 21

They enhance the effects of GABA at the GABA-A receptor

Front 22

How do Benzodiazepines enhance the effects of GABA at the GABA-A receptor?

Back 22

-Increase freq of Cl channel opening
-Increase the amt of binding of GABA to the GABA-A receptor

Front 23

How do the Benzodiazepines increase the degree of GABA binding to its GABA-A receptor?

Back 23

Through allosteric interactions between the 2 binding sites on the receptors

Front 24

How does increased opening of the Cl channel affect the nerve terminals at which GABA receptors are located?

Back 24

They become hyperpolarized and unable to transmit AP's and excitation.

Front 25

What drug can reverse the effects of Benzodiazepines?

Back 25

Flumazenil

Front 26

What is Flumazenil

Back 26

A pure antagonist of the benzodiazepine binding site on GABA-A receptors

Front 27

How do the Barbiturates mechanism of action compare to that of benzodiazepines?

Back 27

They do not increase the frequency of Cl channel opening, only increase the duration.

Front 28

How do inverse agonists of Benzodiazepine receptors affect the actions of BDZ's? What effect do they produce

Back 28

They block the actions of BDZ's and hence produce anxiogenic effects.

Front 29

Do we know what the endogenous agonist of the bzd receptor is?

Back 29

No - it could be anxiolytic or anxiogenic.

Front 30

Why have the benzodiazepines supplanted the barbiturates in being used for treating anxiety and insomnia disorders?

Back 30

1. Less likely to cause resp depression and death
2. Less addictive

Front 31

What are the 2 most important pharmacokinetic properties of benzodiazepines?

Back 31

-Lipophilicity
-Metabolism

Front 32

What benzodiazepine is very rapidly absorbed from the GI tract? Why?

Back 32

Diazepam - it is very lipophilic

Front 33

What else does lipophilicity determine?

Back 33

Rate of entry into the CNS

Front 34

What determines the duration of action of a benzodiazepine after a single dose?

Back 34

The rate of redistribution from the CNS

Front 35

So what is the duration of action of Diazepam after a SINGLE dose?

Back 35

Short

Front 36

Why does Diazepam often have long duration of effects?

Back 36

Because it is metabolized to an active metabolite with a very long half life, so that it builds up in the bloodstream.

Front 37

What 2 benzodiazepines do NOT have active metabolites?

Back 37

-Lorazepam
-Oxazepam

Front 38

So what is the onset and duration of action of lorazepam after a single dose?

Back 38

-Slow onset
-Longer duration than a single dose of Diazepam will have

Front 39

What are 7 important effects of Benzodiazepines to remember?

Back 39

ASHMAMA

Front 40

What is ASHMAMA?

Back 40

Anxiolytic
Sedative
Hypnotic
Muscle relaxation
Anterograde amnesia
Minimal CV/Resp depression
Anticonvulsant

Front 41

What type of administration most often results in Anterograde amnesia with BDZ's?

Back 41

IV infusion - during anesthesia

Front 42

How do the BDZ's produce their Hypnotic effects?

Back 42

-Decrease sleep latency
-Decrease the # of awakenings

Front 43

What benzodiazepine is used for its muscle relaxation effects?

Back 43

Diazepam

Front 44

pg 7

Back 44

ok