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21 Cards in this Set
- Front
- Back
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anxiety
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unrealistic, unfounded or inappropriate expression of fear and anxiety.
- inappropriate stress response via HPA (w/ or w/o stressor present) - amygdala (working with hippocampus) CPU of fear amy - hypotal - CRH - ant pit ACTH - adrenal cortisol |
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cortisol effects
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- loss of hippo plasticity
- memory function - can't shut off stress response, hippo atropy problems in depression, aging b4 demntia, PTSD |
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GABA
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always has normal inhib tonic tone - otherwise epilepsy
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Barbiturates
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Phenobarital & luminal
MOA: binds to barb site on B subunit - increases duriation of open channel - inhibits excitatory AMPA recp & other excit neurons - produce a gen. nonselective neuroal depression in CNS (increased GABA) - reduce anxiety, make sleepy Supresses REM - w/ withdrawl can cause rebound nightmares -depress respiration, INDUCE P450 |
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barbs - diff stages
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thiopental ~ short ~ IV anesthisa
pentobarbital ~ Intermed ~ surg anesttsia/sleep induction phenobarbital ~ long ~ prolonged sedation/seizure control |
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Barb's adverse
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+++ with alcohol
- slowed reflex, loss of Judgement - tolerance to the SEDATIVE effects but not to the adverse effects |
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Benzo's
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MOA: bind to benzo site and alters channel so that GABA binds more efficently,
- increases freq of Cl- channel opening (alcohol and barbz increase BZ binding to its site) - anti-anxeity, sedation - anti convulsants (CLONAZEPAM) no hyperanalegisa - decrease sleep onset time, decrease REM - cause retrograde amenisa - biotransformed in liver - tolerance to anti-anx, sedation |
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Benzo's - long acting
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Diazepam
chlordiazepoxide - active metabolites 20 + 60 |
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benzo's - intermediate
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alprazolam
lorazepam clonazepam 12-30 hours |
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benzo's short
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midazolam
tiazolam 2.5 hours |
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benzo's for elderly
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lorazepam
Oxazepam temazepam no actve metabolism |
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Benzo- use
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SHORT TERM
acute anxiety insomina amnesia ethanol or barbs detox FLUMAZENIL - BZ antag (blocks BZ's) |
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Benzo Adverse
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Impairment of motor ablilties
- higher suicide risk - abuse - cp450 metabolize extensively (grapefruit juice inhibits) - FEtal malformations ! |
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Buspirone - 2nd gen anxiolytics
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5-HT 1A agnoist
- may downregulate receptors if chronic use - onset takes weeks - good with CBT - helps with sexual dysfunction due to GAD - does not enchance alcohol - no abuse liablity |
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Disulfiram
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increases aldehyde by blocking aldehyde dehydrogensae
used for Alcoholics |
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Flumazenil
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competitive blocker of benzo receptor to benzo's + Z drugs
no effect on alcohol, barbs, or busirone |
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GAD screening
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During the past 4weeks, have you been worried, tense or anxious most of the time?”
“Are you frequently tense, irritable, and having trouble sleeping?” |
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Benoz's on sleep
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more time in light sleep (stage 2) then in 3 &4...less REM sleep
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Second gen hypnotic drus Z- drugs
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Zolpidem - Agnoist at GABA alpha 1 site.
onset 30 mins... should taper off use for 5 weeks greater 1/2 in hepatic insuff |
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Zaleplon
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can be used in mid night treatment (4 hours to awakening)
rapid onset Alpha 1 subunit - agnoist |
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Eszopiclone
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alpha 1 subunit
- half life hrs - LT USE - no tolerance, depend, or rebound insomnia - 6-12 mo effectivness |
