Anxiety Disorders and Treatments Quiz

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Questions and Answers

What characterizes anxiety when it becomes an anxiety state?

An excessive and disproportionate reaction to situations (correct)

A universal emotion that needs no treatment

A pleasant emotion that enhances performance

An indication of extreme bravery

Which of the following is NOT classified as a primary anxiety disorder?

Generalized anxiety disorder

Hypothetical emotional disorder (correct)

Panic disorder

Obsessive-compulsive disorder

Which physical symptoms are commonly associated with severe anxiety?

Tachycardia and sweating (correct)

Excessive joy and laughter

Calmness and tranquility

Increased sleep and fatigue

What is the primary function of sedative-hypnotic drugs?

To reduce excitement and promote sleep Signup and view all the answers

Which drug category includes diazepam?

Benzodiazepines Signup and view all the answers

What type of anxiety disorder is characterized by repetitive behavior due to obsessive thoughts?

Obsessive-compulsive disorder Signup and view all the answers

Which of the following statements about sedatives and hypnotics is accurate?

Sedatives calm a person, while hypnotics induce sleep Signup and view all the answers

When anxiety symptoms do not warrant treatment, which level of anxiety is being described?

Mild anxiety Signup and view all the answers

What is a common effect of benzodiazepines (BZDs) on sleep?

BZDs reduce night awakenings. Signup and view all the answers

Which benzodiazepine is preferred for short-term management of panic disorders?

Alprazolam Signup and view all the answers

In high doses, benzodiazepines primarily act as muscle relaxants through which mechanism?

Increasing presynaptic inhibition in the spinal cord Signup and view all the answers

What is a critical consideration when prescribing BZDs for anxiety disorders?

They should be reserved for severe anxiety and short-term use. Signup and view all the answers

Which of the following benzodiazepines is associated with a higher risk of withdrawal and rebound insomnia?

Triazolam Signup and view all the answers

Which of the following conditions can diazepam help treat as an anticonvulsant?

Status epilepticus Signup and view all the answers

What is one of the reasons why long-acting benzodiazepines like flurazepam are rarely used?

They can lead to excessive daytime sedation. Signup and view all the answers

Which statement about the antianxiety effects of benzodiazepines is true?

They are less subject to tolerance than sedative and hypnotic effects. Signup and view all the answers

What is one of the uses of benzodiazepines in minor operative procedures?

Muscle relaxant properties Signup and view all the answers

What is a primary use of Flumazenil?

To reverse benzodiazepine overdosage Signup and view all the answers

What are common side effects of benzodiazepines?

Blurred vision Signup and view all the answers

Which of the following statements about Flumazenil is correct?

It is administered intravenously. Signup and view all the answers

What happens when long-acting benzodiazepines are withdrawn?

Symptoms are mild and slow in onset Signup and view all the answers

What adverse effect may occur when using Flumazenil in dependent individuals?

Precipitation of withdrawal symptoms Signup and view all the answers

What describes physiological dependence on benzodiazepines?

Unpleasant symptoms upon removal of the drug Signup and view all the answers

Which benzodiazepine is commonly used for treating alcohol withdrawal symptoms?

Diazepam Signup and view all the answers

What class of drugs have largely replaced barbiturates in clinical practice?

Benzodiazepines Signup and view all the answers

Which of the following is a known effect of barbiturates?

Can be lethal in overdose Signup and view all the answers

What effect occurs as a result of tolerance to benzodiazepines?

Decreased responsiveness to the drug Signup and view all the answers

What can be a side effect when benzodiazepines are administered to pregnant women during labor?

Hypotonia in the neonate Signup and view all the answers

What is the mechanism of action for barbiturates?

They enhance GABAergic transmission. Signup and view all the answers

What classification does Thiopentone belong to?

Ultra short-acting barbiturate Signup and view all the answers

What is a notable difference in the withdrawal symptoms between long-acting and short-acting benzodiazepines?

Long-acting withdrawal symptoms are more mild and slow Signup and view all the answers

Which of the following properties is true for barbiturates?

They induce physical dependence. Signup and view all the answers

Which subunit combinations of GABA receptors are primarily responsible for sedative and amnesic effects?

Two α1 subunits, two β2 subunits, and one γ2 subunit Signup and view all the answers

What is the primary mechanism of action of benzodiazepines at the GABAA receptors?

They increase the affinity of GABA for its binding site Signup and view all the answers

Which of the following effects is NOT associated with the activation of the α5 subtype of GABA receptors?

Anxiolytic effects Signup and view all the answers

What effect do benzodiazepines have on the duration of REM sleep?

Decreases the duration of REM sleep Signup and view all the answers

Which component of the GABAA receptor does zolpidem primarily bind to?

Between the α and γ subunits Signup and view all the answers

At low doses, which pharmacological action do benzodiazepines primarily exhibit?

Anxiolytic effects Signup and view all the answers

What is an expected consequence of benzodiazepines on the latency of sleep onset?

Decreases latency Signup and view all the answers

Which property is characteristic of the high doses of benzodiazepines?

Produces hypnosis Signup and view all the answers

What is the primary role of glucoronyl transferase in the body?

To metabolize and excrete excess bilirubin Signup and view all the answers

Which of the following is NOT an adverse reaction associated with certain CNS depressants?

Respiratory stimulation Signup and view all the answers

What type of drug interaction occurs when barbiturates are combined with ethyl alcohol?

Synergism Signup and view all the answers

Which of the following Z drugs is used for patients with long sleep latency?

Zaleplon Signup and view all the answers

What is a significant advantage of newer non-BZD anxiolytic agents over benzodiazepines?

Lesser incidence of dependence and tolerance Signup and view all the answers

What is the elimination half-life of Zolpidem?

2 hours Signup and view all the answers

Which of the following side effects is common with Zopiclone?

Metallic taste Signup and view all the answers

What withdrawal symptoms might occur with prolonged use of certain anxiolytics?

Anxiety and restlessness Signup and view all the answers

Study Notes

Sedative-Hypnotic Drugs

Sedative is a drug that calms a person, reducing excitement.
Hypnotic produces sleep-like normal sleep.
Sedative-hypnotic drugs in small doses are sedatives and in large doses are hypnotics.
Sedation and hypnosis are different degrees of CNS depression.

Anxiety

Anxiety can be a normal emotion and a psychiatric illness.
A certain amount of anxiety is helpful, acting as a stimulant and improving efficiency.
Excessive anxiety, disproportionate to the situation, becomes a pathological, disabling condition requiring treatment.

Anxiety Classification

Primary Anxiety Disorders:
- Generalized anxiety disorder (GAD): Apprehensive and tense with no specific reason.
- Panic disorder: Unexpected anxiety attacks.
- Phobic disorders: Fears of specific situations (e.g., agoraphobia).
- Obsessive-compulsive disorder (OCD): Repetitive behaviors or thoughts.
- Post-traumatic stress disorder (PTSD): After traumatic events (e.g., rape, warfare).
Secondary Anxiety Disorders: Caused by medical conditions or substances.

Anxiety and Anxiolytic Drugs

Anxiety is one of the most common mental disorders.
Anxiety is a state of tension, apprehension, or unease, stemming from known or unknown sources.
Physical symptoms of severe anxiety mimic fear, involving sympathetic activation (e.g., tachycardia, sweating).
Mild anxiety is a common life experience and usually doesn't need treatment.
Severe or chronic anxiety may be treated with anxiolytics (anti-anxiety drugs).

Classification of Sedatives and Hypnotics

Benzodiazepines (BZDs): Diazepam (Valium)
Barbiturates: Phenobarbital
Nonbenzodiazepine hypnotics: Zolpidem, zopiclone, zaleplon, eszopiclone
Others: Melatonin, ramelteon, suvorexant

Benzodiazepines

Widely used anxiolytics.
Replaced barbiturates in anxiety and insomnia treatment due to their perceived safety and effectiveness.
Although commonly used, they are not always the best choice.
Certain antidepressants (SSRIs) and non-benzodiazepine hypnotics may be preferable in some cases.

Pharmacokinetics of BZDs

Typically administered orally or intravenously (occasionally rectally in children).
Oral absorption is variable; intramuscular route less reliable.
Triazolam absorption is rapid.
High volume of distribution.
Short duration of action despite long elimination half-lives.
Metabolized in the liver; some undergo enterohepatic recycling.
Metabolites often have long half-lives, leading to cumulative effects.
Clorazepate is a prodrug.
Crosses the placental barrier.

Duration of Action of Benzodiazepines

Classified by duration of action as long-acting, intermediate-acting, and short-acting.

Mechanism of Action of BZDs

Bind to GABA A receptors, distinct from GABA-binding sites.
Potentiate GABAergic inhibition at all levels of the nervous system.
Enhance GABA's ability to open chloride channels, increasing frequency of channel opening.
Chloride entry into neurons leads to hyperpolarization, reducing neuronal excitability.

Pharmacological Actions of BZDs

Reduction of anxiety: At low doses, benzodiazepines are anxiolytics, working to selectively enhance GABAergic transmission.
Anterograde amnesia: Temporary memory problems are also associated with benzodiazepine use.
Sedative/hypnotic effects: Used as hypnotics in higher doses, reducing latency to sleep, increasing stage 2 NREM sleep duration while reducing REM and stage 4 NREM sleep duration.
Anticonvulsant: Reducing seizure activity (partially mediated by GABA A receptors.)
Muscle relaxant: High doses can relax skeletal muscles by increasing presynaptic inhibition in the spinal cord.

Uses of BZDs

Anxiety: Used in anxiety disorders including those associated with depression and schizophrenia, but generally not for everyday stress management. Longer-acting agents (clonazepam, lorazepam, diazepam) favored for prolonged treatment as they have less tolerance. Alprazolam for short- and long-term panic treatment.
Insomnia: Short-acting (triazolam) useful for falling asleep problems. Intermediate-acting (temazepam) helpful for frequent awakenings. Long-acting (flurazepam) rarely used due to extended half-life concerns; especially in the elderly due to the risk of accumulating the drug.
Muscular disorders: Diazepam to treat muscle spasms and spasticity.
Diagnostic procedures: Used intravenously for sedative-amnesic and muscle-relaxant effect.
Pre-anesthetic medication: Used in pre-op procedures to reduce anxiety and induce amnesia, often combined with other CNS depressants.
Alcohol withdrawal: Long-acting BZDs can help manage withdrawal symptoms.

Adverse Effects of BZDs

Generally well-tolerated; common side effects include drowsiness, confusion, amnesia, lethargy, weakness, blurred vision, ataxia, and impaired motor coordination.
Paradoxical irritability and anxiety can occur in some patients.
Tolerance and dependence potential less than barbiturates.
Withdrawal symptoms vary depending on the specific BZD and whether use is short-term or long-term. Withdrawal symptoms in short-acting benzodiazepines are more intense than in those of long acting.
Administration to pregnant women can pose risks to the developing fetus.

Tolerance and Dependence of BZDs

Chronic use leads to a decreased responsiveness to benzodiazepines.
Associated with a reduction in GABA receptor density.
Anti-anxiety effects may be less subject to tolerance than sedative/hypnotic effects.
Dependence can develop within weeks/months of continued use.
Physiological dependence: Removal evokes unpleasant symptoms opposite to the medication's effects.
Psychological dependence: Compulsion to use the drug and anxiety upon separation from it.

Benzodiazepine Antagonist (Flumazenil)

Competitive antagonist to benzodiazepines.
Reverses both benzodiazepine agonist (CNS depression) and benzodiazepine inverse agonist effects.
Not used orally due to high first-pass metabolism.
Administered intravenously for rapid onset of action useful for overdose.

Barbiturates

Historically principal sedative hypnotics/anesthetics.
Replaced by BZDs because of associated tolerance and harmful side effects.
Highly lethal in overdose.
Association with dependence and severe withdrawal symptoms.
Classified as ultra-short-acting (thiopental), short-acting (pentobarbital), and long-acting (phenobarbital).

Pharmacokinetics of Barbiturates

Usually well-absorbed orally.
Wide tissue distribution, high lipid solubility
Rapid onset of action.
Redistributed to adipose tissue, leading to short duration of action.
Metabolized and excreted in the urine.
Cross the placenta and may depress the fetus.
Potent inducers of microsomal liver enzymes.

Mechanism of Action of Barbiturates

Enhance GABAergic transmission by prolonging the duration of GABA-mediated chloride channel openings.
At high concentrations, can exert GABA-mimetic effect.
Possibly also have actions at glutamate receptors.

Pharmacological Actions of Barbiturates

CNS depression: Wide range of CNS effects. Sedation, hypnosis, amnesia, and respiratory depression.
Anesthesia: Used in high doses
Anticonvulsant: Reduced seizure activity in some cases
Respiratory system depression.
CVS: Hypnotic doses may cause slight decrease in BP and HR. Overdose can lead to significant decrease in these
Skeletal muscles: decreased excitability
Liver enzyme induction
Produces euphoria, which can lead to addiction potential.
Adverse reactions such as hangover, distortion of mood, impaired judgement/motor skills, excitement/irritability in children.

Therapeutic Uses of Barbiturates

Anesthesia (historically)
Anticonvulsant (status epilepticus, generalized tonic-clonic seizures)
Neonatal jaundice (as an enzyme inducer)

Adverse reactions of Barbiturates

Hangover due to residual CNS depression
Mood distortion
Impaired judgement and fine motor skills
Excitement/irritability in children
Respiratory depression (severe in patients with pre-existing respiratory issues), even in therapeutic doses.
Tolerance/dependence (more prominent than in BZDs)
Physical/psychological dependence, high abuse potential.
Withdrawal symptoms (anxiety, restlessness, hallucinations, delirium, convulsions).
Drug interactions (e.g., potentiates effects of alcohol).

Other Anxiolytic Agents

Newer, non-benzodiazepine agents (e.g., zolpidem, zopiclone, eszopiclone) have effects similar to BZDs, but with less risk of dependence.
Classified as non-benzodiazepine hypnotics.
Acts to bind to the GABA A receptor, facilitating inhibitory signal transmission.
Improved profile of side effects and less tolerance compared to BZDs. Useful in short-term treatment of insomnia.

Melatonin-Receptor Agonist

Melatonin is a hormone that regulates sleep-wake cycles.
Ramelteon is a melatonin receptor agonist.
Used orally for sleep-onset insomnia.
Increases total sleep duration without withdrawal problems.
Less likely to lead to tolerance, but fatigue and dizziness are possible side effects; prolactin elevation noted in some.
Used for non-24 hour sleep-wake cycle disorders in some patients.

Orexin Receptor Antagonist

Suvorexant blocks orexin receptors to prevent wakefulness.
Useful in chronic insomnia and narcolepsy.

Buspirone

Useful long-term treatment of Generalized Anxiety Disorder (GAD).
Slow onset of action makes it less helpful for acute anxiety.
Has a different mechanism of action than benzodiazepines; partial 5-HT1A agonist.
Lacks the anticonvulsant and muscle relaxant effects.
Mild side effects, low dependence potential.
Not suitable for acute anxiety treatment.
Appears safe in pregnancy.

Antidepressants

SSRIs and SNRIs can treat chronic anxiety disorders.
Often used in combination with benzodiazepines initially for patients with difficulty managing anxiety during the first week.
Antidepressant dose can be reduced after effectiveness is observed, and eventually benzodiazepine use can cease.

Antihistamines

Sedating antihistamines like diphenhydramine, hydroxyzine, and doxylamine are effective for mild insomnia.
However, they have undesirable effects (e.g., anticholinergic effects).
Commonly available over-the-counter.

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Description

Test your knowledge on anxiety disorders, their characteristics, and treatments. This quiz covers primary anxiety disorders, physical symptoms, and drug classifications. Answer questions about sedative-hypnotics and the levels of anxiety requiring treatment.