PCOL 10-1 Anxiety (sedatives, hypnotics and anxiolytics)

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Questions and Answers

Which neurotransmitter is involved in promoting wakefulness through the ARAS?

Dopamine (DA)

Norepinephrine (NAd) (correct)

Gamma-aminobutyric acid (GABA)

Serotonin (5HT)

What is the primary effect of adenosine on acetylcholine in the substantia innominate?

Modulation

Stimulation

Neutralization

Inhibition (correct)

Which of the following is NOT a treatment for insomnia that acts on GABA receptors?

Barbiturates

Histamines (correct)

Antihistamines

Z-drugs

What is the main difference between Z drugs and benzodiazepines?

Z drugs have a shorter half-life, leading to less daytime sedation. Signup and view all the answers

Maximum length of ongoing use of Benzodiazepines?

1 month Signup and view all the answers

What is the primary target of benzodiazepines in the treatment of insomnia?

GABA receptors Signup and view all the answers

How do benzodiazepines differ from barbiturates in terms of their effect on GABA receptors?

Benzodiazepines increase GABA receptor opening time, while barbiturates increase both opening time and frequency in the absence of GABA Signup and view all the answers

Which clinical effect is associated with benzodiazepine treatment for insomnia?

Hypnotic Signup and view all the answers

Which disorder is characterized by upregulated activity in fear disorders and may result from synaptic plasticity in amygdala circuits?

Post-traumatic stress disorder (PTSD) Signup and view all the answers

Which class of drugs is not recommended as a first-line treatment for anxiety due to their dependence liability and drowsiness?

Benzodiazepines Signup and view all the answers

Which benzodiazepine is suitable for treating Generalized Anxiety Disorder (GAD) due to its long half-life?

Diazepam Signup and view all the answers

Which neurotransmitter is exclusively released from the raphe nuclei and is influenced by SSRI’s?

Serotonin Signup and view all the answers

Which class of drugs is known for being slow-acting and sometimes causing difficult side effects, but is often effective as a treatment for anxiety and depression?

SSRI’s Signup and view all the answers

Which drug class would be trialled if SSRI’s are unsuccessful in treating anxiety?

SNRI’s Signup and view all the answers

Which anxiolytic drugs are preferred for their higher affinity to α2 and α3 subunits?

Alprazolam, Clonazepam Signup and view all the answers

Which anxiolytic drug class is known for having fewer side effects than others, but is slow-acting and sometimes causes difficult side effects?

SSRI’s Signup and view all the answers

Which neurotransmitter influences sleep, arousal, attention, sensory processing, emotion, and mood, and is exclusively released from the raphe nuclei?

Serotonin Signup and view all the answers

Which drug class is not suitable due to some α1 preference, making them unsuitable for targeting α2 and α3 subunits?

Z-drugs Signup and view all the answers

Study Notes

Neurotransmitters and Wakefulness

Adenosine promotes sleepiness by inhibiting acetylcholine release in the substantia innominata, promoting wakefulness through the Ascending Reticular Activating System (ARAS).

Insomnia Treatments

GABA receptor treatments include benzodiazepines and Z drugs; however, some options like melatonin are not GABAergic.
Z drugs differ from benzodiazepines in structure and pharmacokinetics but typically act on similar GABA receptor sites.

Benzodiazepine Use

Ongoing benzodiazepine use is generally limited to 2-4 weeks to avoid dependency.
Primary target for benzodiazepines in insomnia treatment is the GABA-A receptor, enhancing inhibitory neurotransmission.
Benzodiazepines modulate GABA receptors by increasing the frequency of channel opening, while barbiturates increase the duration of channel opening.

Clinical Effects and Disorders

Common clinical effects of benzodiazepines for insomnia include sedation and anxiety reduction.
Fear disorders show increased amygdala activity as a result of synaptic plasticity, impacting emotional regulation.

Anxiety Treatment Considerations

Benzodiazepines are not recommended as first-line anxiety treatments due to potential for dependence and sedation.
Diazepam is preferred for Generalized Anxiety Disorder (GAD) due to its long half-life.
SSRIs influence serotonin release from raphe nuclei, effective in treating anxiety and depression.

Alternative Treatments

If SSRIs fail, SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) may be considered as an alternative anxiety treatment.
Higher affinity anxiolytics target α2 and α3 GABA receptor subunits, leading to fewer side effects.
Anxiolytics with fewer side effects but slower onset may include selective drugs that target specific receptor subtypes for better efficacy.

Neurotransmitters in Emotion and Mood

Serotonin, released exclusively from the raphe nuclei, influences sleep, emotion, mood, attention, and sensory processing.
The drug class known for α1 preference may not effectively target α2 and α3 subunits, limiting their efficacy as anxiolytics.

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Description

Test your knowledge of sleep, arousal, sedation, and hypnosis with this quiz. Explore the different phases of sleep and the role of the ascending reticular activating system in promoting wakefulness. Delve into the effects of lesions in the anterior and posterior hypothalamus.