Learning module week 7 1st part (anxiety & sleep)

Limbic system

responsible for emotional expression, learning & memory

Hypothalmus

associtated w/ the autonomic nervous system and the fight or flight response

(in anxiety it activates the sympathetic nervous system and releases coricosteroids)

Reticular formation

• connected to the hypothalmus 

• stimulation of this system causes alertness/arousal

• inhibition causes drowsiness/induction of sleep

Reticular activating system (RAS)

part of the reticular formation, regulates the sleep-wake cycle

Cingulate gyrus

part of limbic system, resposnible for the fomraiton and proccesing of emotions

Locus Coeruleus

Releases norepinephrine during period of anxiety or stress to activate fight-or-flight response

Thalamus

Helps regulate consciousness, sleep, and alertness

Hippocampus

Maintains long-term storage of memory related to emotions

Amygdala

recognizes harmful stimuli and generates an emotional response such as anxiety or fear

Reticular formation

regulates which sensory signals reach the cerebrum; sleep and alertness

Acetylcholine

Both excitatory and inhibitory

Norepinephrine

Both excitatory and inhibitory

Serotonin

inhibitory

Dopamine

excitatory

Histamine

(H1, H2) excitatory

(H3) inhibitory

Gamma-aminobutyric acid (GABA)

inhibitory (Majority of postsynaptic inhibiton in the brain)

Glycine

inhibitory (Majority of postsynaptic inhibiton in the spinal cord)

Glutamate/asparate

Excitatory

Endorphins/enkephalins

Inhibitory

Substance P

excitatory

Vasoactive intestinal peptide 

excitatory

Types of anxiety disorders

• Generalized anxiety disorder

• Panic disorder

• Phobias (agoraphobia=fear of place or situation)

• Seperation anxiety

• OCD

• PTSD

What are somatic symptoms?

pDhsyical symptoms that a person experiences which may not have clear medical explanation but can be due to mental

Disorders associatted w/ excessive daytime sleepiness

• narcolepsy, Obstrutive sleep apnea, restless legs syndrome

sedative-hypnotic medication

drug w/ ability to produce a calming effect at lower doses & ability to induce sleep at higher doses

Anxiolytics

Drugs that have an ability to reduce anxiety symptoms by altering levels of 2 neurotransmitters: norepinephrine and serotonin

Commonly used classes for insomnia and anxiety

• Benzodiazepines: short term/ intermmediate-term

• Nonbenzodiazepine: buspirone (anxiolytics), Z-drugs (insomnia only)

• Antidepressants

• Barbiturates: rarely used

• First generation antihistamines

What do benzodiazepines do?

Bind to GABA receptors, enhancing GABA effects. (significant abuse potential)

Includes: alprazolam, diazepam, clonazepam, lorazepam

Benzodiazepines used for anxiety:

• Alprazolam (xanax),

• diazepam,

• clonazepam,

• Lorazepam (Ativan)

Benzodiazepines used for Insomnia:

• Temazepam

• Triazolam

• Estazolam

Reversal agent for benzodiazepines

Flumazenil

Which of the following drugs is
a benzodiazepine?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

Diazepam

What are the 3 types of antidepressants used to treat anxiety & insomnia?

SSRIs, atypical antidepressants, & tricyclic antidepressants

Hoe do SSRIs function as antidepressants? & examples

First line pharmacological treatment for anxiety & depression bc they don’t affect reuptake of noripeniphrine or dopamine so it’s not addictive & few side effects\

• Fluxetine

• Citalopram

• Escitalopram

• Paroxetine

• Sertraline

• Fluvoxamine

What are the atyplical antidepressants?

• Selective norepineprhrine reuptake inhibitors (SNRIs): duloxetine & venlafaxine

• Serotonin Modulator: trazodone 

What are the Tricyclic Antidepressants (TCAs)?

• Doxepin (FDA approved for insomnia at low dose)

• Imipramine

• amitriptyline

Which of the following drugs is a selective
serotonin reuptake inhibitor (SSRI)?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

Fluoxetine

Which of the following drugs is a serotonin
norepinephrine reuptake inhibitor (SNRI)?
Tricyclic Antidepressant?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

Venlafaxine

What are the non-benzodiazepine drugs?

Z-drugs, first generation antipsychotic drugs & hydroxyzine

Z drugs

GABBA receptors of the benzodiazepine-binding sites

FDA approved for insomnia:

• Zolpidem

• Zaleplon

• Eszopiclone

First generation antipsychotic drugs

• Hydroxyzine

• Busiprone

• Meprobamate

Hydroxyzine

non-selectively blocks central & peripheral histamine H1 receptors reffered to as first generation antihistamine—> no abuse potential

Antiseizure medications used for anxiety and insomnia

valporic acid

Beta blockers used for anxiety and insomnia

propranolol

Melatonin receptor drugs used for anxiety and insomnia

Ramelteon is a melatonin receptor agonist

Barbiturates used for axniety and insomnia

pentobarbital & phenobarbital- these drugs bind to and enhance activity of GABA

• Secobarbital

• Phenobarbital

• Addictive and overdosing issue

Which of the
following drugs are
FDA approved for
insomnia?
1.Diphenhydramine
2.Doxepin
3.Trazodone
4.Zolpidem

Doxepin and Zolpidem