Which anxiety symptoms are “physical/sympathetic” targets for beta-blockers?
A: Tremor, sweating, palpitations (somatic symptoms).
Anxiolytics, Sedatives Hypnoti…
Most common anxiety disorders
gad, agoraphobia, panic
Which neurotransmitter system do benzodiazepines and z-drugs enhance to reduce anxiety/sedate?
GABA-A inhibitory signalling.
Which is key structure in brain to regulating fear and anxiety
Studies show that people show heightened ______ response to anxirty
amygdala
Chemical imbalances: norepinephrine,serotonin,dopamineandgamma-aminobutyric acid (GABA).
Evidence for the role of brain-derived neurotrophic factor (BDNF) in modulating neural plasticity in anxiety states . i.e, down regulation of BDNF is found in anxiety states
why is there considerable overlap between anxiolytic sedative and hypnotic
Duh
Dose–response: increasing CNS inhibition → calming → sedation → sleep induction.
duh
Q: In GAD, where do benzodiazepines sit in stepped care?
A: Short-term option (not long-term first-line), while SSRIs !!!!! are the first-choice drugs in the same Step number 3
What receptor do benzodiazepines modulate, and what is its fast inhibitory ion?
GABA-A receptor; increases chloride (Cl⁻) conductance → neuronal inhibition.
Benzos are an agonist for GABA A what other things enhance its activity
Z drugs
Barbiturares
Alcohol
Benzodiazepines bind where on GABA-A and do what type of modulation
: What functional effect do benzodiazepines cause at the channel level?
A: Bind γ (gamma) subunit; positive allosteric modulation
benzos Increase frequency of channel opening → ↑ Cl⁻ influx → ↓ action potential firing.
Q: List the key clinical effects you must anticipate/counsel for benzodiazepines. important
A: Sedation, hypnosis (higher dose), anterograde amnesia, anxiolysis, anticonvulsant activity, reduced skeletal muscle tone.
SUPREMELY IMPORTANT
WHAT are the indcatons and time limits of benzodiazepine
Indicated for SHORT TERM RELIEF from SEVERE anxiety and INSOMNIA
what are z drugs? whats their indication
short term insomnia use
: Why choose a short-acting BDZ (e.g., temazepam) for insomnia, to act as a hypnotic (sleep inducing)
They are rapidly absorbed by the gut = fast sedation = short duration of morning ‘hangoer’ , -(by using drugs metabolized y inactive compounds)
why are the anxiolytic properties of beznodiazepines best used with a compound of a long duration
smaller dose is used for less sedation, long duration reduces rebound anxiety between doses seen w short acting doses
very important
Main adverse effect risk of long-term benzodiazepines?
Q: Who is at higher risk of benzodiazepine dependence/withdrawal problems?
Dependence with physical + psychological withdrawal.
Personality disorders; prior alcohol/drug dependence; high doses.
common benzo wthdrawal symptoms?
Q: Severe withdrawal features (rare but serious)?
A: Anxiety (most common), insomnia, depression, perceptual sensitivity (noise/light/touch).
A - A: Psychosis or convulsions (rare)
Q: How should long-term benzodiazepines be stopped?
What prescribing rule reduces dependence risk?
Q: How should long-term benzodiazepines be stopped?
A: Gradual withdrawal over ~4–8 weeks; sometimes full withdrawal can take up to 1 year
A: Restrict to ≤4 weeks where possible.
also bzds are drvng rskk
benzo overdose ???
FLUMAZENL
barbiturate mechanism ? whats it the same as
Q: Barbiturates MOA at inhibitory and excitatory receptors?
same moa as benz ut diff binding sites
A: Potentiate GABA-A and inhibit AMPA receptors.
How are barbiturates “similar but different” to benzodiazepines?
A: Same overall pathway (enhance GABA-A), but different binding site
: Why were barbiturates largely replaced by benzodiazepines?
A: Safety (narrower safety margin; more dangerous in overdose/with interactions) — hence rarely used as anxiolytics/hypnotics now
Any remaining barbiturate uses to recognise?
A: Intermediate-acting: only in severe intractable insomnia in patients already taking barbiturates (avoid elderly). Phenobarbital: still useful in epilepsy (sedative use unjustified). Thiopental: anaesthesia.
whagts a barbturate stll used
Very short acting barbituate thiopental sodum used for anaesthesa
