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2024 NR546 MIDTERM EXAM WITH CORRECT ANSWERS
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2024 NR546 MIDTERM EXAM WITH CORRECT ANSWERS
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2024 NR546 MIDTERM EXAM WITHCORRECT ANSWERS
autonomic and cardiovascular responses are mediated by: - CORRECT-
ANSWERSconnections between the amygdala and the locus coeruleus, home
of the noradrenergic cell bodies
-When autonomic responses are repetitive, inappropriately or chronically
triggered as part of an anxiety disorder, this can lead to increases in
atherosclerosis, cardiac ischemia, hypertension, myocardial infarction, and
even sudden death
The known neurobiological regulators of the amygdala: - CORRECT-
ANSWERSneurotransmitters GABA, serotonin, norepinephrine, and the
voltage-gated calcium channels
-known anxiolytics act upon these same neurotransmitters hypothetically in
order to mediate their therapeutic actions
neurotransmitters and regulators that modulate CSTC circuit - CORRECT-
ANSWERS-serotonin
-GABA
-dopamine
-norepinephrine
-glutamate
-voltage-gated ion channels
Excessive amygdala activity is theoretically reduced by: - CORRECT-
ANSWERSbenzodiazepines
-enhance phasic inhibition of GABA (γ-aminobutyric acid) by positive
allosteric modulation of postsynaptic GABA receptors
-blunt fear-associated outputs
modulate excessive output from worry loops - CORRECT-
ANSWERSbenzodiazepines
-enhancing the actions of inhibitory interneurons in CSTC circuits
-reduce symptoms of worry
also known as α2δ ligands since they bind to the α2δ subunit of presynaptic
N and P/Q VSCCs, block the release of excitatory neurotransmitters such as
glutamate that occurs when neurotransmission is excessive, as postulated in
the amygdala to cause fear (Figure 8-17A) and in CSTC circuits to cause
worry - CORRECT-ANSWERSGabapentin and pregabalin
,key neurotransmitter that innervates the amygdala as well as all the
elements of CSTC circuits - CORRECT-ANSWERSSerotonin
-regulate both the symptoms of fear and worry
Noradrenergic hyperactivity in anxiety - CORRECT-ANSWERSNorepinephrine
is another neurotransmitter with important regulatory input to the amygdala,
and to the prefrontal cortex and thalamus in CSTC circuits
__% of the population will develop an anxiety disorder - CORRECT-
ANSWERS30%
Treatment for anxiety disorder subtypes: Generalized Anxiety Disorder -
CORRECT-ANSWERSSSRIs, SNRIs, benzodiazepines, buspirone, and α2δ
ligands such as pregabalin and gabapentin
Other "off-label" treatments for anxiety can
include mirtazapine, trazodone, vilazodone, tricyclic antidepressants, or even
sedating antihistamines such as hydroxyzine.
Treatment for anxiety disorder subtypes: PTSD - CORRECT-
ANSWERSpsychopharmacological treatments
-not as effective as these same treatments are in anxiety disorders
-more effectively aimed at comorbidities: depression, insomnia, substance
abuse, and pain
Benzodiazepines are to be used with caution
-limited evidence from clinical trials for efficacy in PTSD
-many PTSD patients abuse alcohol and other substances
unique treatment for PTSD is the administration of α1 antagonists at night to
prevent nightmares
The amygdala hypothetically plays a central role in the _______________.
Cortico-striato-thalamo-cortical (CSTC) circuits are thought to play a key role
in mediating the symptom of __________. - CORRECT-ANSWERSfear response,
worry
________,_________,_________,________ are all key modulators of the
hypothetical fear and worry circuits - CORRECT-ANSWERSSerotonin,
norepinephrine, alpha-2 delta ligands and GABA
Amygdala-centered circuit - CORRECT-ANSWERSFear
-panic
-phobia
cortico-striato-thalamo-corical (CSTC) circuit - CORRECT-ANSWERSworry
-anxious misery
,-apprehensive expectation
-obsession
Gabapentin - CORRECT-ANSWERSAnxiolytic
glutamate voltage-gated calcium channel blocker, Anticonvulsant; alpha 2
delta ligand at voltage-sensitive calcium channels
-Indication: Partial seizures with or without secondary generalization,
postherpetic neuralgia, restless leg syndrome, neuropathic pain/chronic pain,
anxiety, bipolar disorder.
-Dosing: 900-1800 mg/day in 3 divided doses
Risks: CNS side effects:
Sedation
Ataxia
fatigue
nystagmus
tremor
Pearls:
-Most use if off-label
-Off-label use for first-line treatment of neuropathic pain may be justified
Pregabalin - CORRECT-ANSWERSAnxiolytic
glutamate voltage-gated calcium channel blocker, Anticonvulsant; alpha 2
delta ligand at voltage-sensitive calcium channels
-Indication: Diabetic peripheral neuropathy, postherpetic neuralgia,
fibromyalgia, neuropathic pain associated with spinal cord injury, partial
onset seizures, peripheral neuropathic pain, GAD, panic disorder, social
anxiety disorder.
-Dosing: IR: 150-600 mg/day in 2-3 doses, CR: 330 mg once per day
Risks: CNS side effects:
Sedation
Pearls:
-First treatment approved for fibromyalgia
-Off-label use for GAD, panic disorder, and social anxiety disorder may be
justified in the USA
Buspirone - CORRECT-ANSWERSAnxiolytic
serotonin receptor partial agonist
-Indication: Anxiety, depression, treatment-resistant depression
-Dosing: usual 20-30 mg/day. Initial 15 mg twice a day; increase in 5 mg/day
increments every 2-3 days until desired efficacy reached (max 60 mg/day)
Risks:
, Dizziness
Headache
Nervousness
Sedation
Pearls:
-Do not use if patient taking an MAOI
-generally reserved as an augmenting agent to treat anxiety
Hydroxyzine - CORRECT-ANSWERSAnxiolytic
histamine receptor antagonist
-Indication: Anxiety and tension associated with psychoneurosis, pruritus,
sedation, hysteria, withdrawal symptoms, delirium tremens, nausea and
vomiting, insomnia.
-Dosing:
• Anxiety: 50-100 mg 4 times a day
• Sedative: 50-100 mg oral, 25-100 mg intramuscular injection
• Pruritus: 75 mg/day divided into 3-4 doses
Risks: Blocking histamine 1 receptors can cause sedation
Pearls:
-preferred anxiolytic for patients with dermatitis or skin symptoms such as
pruritis
Alprazolam - CORRECT-ANSWERSAnxiolytic
BENZODIAZEPINE
GABA positive allosteric modulator
-Indication: Generalized anxiety disorder, other anxiety disorders, panic
disorder, premenstrual dysphoric disorder, irritable bowel syndrome,
insomnia, acute mania, acute psychosis, catatonia.
-Dosing:
• Anxiety: alprazolam IR: 1-4 mg/day (start at 0.75-1.5, 3 divided doses)
• Panic: alprazolam IR: 5-6 mg/day (start at 1.5, 3 divided doses)
• Panic: alprazolam XR: 3-6 mg/day (start at 0.5-1 QD AM)
Risks:
-Sedation, fatigue, depression
-Dizziness, ataxia, slurred speech, weakness
-Forgetfulness, confusion
-Hyperexcitability, nervousness
Pearls:
-not recommended during pregnancy, especially during first trimester
-Recommended either D/C drug or bottle feed
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