anxiolytic hypnotic drugs 2010Bb - ANXIOLYTICS AND...

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ANXIOLYTICS AND HYPNOTICS
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Lecture Preview I. Anxiety Disorders II. Sleep Disorders III. Pharmacotherapy A. Review GABAergic system B. Intro to Benzodiazepines Modulation Pharmacokinetics Selectivity Adverse-effects IV. Other Anxiolytics A. Buspirone V. Other Sedative & Hypnotics A. Non-Benzodiazepines B. Melatonin agonists
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Case Study: TR is a 65 yr widowed male who complains of difficulty sleeping for the past 3 weeks. His mid- nocturnal awakening has improved since he started taking the OTC agent diphenhydramine, but still has difficulty falling asleep and wakes up groggy, confused with dry mouth and constipation. He has followed the “good sleep” hygiene procedures and denies use of alcohol, tobacco or caffeine. What would you recommend? Why?
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I. Anxiety Disorders Generalized Anxiety Disorder (GAD) Fears that are not attached to any particular object or circumstance chronic, non-reactive motor tension trembling, twitching autonomic arousal respiration, heart rate, sweating, nausea vigilance startle, irritable, difficulty concentrating
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Anxiety Disorders Panic Disorder (PD) sudden attacks of extremely intense fear and panic resembling a heart attack. May strike at any time and occur without a known reason recurrent, non-reactive Terror, doom Autonomic arousal Obsessive-Compulsive Disorder (OCD) Obsessive thoughts and compulsive actions, such as cleaning, checking, counting, or hoarding. Compulsive pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome
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trichotillomania hoarding hand washing
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Anxiety Disorders Acute/Post-traumatic Stress Disorder (PTSD) develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened trouble sleeping feeling irritable overreacting when startled angry outbursts trouble concentrating
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Anxiety Disorders Phobias An unreasonable fear that can cause avoidance and panic. fear of spiders is called arachnophobia fear of being outside is known as agoraphobia Fears of specific objects Treated with cognitive behavioral therapy and or drugs
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II. Sleep Disorders: A hypnotic should produce a state of sleep that resembles normal sleep Normal sleep consists of distinct stages: which occur cyclically over 90 min: Non-rapid eye movement (NREM). 70-75% of total sleep with 4 stages. Includes slow wave sleep (SWS) or deep sleep Rapid eye movement (REM). Eyes move in a rapid, flickering, twitching motion while their eyelids are closed.
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