Chapter 54 Drug Therapy for
Anxiety and Insomnia with
complete verified solutions
Describe the Etiology of Anxiety (Situational vs Anxiety Disorder)
Described as an unpleasant feeling that occurs when one perceives
something as being threatening to well being. Situational anxiety is
a normal response to a stressful situation that could be beneficial
and lasts 2-3 wks. An anxiety disorder is severe and prolonged and
interferes with day to day activities.
Describe the Pathophysiology of Anxiety
Exact physiology is unknown. Evidence suggests it involves excess
of excitatory neurotransmitters such as Norepinephrine or
deficiency of inhibitory transmitters such as GABA.
Generalized Anxiety Disorder (GCD)
Excessive and exaggerated anxiety about everyday circumstances
with symptoms lasting 6 months or longer. Symptoms are related to
motor tension (trembling), ANS (palpitations and tachycardia), and
increased vigilance (insomnia).
Could occur with medical disorders, CNS stimulants, and when CNS
depressants are stopped abruptly. Experience little relief when one
stressful situation is resolved, instead move on to next worry.
Obsessive Compulsive Disorder (OCD)
Uncontrollable desire to dwell on recurring unwanted ideas.
Involves a repeated performance to relieve the fear and anxiety
associated with obsession. Is characterized by compulsions that are
time consuming and impair day to day life.
Panic Disorder
Acute and sudden recurrent attacks of anxiety with feelings of
intense fear, terror, or impending doom. Symptoms include SOB,
palpitations, etc. and build to peak at around 10 minutes. Post
, attack individuals live in fear of another attack and can avoid place
where it occurred and leaving the house.
Posttraumatic Stress Disorder (PTSD)
Trauma and stress related disorder associated with history of
stressful events such as threatened death and serious injury.
Individual can experience intense fear, helplessness, difficulty
sleeping, etc. Traumatic event is relieved through images,
nightmares, and flashbacks.
Discomfort causes individuals to avoid situations in which they are
reminded of event. Intensive counseling needed since detachment
can occur.
Social Anxiety Disorder (SAD)
Excessive concern about the critical judgement of others.
Individuals are afraid that something they do will cause humiliation,
therefore they try to avoid certain situations. Symptoms can include
tachycardia, nausea, and sweating.
Describe the Etiology of Insomnia
Prolonged difficulty going to sleep or staying asleep. Could be
caused by medical disorders, environmental factors, and
stress. Considered chronic if lasting longer than a month.
Describe the Pathophysiology of Insomnia
During sleep period there is initial sleep latency which lasts about
30 min. There are four stages of sleep stage one involves
drowsiness and stage four involves deep sleep. During NON REM
believed to be physically restorative and REM sleep is emotionally
restorative. 75% of sleep is NON REM and 25% is REM.
Describe prototype, pharmacokinetics (5), action, and use (6) of
Benzodiazepines
Prototype: Diazepam
Pharmacokinetics: rarely fatal unless mixed with alcohol and other
depressants, schedule IV drug, withdrawal symptoms if stopped
abruptly, half lives longer than 24 hrs, and therapeutic/adverse
effects after 2-3 days of therapy.
Action: Enhances inhibitory effect of GABA in order to relieve
anxiety, nervousness, and produce sleep. (Decreased neuronal
excitability)
Anxiety and Insomnia with
complete verified solutions
Describe the Etiology of Anxiety (Situational vs Anxiety Disorder)
Described as an unpleasant feeling that occurs when one perceives
something as being threatening to well being. Situational anxiety is
a normal response to a stressful situation that could be beneficial
and lasts 2-3 wks. An anxiety disorder is severe and prolonged and
interferes with day to day activities.
Describe the Pathophysiology of Anxiety
Exact physiology is unknown. Evidence suggests it involves excess
of excitatory neurotransmitters such as Norepinephrine or
deficiency of inhibitory transmitters such as GABA.
Generalized Anxiety Disorder (GCD)
Excessive and exaggerated anxiety about everyday circumstances
with symptoms lasting 6 months or longer. Symptoms are related to
motor tension (trembling), ANS (palpitations and tachycardia), and
increased vigilance (insomnia).
Could occur with medical disorders, CNS stimulants, and when CNS
depressants are stopped abruptly. Experience little relief when one
stressful situation is resolved, instead move on to next worry.
Obsessive Compulsive Disorder (OCD)
Uncontrollable desire to dwell on recurring unwanted ideas.
Involves a repeated performance to relieve the fear and anxiety
associated with obsession. Is characterized by compulsions that are
time consuming and impair day to day life.
Panic Disorder
Acute and sudden recurrent attacks of anxiety with feelings of
intense fear, terror, or impending doom. Symptoms include SOB,
palpitations, etc. and build to peak at around 10 minutes. Post
, attack individuals live in fear of another attack and can avoid place
where it occurred and leaving the house.
Posttraumatic Stress Disorder (PTSD)
Trauma and stress related disorder associated with history of
stressful events such as threatened death and serious injury.
Individual can experience intense fear, helplessness, difficulty
sleeping, etc. Traumatic event is relieved through images,
nightmares, and flashbacks.
Discomfort causes individuals to avoid situations in which they are
reminded of event. Intensive counseling needed since detachment
can occur.
Social Anxiety Disorder (SAD)
Excessive concern about the critical judgement of others.
Individuals are afraid that something they do will cause humiliation,
therefore they try to avoid certain situations. Symptoms can include
tachycardia, nausea, and sweating.
Describe the Etiology of Insomnia
Prolonged difficulty going to sleep or staying asleep. Could be
caused by medical disorders, environmental factors, and
stress. Considered chronic if lasting longer than a month.
Describe the Pathophysiology of Insomnia
During sleep period there is initial sleep latency which lasts about
30 min. There are four stages of sleep stage one involves
drowsiness and stage four involves deep sleep. During NON REM
believed to be physically restorative and REM sleep is emotionally
restorative. 75% of sleep is NON REM and 25% is REM.
Describe prototype, pharmacokinetics (5), action, and use (6) of
Benzodiazepines
Prototype: Diazepam
Pharmacokinetics: rarely fatal unless mixed with alcohol and other
depressants, schedule IV drug, withdrawal symptoms if stopped
abruptly, half lives longer than 24 hrs, and therapeutic/adverse
effects after 2-3 days of therapy.
Action: Enhances inhibitory effect of GABA in order to relieve
anxiety, nervousness, and produce sleep. (Decreased neuronal
excitability)
