Anxiety Pharmacology (Hoyt)
Anxiety is a state of pervasive apprehension that may be triggered by specific environmental or personal factors. Many patients with anxiety disorders do not respond completely to initial treatment and prescribers often combine an antidepressant with an effective anxiolytic drug that has a different mechanism of action. See what you know by taking this quiz.
- 1.During development, two influences interact to modulate neuronal maturation and determine levels of anxiety. These two influences include: (Check all that apply)
- A.
Age
- B.
Environment
- C.
Gender
- D.
Genetics
- E.
All of the above
- 2.High anxiety can be overcome by rapid pharmacological treatment, that directly blocks excessive excitability. This is termed:
- A.
GABA inhibition
- B.
GABA activation
- C.
Glutamate inhibition
- D.
Glutamate activation
- E.
None of the above
- 3.High anxiety can be overcome by slow therapy pharmacological treatment, including: (Check all that apply)
- A.
SSRIs
- B.
Benzodiazepines
- C.
Psychotherapy
- D.
TCAs
- E.
All of the above are options for slow therapeutic treatment of high anxiety
- 4.Which one of the following parts of the brain is responsible for processing incoming sensory signals and relaying the signals on to parts that interpret them?
- A.
Hippocampus
- B.
Frontal lobe
- C.
Amygdala
- D.
A & B
- E.
B & C
- 5.The amygdala is responsible for which of the following roles?
- A.
Plays a role in disorders involving very distinct fears
- B.
Processing threatening stimuli
- C.
Storage of emotional memories
- D.
A & C
- E.
B & C
- 6.The hippocampus is responsible for encoding information into memories. This area appears to be ______ in people who have undergone severe stress because of childhood abuse or military combat.
- A.
Enlarged in size
- B.
Secrete more GABA than any other brain section
- C.
Reduced in size
- D.
Secretes less GABA than any other brain section
- E.
Two of the above
- 7.Anxiolytics include the following four types of treatment options. Which of the following will provide the quickest response to decrease anxiety in a patient?
- A.
Antidepressants (SSRIs)
- B.
Buspirone
- C.
Benzodiazepines
- D.
Cognitive-behavioral therapy
- E.
All the treatment options above have the same effect on antianxiety time.
- 8.Buspirone is a treatment option for anxiety. What is the therapeutic mechanism of action of buspirone?
- A.
Partial agonist at the 5HT(1A) receptor
- B.
Partial antagonist at the 5HT(1A) receptor
- C.
Selective agonist at the GABA(A) receptor
- D.
Selective antagonist at the GABA(A) receptor
- E.
Selective reuptake inhibitor of 5-HT
- 9.Which of the following is NOT a characteristic of buspirone?
- A.
Preferred as treatment for patients with chronic anxiety who are not responding to acute stresses
- B.
S/E profile: nausea, dizziness, headaches, and fatigue
- C.
Was discovered because practitioners were concerned about the S/E profile and risk of benzodiazepines
- D.
S/E profile: sedation, psychomotor impairment, dependence, withdrawal syndrome, and abuse potential
- E.
All of the above are characteristic of buspirone
- 10.True or False: Buspirone is cross-tolerant with benzodiazepines. (Hint: cross-tolerance means that you can substitute one agent for another.)
- A.
True
- B.
False
- 11.True or False: Benzodiazepines have NO anti-depressant activity.
- A.
True
- B.
False
- 12.What is the therapeutic mechanism of action of benzodiazepines?
- A.
Partial agonist at the 5-HT(1A) receptor
- B.
Partial antagonist at the 5-HT(1A) receptor
- C.
Agonist at the GABA(A) receptor
- D.
Antagonist at the GABA(A) receptor
- E.
Selective reuptake inhibitor of 5-HT
- 13.Benzodiazepines at the receptor in Question #12 to perform which of the following?
- A.
Enhance the response to serotonin; opening the 5-HT receptors
- B.
Depress the response to serotonin; closing the 5-HT receptors
- C.
Depress the response to serotonin; opening the 5-HT receptors
- D.
Enhance the response to GABA; opening the GABA(A) receptors
- E.
Depress the response to GABA; closing the GABA(A) receptors
- 14.During an electrical recording of neurons, which of the following responses is observed following the administration of the benzodiazepine, diazepam?
- A.
Decrease frequency of channel opening
- B.
Increase frequency of channel opening
- C.
Decrease duration of channel opening
- D.
Increase duration of channel opening
- E.
Two of the above
- 15.The GABA channel that benzodiazepines act on involve the flow of what ion?
- A.
Na+
- B.
K+
- C.
Mg++
- D.
Ca++
- E.
Cl-
- 16.Glutamate synthesis and metabolism is intertwined with gamma-aminobutyric acid (GABA) synthesis and metabolism. What is the enzyme responsible for converting glutamate to GABA?
- A.
GABA transaminase (GABA-T)
- B.
Glutamic acid decarboxylase (GAD)
- C.
GABA decarboxylase (GDC)
- D.
Succinic semialdehyde dehydrogenase (SSADH)
- E.
GABA is synthesized from the precursor succinic semi-aldehyde only, not Glutmate
- 17.Which of the following statmements is TRUE about the GABA(A) receptor?
- A.
Activation leads to repolarization
- B.
A channel for sodium (Na+) ions
- C.
Hexameric structure (6 subunits)
- D.
Is the binding site for both GABA and benzodiazepines
- E.
None of the above are true statements
- 18.GABA, the neurotransmitter that binds to the GABA(A) receptor and requires which of the following subunits to bind? (Check all that apply)
- A.
Alpha
- B.
Beta
- C.
Gamma
- D.
All of the above
- E.
None of the above
- 19.Benzodiazepines bind to the GABA(A) receptor and requires which of the following subunits to bind? (Check all that apply)
- A.
Alpha
- B.
Beta
- C.
Gamma
- D.
All of the above
- E.
None of the above
- 20.Which one of the following statements is NOT characteristic of benzodiazepines?
- A.
Strong anxiolytic effect
- B.
All agents are schedule IV (C-IV)
- C.
Slow on/off kinetics
- D.
Low risk of interaction with other medications
- E.
Good safety profiles, compared to older agents such as barbituates
- 21.The time to benzodiazepine's onset of action is dependent on which of the following TWO events? (Check TWO of the following answers)
- A.
Rate of uptake into the brain
- B.
Rate of uptake into adipose tissue
- C.
Equilibration between serum and plasma
- D.
Equilibration between adipose tissue and serum
- E.
Equilibration between brain and plasma
- 22.Termination of action of benzodiazepines very dependent on the manner of administration. For acute administration, termination of action is dependent on _________ and occurs ________.
- A.
Distribution; slowly
- B.
Metabolic processes; slowly
- C.
Distribution; rapidly
- D.
Metabolic processes; rapidly
- 23.With long-term administration of benzodiazepines, termination of action is dependent upon metabolism via which of the following processes:
- A.
Reduction
- B.
Glucuronidation
- C.
Transamination
- D.
Electrophilic substitution
- E.
Oxidation
- 24.Shorter half-life benzodiazepines reach a stable plasma level _____ after initiation, compared to agents with longer half-lives.
- A.
Sooner
- B.
Later
- C.
At the same time
- D.
Time to Cp,ss is variable with the benzodiazepine agent
- 25.Which of the following is NOT a characteristic of short half-life benzodiazepines?
- A.
S/E's are subtractive with the concurrent intake of alcohol
- B.
Higher risk of interdose symptoms breakthrough
- C.
Require more care in tapering after prolonged use
- D.
Short term S/E include: sedation, fatigue, ataxia, slurred speech, impaired cognitive and motor performance
- E.
Effects wash out sooner after discontinuation than long half-life BZD's
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