ANXIETY

• Types of channels on the membrane of nerve cells

  Voltage-gated channels

  Ligand-gated channels –(Ionotropic receptors)
• Ion channels

  Voltage gated channels

  Ligand gated channels
• Neurotransmitter receptors 

  Ionotropic receptors

  Metabotropic receptors
• Metabotropic receptors

  Membrane delimited

  Diffusible second messenger
• EFFLUX OF K, INFLUX OF CL-, CHANGE IN CELL MEMBRANE POTENTIAL 

  HYPERPOLARIZATION
• INFLUX OF NA AND CA– CELL BECOMES POSITIVE

  DEPOLARIZATION
• CHANGE IN THE MEMBRANE POTENTIAL THAT RETURNS IT TO NEGATIVE, HAPPENS AFTER DEPOLARIZATION

  REPOLARIZATION
• Excitatory postsynaptic potential (EPSP), depolarization 

  Excitatory
• Inhibitory postsynaptic potential (IPSP), hyperpolarization

  Inhibitory
• opens Na or Ca channels/ influx depolarization (more positive) nerve impulse

  Excitatory neurotransmitters
• example of Excitatory neurotransmitters

  Norepinephrine, Dopamine, Acetylcholine, Glutamate, Aspartate 
• opens Cl channels hyperpolarization (more negative) no nerve impulse

  Inhibitory neurotransmitters
• examples of Inhibitory neurotransmitters

  glycine, gamma-aminobutyric acid
• DECREASE GABA INCREASE 5HT, D, NE

  ANXIETY
• INCREASE GLUTAMATE INCREASE D 

  PSYCHOSIS
• DECREASE NE, 5HT, D

  DEPRESSION
• IMBALANCE IN NT

  MOOD DISORDER
• INCREASE NEURON FIRING INCREASE 5HT, NE, D 

  SEIZURE
• DECREASE D INCREASE ACH 

  PARKINSON’S
• INCREASE ACH

  ALZHEIMER’S
• is an emotional state commonly caused by the perception of real or potential danger that threatens the security of an individual

  Anxiety
• recurrent unexpected panic attacks that can occur with agoraphobia in which patients fear places in which escape might be difficult.

  Panic disorder
• intense fear of particular objects or situations (e.g. snakes, heights);most common psychiatric disorder

  Specific phobia
• intense fear of being scrutinized in social or public situations (e.g., giving a speech, speaking in class).

  Social phobia
• intense pervasive worry over virtually every aspect of life 

  Generalized anxiety disorder
• persistent re experience of a trauma, efforts to avoid recollecting the trauma, and hyperarousal 

  Post-traumatic stress disorder
• recurrent obsessions and compulsions that cause significant distress and occupy a significant portion of one’s life

  Obsessive-compulsive disorder
• Excessive and uncontrollable anxiety and worry Anxiety and worry

  GAD-Generalized Anxiety Disorder
• most widely used anxiolytic benzene ring, fused to a seven-membered diazepine ring, usually contain a 5-aryl substituent (ring C) and a 1,4-diazepine

  Benzodiazepines
• Drugs of Choice for treating GADBind to GABAA receptor subunits at CNS neuronal synapse Increase frequency of chloride channel opening enhancing membrane hyperpolarization 

  BENZODIAZEPINES
• Short-acting (2-8 hrs)

  Oxazepam (Serax)

  Triazolam (Halcion)

  Clonazepam (Klonopin, Rivotril)

  Midazolam (Versed, Dormicum)

  Temazepam (Restoril) 
•  Intermediate-acting (10-20 hrs) 


  Lorazepam (Ativan)

  Alprazolam (Xanax, Xanor)

  Temazepam (Restoril)

  Flunitrazepam (Rohypnol) 
•  Long-acting (1-3 days) 


  Diazepam (Valium, Anxionil)

  Chlordiazepoxide (Librium)

  Flurazepam (Dalmane)
• Many benzodiazepines are converted to?

  N Desmethyldiazepam(N-DMDZ)
• At low doses, exert calming effects with concomitant reduction of anxiety Clinical uses: Anxiety (GAD) and panic disorders, phobias

  Sedative
• Behavioral disinhibitory effects of sedative hypnotics

  Euphoria, Being in a happy world

  Impaired judgment

  Loss of self control
• at high doses Clinical uses: for insomnia

  Hypnotic
• at high doses : CNS depression to the point known as stage III of GA for induction of anesthesia midazolam 

  Anesthesia
•  Can exert anticonvulsant effects without marked central nervous system depression

  Anticonvulsant
• Carbamates and BZDs exert inhibitory effects on polysynaptic reflexes and internuncial transmission and at high doses may also depress transmission at the skeletal neuromuscular junction 

   Muscle relaxant