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Pharmacology > Anixety,hypnotics,alcohol > Flashcards

Anixety,hypnotics,alcohol Flashcards

1
Q

Which drug is not a CNS depressant?

A

Buspirone

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2
Q

Which drugs have steep dose-response curves?

A

Alcohol, barbiturate

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3
Q

What is major advantage of using benzodiazepines over barbiturates?

A

Bzds have a very shallow dose response curve, least likely to be fatal in overdose.

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4
Q

BZD are used to treat what conditions?

A

Anxiety in limbic system
Sedative/hypnotic in reticular activating system
Anticonvulsants in cerebral cortex
Muscle relaxation in internuncial polysynaptic reflexes in brainstem and spinal cord.

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5
Q

The MoA of BZD is?

A

BZD enhance the inhibitory effect of GABA. They bind to a separate receptor GABAa. GABA also must be present. Binding results in the opening of chloride channels. The influx of chloride causes a hyperpolarization and decreases neuronal firing.

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6
Q

Which BZDs can cause rebound anxiety?

A

Short acting such as triazolam.

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7
Q

Respiratory depression is associated with which BZD?

A

Midazolam used to induce surgical anesthesia

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8
Q

Cross tolerance and cross dependence occurs between what drug classes?

A

BZDs, barbiturates, and alcohol.

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9
Q

What are some signs of BZD toxicity?

A

Sedation, drowsiness, lightheaded, confusion, psychomotor impairment, slurred speech, ataxia, memory impairment, anterograde amnesia, increased aggression, euphoria, hangover.

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10
Q

What are signs of BZDs withdrawal?

A

Agitation, anxiety, irritability, insomnia, ab cramps, sweating, Seizures.
Treatment is weaning off by 10% every 3 days over 2-3 weeks.

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11
Q

BZDs alter sleep patterns in what ways?

A

Decrease latency, duration of stage 3/4, number of awakenings, duration of REM sleep.

Cessation can cause REM rebound resulting in increased frequency and intensity of dreams

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12
Q

If a person has trouble falling asleep, which BZD would help?

A

Triazolam

May cause rebound anxiety.

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13
Q

If a person has trouble staying asleep, which BZD is used?

A

Flurazepam

May cause hangover effect

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14
Q

Redistribution of which BZD is important for termination of drug action?

A

Diazepam

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15
Q

Which BZDs are not oxidized by the liver and therefore may be usedin patients with impaired liver function?

A

Lorazepam, oxazepam

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16
Q

How do BZDs differ from Barbs in respect to metabolizing liver enzymes?

A

BZD do not induce enzymes, barbs do.

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17
Q

What drugs can prolong action of BZDs?

A

Cimetidine, disulfiram, isoniazide

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18
Q

BZDs can increase the serum levels of?

A

Digoxin, phenytoin

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19
Q

Which drug is used to induce anesthesia?

A

Midazolam

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20
Q

Which BZDs are used for hypnotic effect?

A

Triazolam, temazepam, oxazepam, lorazepam

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21
Q

Which BZDs are used for anxiety?

A

Oxazepam, lorazepam, alpeazolam, clorazepate, chlordiazepoxide, diazepam

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22
Q

Which BZDs are used to suppress withdrawal?

A

Lorazepam, chlordiazepoxide, diazepam

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23
Q

Which BZDs is also a muscle relaxant?

A

Diazepam

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24
Q

Which barb is long acting and used as anticonvulsant?

A

Phenobarbital

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25
Q

Which barbs are used for sedative/hypnotic effects?

A

Pentobarabital, butalbital

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26
Q

Which barb is ultra short acting?

A

Thiopental

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27
Q

How is the MoA of barbs different from BZDs?

A

Barbs have ability to open chloride channels without GABA presence.

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28
Q

How to barbs differ from BZDs in terms of side effects?

A

Barbs suppress REM sleep more, REM rebound, hangover effect, respiratory depression.
Most barbs induce state of surgical anesthesia.

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29
Q

Redistribution is important for the termination of which barb?

A

Thiopental

30
Q

Aggravation of acute intermittent porphyria is associated with which drug class?

A

Barbiturates

31
Q

Phenbarbital can interact with which drug’s effect?

A

Warfarin

32
Q

MAOI enhance CNS depression with which drug class?

A

Barbiturates

33
Q

Which drug class canbe used as adjuncts for tension headache?

A

Barbiturates

34
Q

Which drug is used for mild/moderate anxiety with minimal sedative/hypnotic, muscle relaxant, or respiratory depression effects?

A

Buspirone

35
Q

How long for treatment with buspirone until effects are seen?

A

1-2 weeks

36
Q

What is buspirone MOA?

A

Thought to be a partial agonist at 5-HT1a

37
Q

What drug is a good choice to treat anxiety in patients with a history of alcohol or sedative abuse?

A

Buspirone

38
Q

Buspirone interacts with MAOI and causes what?

A

Hypertension

39
Q

Which drugs are thought to interact with BZD receptors, subtype omega-1, enhancing GABA effects?

A

Zolpidem, zaleplon, eszopiclone

40
Q

Of zolpidem, zaleplon, eszopiclone which are long and which are short acting?

A

Zolpidem, eszopiclone are long acting.

Zaleplon is short acting

41
Q

Which drug is an analog of GABA?

A

Gammahydroxybutyrate, GHB

42
Q

Which drug has ergogenic effects, used by athletes?

A

GHB

43
Q

Which antihistamine also has anti anxiety effects?

A

Hydroxyzine

44
Q

Which drug acts as an agonist at melatonin receptors?

A

Ramelteon

45
Q

What are cautions with use of ramelteon?

A

Impaired liver function patients

Increase prolactin, decrease testosterone.

46
Q

Which drugs are useful for situational anxiety?

A

Beta blockers such as propranolol

47
Q

Wch drug is an BZD antagonist, and reverses the CNS depressant effects?

A

Flumazenil

48
Q

What is the major adverse effect of flumazenil?

A

Can trigger seizures, and preciptate withdrawal symptoms

49
Q

The most effective muscle relaxants act at brainstem and spinal cord, which are they?

A

Diazepam, baclofen

50
Q

Which drug is used to treat spasticity from MS, spinal cord injury

A

Baclofen

51
Q

Which drug is an analog of GABA and acts as an agonist at GABAb ceptors?

A

Baclofen

52
Q

Which muscle relaxant is structurally similar to tricyclic antipressants?

A

Cyclobenzaprene

53
Q

What drug acts at brainstem to inhibit both GABA and alpha motor systems?

A

Cyclobenzaprene

54
Q

Which muscle relaxant is used for muscle spasms of local origin?

A

Cyclobenzaprene

55
Q

Which drug is an alpha-2 agonist used for skeletal muscle relaxation?

A

Tizanidine

56
Q

What side effect is seen with tizanidine?

A

Hypotension

57
Q

What follows zero order kinetics, metabolism is independent of time or concentration?

A

Alcohol

58
Q

Alcohol dehydrogenase pathway is responsible for?

A

Dvelopment of acetaldehyde accumulation causing toxic effects

59
Q

The microsomal ethanol oxidizing system is responsible for?

A

Alcohol tolerance, system is induced by chronic alcohol consumption

60
Q

Which drug is an inhibitor of aldehyde dehydrogenase?

A

Disulfiram

61
Q

What reaction occurs when alcohol is consumed with disulfiram?

A

Flushing, headache, nausea, confusion.

Drug is also hepatotoxic.

62
Q

The initial phase of alcohol appears to be stimulatory, why?

A

Due to pression of inhibitory mechanisms in the brain

63
Q

What is alcohol MoA inthe CNS?

A

Disorder of membrane lipids
Secondary change to neurotransmitter, receptor, ion channel
Enhance GABA effects

64
Q

How does alcohol have a diuretic effect?

A

It inhibits the secretion of ADH

65
Q

Alcohol can contribute to erosive gastritis by?

A

Stimulating secretion of gastric acid concentration

66
Q

Which drug is given during alcohol withdrawal for autonomic effects?

A

Clonidine

67
Q

Which drug is used to control seizures during alcohol withdraw?

A

Phenytoin

68
Q

Which drug is used tocontrol hallucinations during alcohol withdraw?

A

Haloperidol

69
Q

Which opioid antagonist is usedto reduce alcohol cravings?

A

Naltrexone

70
Q

What drug is usedto reduce alcohol cravings, and help maintain abstinence in recovering alcoholics?

A

Acamprosate

71
Q

Which drug is preferred for alcoholics with liver impairment?

A

Acamprosate

Pharmacology (13 decks)

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