Anxiety and dysomnia pharmacology Flashcards
W/drawal sxs from benzos are correlated with what? Which benzo has lower w/d sxs?
Higher affinity for GABA-A receptor -> worse w/d
Oxazepam -> lower receptor affinity -> fewer w/d sxs
Name 3 benzos that are metabolized by glucuronidation.
- lorazepam
- oxazepam
- temazepam
Age related decline in phase I or phase II metabolism?
Phase I - oxidative
Benzo drug ix
- Cimetidine
- Fluoxetine
- CYP3A4 inhibitors
Cimetidine
-inhibits metabolism of longer acting benzos
Fluoxetine
-decreases clearance of diazepam
CYP3A4
-decreased clearance of alprazolam and midazolam as well as triazolam
List the pharmacological factors and clinical factors that increase complications and difficulty associated w/ benzo w/d
• Pharmacologic factors
– Higher daily dose
– Shorter half-life
– Longer duration of prior benzodiazepine therapy – More rapid taper
• Clinical factors
– Panic disorder
– Higher pre-taper levels of anxiety or depression – More personality psychopathology
– Concomitant substance abuse/use
For alcohol w/d tx, if delirium and seizures have already begun, what should the drug of choice?
Lorazepam continuous infusion
Flumazenil
- MoA
- use
- major concern
- BZD receptor antagonist
- used to reverse sedative effects of BZDs with overdose or when administered for anesthetic purposes
- seizures
Buspirone
- MoA
- duration for onset of action
- 5-HT1A agonist
- slow onset of action
List the 3 GABA-A PAM drugs and their duration of action
What class are all the Z-drugs
- Zaleplon
- rapid onset (t1/2 of 1 hour)
- good for jet lag - Zolpidem
- t1/2 = 2.5 hours
- no AM hangover
- reduced dosing in women vs men - Eszopiclone
- 6 hours
ALL ARE CLASS 4
Clonidine
-MoA
presynaptic alpha-2 receptor agonist
decreases epi and NE release at the synaptic level
used for childhood insomnia
