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Pharm 6 > anxiety and sleep > Flashcards

anxiety and sleep Flashcards

1
Q

eszopiclone

A

BZD-R agonist (GABA-a-R agonist)

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2
Q

zaleplon

A

BZD-R agonist (GABA-a-R agonist)

short-term tx only

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3
Q

zolpidem

A

BZD-R agonist (GABA-a-R agonist)

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4
Q

estazolam

A

BZD

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5
Q

flurazepam

A

BZD

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6
Q

temazepam

A

BZD

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7
Q

triazolam

A

BZD

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8
Q

ramelteon

A

highly selective melatonin-R agonist

not much change in sleep latency or total sleep time

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9
Q

doxepin

A

TCA

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10
Q

suvorexant

A

orexin-R antagonist

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11
Q

barbiturate and BZD effect on GABA-R

A

barbs: inc duration of opening of channel
BZD: inc frequency of opening of channel

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12
Q

BZD effect on sleep

A

shorten REM, prolong stage 2 of NREM

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13
Q

BZD in elderly

A

LOT: lorazepam, oxazepam, temazepam

b/c phase 2 conjugation, not affected by CYP 3A4, and no active metabolites

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14
Q

desmethyldiazepam (DMDZ)

A

active metabolite of many BZDs, T1/2 = 100 h

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15
Q

uses of BZDs

A

anxiety relief, insomnia, epilepsy (DOC for status epilepticus), febrile convulsions in children (DOC), relieve muscle spasm induced by joint problems, tetanus, eclampsia, EtOH/sedative withdrawal, anesthesia, sedation

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16
Q

diazepam/ lorazepam uses

A

DOC for status epilepticus, mm spasm, tetanus, general anesthesia, febrile convulsions, withdrawal

17
Q

alprazolam uses

A

DOC for panic d/o and some phobias

18
Q

midazolam uses

A

preanesthesia, general anesthesia

19
Q

flunitrazepam uses

A

abused for date rape

20
Q

BZD ADRs

A

drowsiness/lethargy
retrograde amnesia, rebound insomnia w withdrawal, daytime sedation or depression, tolerance (cross w EtOH), physical and psych dependence
tx OD: flumazenil (BZD-R antagonist)

21
Q

GABA-a-R agonist MOA and effect on sleep

A

bind a1 subtype GABA-a receptor
decreased sleep latency, inc total sleep time, no effect on REM at normal dose (dec REM at high dose)
*insomnia and sleep-walking

22
Q

CBT vs Z-drugs

A

CBT > Z-drugs for sleep efficiency, inc slow wave sleep, fewer awakenings

23
Q

buspirone

A

partial 5HT-1a-R agonist with delayed onset
for chronic anxiety
no psychomotor coordination effect - can drive
minimal dependence and abuse risk b/c no effect on GABA

24
Q

diphenhydramine, doxylamine, hydroxyzine

A

antihistamines for insomnia, can reduce sleep latency and inc total sleep time
ADR: anti-ACh effects, cognitive impairment, daytime sleepiness - limited use esp in elderly
tolerance after 4 days of use
*most useful for pts with allergies/ pruritus

25
Q

barbiturates for sleep

A

inc CNS depression vs BZDs, can progress to coma and death

Pharm 6 (5 decks)

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