Anxiety/Hypnotic Flashcards
this class of drug suppresses the nervous system
sedative
hypnotic vs anxiolytic fxn
Anxiety relief = anxiolytics
Promote sleep = hypnotics
A lot of the sedatives are used for anxiety or insomnia management. What determines that difference?
Dosage!
Low = anxiety relief High = sleep induction
2 classes of hypnotics
- Benzodiazepines
- ->*drug of choice - Benzodiazepine-like drugs
which hypnotic class is drug of choice for sleep induction?
Benzodiazepines
Why do we like Benzodiazepines more than barbituates?
SAFER!
- ->Lower potential for abuse
- ->Fewer drug interactions
prototype for benzodiazepines for hypnotic
triazolam (Halcion)
benzodiazepines for anxiety (3)
lorazepam (Ativan) ,
alprazolam (Xanax)
diazepam (Valium),
(this LAD Ben is making me anxious)
Random benzo used for procedures prototype
midazolam (Versed)
What schedule drugs are benzodiazepines
schedule IV!
How do all benzodiazepines fxn?
Potentiate GABA
Triazolam- what does it do to your sleep? what happen to your sleep when you stop taking it?
decrease interval to sleep onset, # of intervals of waking = increase total sleep time
-no rebound insomnia!
Triazolam- 3 main categories of side effects
- CNS
- Cardiovascular
- Respiratory
What will Triazolam do to your CNS? Which of those side effects will improve?
-sedation, confusion, anterograde amnesia, drowsiness, sleep-driving
(sedation and psychomotor slowing improve in 2 weeks)
Oral vs IV Triazolam effects on your CV system… how do we give it iv?
Oral – little to no effect on heart and vessels
IV – profound HYPOTENSION and CARDIAC ARREST
= give slowly, port closest to IV
Oral vs IV Triazolam effects on respiratory
- Oral – little to no effect
- IV: resp depression (esp if taken w/ other CNS depressant)
-Can worsen airway obstruction in OSA or COPD
are we giving Triazolam to a preggo?
no no
considerations for stopping Triazolam
- Physical dependence–>wean the drug slowly
- Withdrawal syndrome: If on high doses can be severe (panic, paranoia, delirium, HTN, muscle twitches, convulsions)
what is flumazenil (Romazicon)?
how do we give it?
antidote for triazolam
- Admin/ Duration: over 15 seconds. Repeat Q min.
- ->Effects last 1 hour.
what does flumazenil (Romazicon) do yo resp. depression?
NOTHING. it only reverses the sedation aspect of overdose on triazolam
prototype for hypnotic benzodiazepine like drug?
zolpidem (Ambien)
how does zolpidem (Ambien) fxn?
Act as agonists at the benzodiazepine receptor site on the GABA receptor-chloride channel
side effects of zolpidem?
- sleep driving
- daytime drowsiness/dizziness (most common)
Is zolpidem a scheduled drug?
Class IV, fool
What is good about zolpidem?
-no tolerance or physical dependence–>-no rebound insomnia when stopped, no wean off
3 classes of drugs to treat anxiety
1.Selective Serotonin Reuptake Inhibitors (SSRI)
Discussed later in semester
2.Benzodiazepines
Prototype: diazepam (Valium)
3.Non-Benzo; Non-Barbituates
Prototype: buspirone (BuSpar)
4.dogs
prototype for benzo for anxiety is
diazepam (Valium)
I am ANXIOUS every DIA of nursing school
prototypes for Non-Benzo; Non-Barbituates for anxiety
buspirone (BuSpar)
Hydroxyzine
admin and onset of buspirone (BuSpar)
- Weeks before peak response
- Not for PRN use
considerations that make us like buspirone (BuSpar)
- Not a CNS depressant
- No abuse potential
- No suicide risk
- No increased CNS effects with other drugs (ETOH, benzos, etc.)
1 thing that makes us sad about buspirone (BuSpar)
no grapefruit
Hydroxyzine is what special class of drug that is nonbenzo for anxiety
antihistamine
Hydroxyzine is different in admin then buspirone. how?
Hydroxyzine can be taken PRN or QID
Prolonged QT interval with which drug long term?
hydroxyzine
side effects of hydroxyzine
dry mouth, constipation, confusion, dizziness, headache, fatigue
is hydroxyzine a scheduled drug?
no!
does hydroxyzine have withdrawal?
no!
is hydroxyzine for anxiety only?
No!
anxiety+ insomnia
s/s of triazolam withdrawal
(panic, paranoia, delirium, HTN, muscle twitches, convulsions)
