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Undeleted > anxiety & insomnia > Flashcards

anxiety & insomnia Flashcards

1
Q

sedative-hypnotics as anti-anxiety agents: kinds (3)

A

benzodiazepines
barbituates
benzodiazepine-like drugs

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2
Q

abuse potential barbituates vs benzodiazepines

A

barbiturates > benzodiazepines

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3
Q

benzodiazepines: class, use, distribution, metabolism

A

sedative-hypnotic

uses: sleep, anxiety
distribution: high lipid solubility, protein bound
metabolism: liver

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4
Q

benzodiazepines: moa

A

enhances GABA

  • binds to specific receptor sites in GABA receptor-channel complex
    • finite number of GABA receptors, difficult to overdose (unless high IV doses)
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5
Q

benzodiazepines: commonly used (4)

A

alprazolam (xanax)
lorazepam (ativan)
clonazepam (klonopin)
diazepam (valium)

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6
Q

benzodiazepines: adverse effects

A
  • CNS depression
  • respiratory depression (VERY QUICKLY)
  • anterograde amnesia
  • paradoxical psychological effects
  • tolerance
  • dependence
  • toxicity
  • abuse (schedule IV)
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7
Q

benzodiazepines: toxicity

A

unusual, unless mixed with other antidepressant

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8
Q

benzodiazepines: rapid toxicity in babies - why?

A

rapid CNS toxicity because underdeveloped BBB

– readily crosses placenta and enters breastmilk

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9
Q

benzodiazepines: drug-drug interaction

A

few - NOTABLY CNS DEPRESSANTS

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10
Q

benzodiazepines: advantages

A 
rapid onset (stops seizures fast!)
well tolerated
few drug-drug interactions 
little effect on CVS
generics available
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11
Q

flumazenil (romazicon)

A

benzodiazepine antagonist

uses:

  • to reverse sedation post-anesthesia
  • overdose

may result in generalized seizures with convulsions

side effects: dizziness, agitation, mood lability, confusion, n, v, ha, blurred vision

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12
Q

benzodiazepine overdose likely due to…

A

IV administration

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13
Q

barbituates: class + use

A

sedative-hypnotic (-arbitol)

use: seizure disorder, sedation (other drugs much safer)

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14
Q

barbituates: moa

A

effect on GABA receptor-channel complex = dose dependent

- accelerates metabolism of some drugs

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15
Q

barbituates: adverse effects

A
  • abuse (schedule II - IV)
  • respiratory depression
  • increased sensitivity to pain; pain
  • tolerance
  • cross tolerance to all general cns depressants (except opioids)
  • toxicity
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16
Q

barbituates classification

A

determined by duration of action related to lipid solubility
– ultrashort, short, intermediate, long-acting

17
Q

barbituates: tolerance nota bene

A

to therapeutic levels, NOT to adverse effects

18
Q

barbituates: early toxicity

A

early: restlessness, insomnia, confusion

19
Q

barbituates: late toxicity

A

late: convulsions, psychosis, cardiac collapse, death
overdose
VERY EASY

20
Q

barbituates: overdose s/s

A

everything is shutting down!

respiratory depression, pin point pupils, coma*
*triad of overdose s/s (RED FLAG! PROB BARBITUATE OD!)

hypotension, hypothermia,

21
Q

barbituates: overdose treatment

A

gastric lavage, multi-system support

- won’t see often, but when you see it, it SUCKS

22
Q

barbituates: triad s/s of overdose, red flag!

A

respiratory depression, pin point pupils, coma

23
Q

benzodiazepine-like drugs: commonly used (3)

A

zolpidem (ambien)
zaleplon (sonata)
eszopiclone (lunesta)

24
Q

benzodiazepine-like drugs: use

A

initially, insomnia

25
Q

benzodiazepine-like drugs: moa

A

selective benzodiazepine agonist qualities (GABA receptor-chloride channel)

26
Q

benzodiazepine-like drugs: common side effects

A

drowsiness, dizziness, headache
dry mouth
controlled substance, schedule IV!

27
Q

benzodiazepine-like drugs: schedule

A

controlled substance, schedule IV!

28
Q

ramelteon (rozerem)

A

class: melatonin agonist
use: insomnia
moa: activates specific receptor subtypes of melatonin

adverse effects: drowsiness, dizziness, fatigue
- neuroendocrine effects secondary to high prolactin and low testosterone

interactions: fluvoxamine (luvox) !!!!!
increases levels 50-60x. VERY DANGEROUS

29
Q

ramelteon (rozerem): notable interaction

A

fluvoxamine (luvox) !!!!!

increases levels 50-60x. VERY DANGEROUS

30
Q

buspirone (buspar)

A

NOT SEDATIVE-HYPNOTIC!

class: spiro compound
moa: not clearly established
- high affinity to 5HT receptors
- low affinity to dopamine receptors
- DOES NOT BIND to GABA or benzo sites

administration: better absorbed when taken with food
- lag time to peak effectiveness (3-6 weeks)

adverse effects
dizziness, headache
nausea
nervousness, excitement

31
Q

zolpidem (intermezzo)

A

use: middle-stage insomnia
route: sublingual!

schedule IV

side effects: similar to other benzo-like meds, does have anterograde side effects

32
Q

trazodone (desyrel)

A

atypical antidepressant, but can be used for insomnia

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