anxiety & insomnia Flashcards
sedative-hypnotics as anti-anxiety agents: kinds (3)
benzodiazepines
barbituates
benzodiazepine-like drugs
abuse potential barbituates vs benzodiazepines
barbiturates > benzodiazepines
benzodiazepines: class, use, distribution, metabolism
sedative-hypnotic
uses: sleep, anxiety
distribution: high lipid solubility, protein bound
metabolism: liver
benzodiazepines: moa
enhances GABA
- binds to specific receptor sites in GABA receptor-channel complex
- finite number of GABA receptors, difficult to overdose (unless high IV doses)
benzodiazepines: commonly used (4)
alprazolam (xanax)
lorazepam (ativan)
clonazepam (klonopin)
diazepam (valium)
benzodiazepines: adverse effects
- CNS depression
- respiratory depression (VERY QUICKLY)
- anterograde amnesia
- paradoxical psychological effects
- tolerance
- dependence
- toxicity
- abuse (schedule IV)
benzodiazepines: toxicity
unusual, unless mixed with other antidepressant
benzodiazepines: rapid toxicity in babies - why?
rapid CNS toxicity because underdeveloped BBB
– readily crosses placenta and enters breastmilk
benzodiazepines: drug-drug interaction
few - NOTABLY CNS DEPRESSANTS
benzodiazepines: advantages
rapid onset (stops seizures fast!) well tolerated few drug-drug interactions little effect on CVS generics available
flumazenil (romazicon)
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
benzodiazepine overdose likely due to…
IV administration
barbituates: class + use
sedative-hypnotic (-arbitol)
use: seizure disorder, sedation (other drugs much safer)
barbituates: moa
effect on GABA receptor-channel complex = dose dependent
- accelerates metabolism of some drugs
barbituates: adverse effects
- abuse (schedule II - IV)
- respiratory depression
- increased sensitivity to pain; pain
- tolerance
- cross tolerance to all general cns depressants (except opioids)
- toxicity
barbituates classification
determined by duration of action related to lipid solubility
– ultrashort, short, intermediate, long-acting
barbituates: tolerance nota bene
to therapeutic levels, NOT to adverse effects
barbituates: early toxicity
early: restlessness, insomnia, confusion
barbituates: late toxicity
late: convulsions, psychosis, cardiac collapse, death
overdose
VERY EASY
barbituates: overdose s/s
everything is shutting down!
respiratory depression, pin point pupils, coma*
*triad of overdose s/s (RED FLAG! PROB BARBITUATE OD!)
hypotension, hypothermia,
barbituates: overdose treatment
gastric lavage, multi-system support
- won’t see often, but when you see it, it SUCKS
barbituates: triad s/s of overdose, red flag!
respiratory depression, pin point pupils, coma
benzodiazepine-like drugs: commonly used (3)
zolpidem (ambien)
zaleplon (sonata)
eszopiclone (lunesta)
benzodiazepine-like drugs: use
initially, insomnia
