Anxiolytic & Hypnotic Agents

Question 1

Define anxiolytic

Answer 1

Drugs used to depress the central nervous system; prevents the signs and symptoms of anxiety

Question 2

Define hypnotic

Answer 2

Drugs used to depress the CNS; causes sleep

Question 3

What is sedation?

Answer 3

Loss of awareness and reaction to environmental stimuli

Question 4

What are the sites of actions of benzodiazepines and barbiturates?

Answer 4

Epinephrine, norepinephrine, acetylcholine, serotonin, GABA

Question 5

What is the action of benzodiazepines?

Answer 5

Act in the limbic system and the RAS
Make GABA more effective 
Causes interference with neuron firing
Lower doses cause anxiolytic effects
Higher doses cause sedation and hypnosis

Question 6

What are the indications for use for benzos?

Answer 6

Anxiety disorders
Alcohol withdrawal
Hyper excitability and agitation
Pre operative relief of anxiety and tension

Question 7

Pharmacokinetics of benzos?

Answer 7

Well absorbed in the GI tract
Metabolized in the liver 
Excreted in the urine 
Lipid soluble and well distributed throughout the body (extended period in body - build up)
Cross placenta and enters breast milk

Question 8

What are the contraindications and cautions of benzos?

Answer 8

Allergy, psychosis, acute narrow angle glaucoma, shock, coma, acute alcohol intoxication, pregnancy

Question 9

In what type of patients are benzos not OK to give?

Answer 9

Patients with known illness or patients with head injury

Question 10

Benzo side effects

Answer 10

Sedation Dry mouth
Drowsiness Constipation
Depression Nausea
Lethargy. Vomiting
Blurred vision. Hypotension
Confusion. Urinary retention

Question 11

Benzos may cause peridoxical effects? True or false

Answer 11

True

Question 12

Who is more sensitive to CNS drugs?

Answer 12

African Americans

Question 13

What is the prototype for benzodiazepines?

Answer 13

Diazepam

Question 14

What is the antagonist for diazepam?

Answer 14

Flumazenil given IV

Question 15

Benzos cause anticholinergic effects?

Answer 15

True - dry eyes, dry mouth, constipation

Question 16

It is important for the nurse to remove a patient from a benzo SLOWLY?

Answer 16

True

Question 17

What are the actions of barbiturates?

Answer 17

CNS depression
Inhibit neuronal impulse conduction in the ascending RAS
Depress cerebral cortex
Depress motor output (lose coordination)
Cause: sedation, hypnosis, anesthesia, and coma

Question 18

Barbiturates have more adverse effects and dependency that benzos?

Answer 18

True

Question 19

What are the indications for barbiturates?

Answer 19

Relief of the signs and symptoms of anxiety 
Sedation
Insomnia 
Pre-anesthesia 
Seizures

Question 20

Pharmacokinetics of barbiturates

Answer 20

Well absorbed
Metabolized in the liver
Excreted in the urine 
Reaches peak in 20-60 minutes 
*KNOW LIVER & KIDNEY FUNCTION

Question 21

Contraindication and cautions with barbiturates

Answer 21

Allergy
Previous history of addiction to sedative-hypnotic drugs
Metabolic dysfunction of ABCs
Marked hepatic impairment or nephritis
Respiratory distress or severe respiratory dysfunction
Pregnancy - crosses placenta and enters breast milk

Question 22

Adverse effects of barbiturates

Answer 22

CNS depression. Vertigo
Physical dependency Nausea
Drowsiness. Vomiting
Somnolence Constipation
Lethargy
Ataxia ( walking )

Question 23

Drug-Drug interactions with barbiturates

Answer 23

Alcohol, antihistamines, other tranquilizers

Phenytoin (seizure med)

Question 24

Prototype for barbiturates

Answer 24

Phenobarbital (luminal)

Question 25

What are the other anxiolytic and hypnotic drugs?

Answer 25

Ambien - short-term treatment of insomnia
Antihistamines- pre-op and post-op meds to decrease narcotics
Buspirone- reduces signs and symptoms of anxiety w/o CNS & A.E.

Question 26

Who is at risk for peridoxical effects?

Answer 26

Older adults and young children

Question 27

When is the best time to take these drugs?

Answer 27

Bed time