Anxiolytics and antipsychotics Flashcards
Widely prescribed for anxiety, insomnia and muscle spasm
Benzodiazepines
Food for short tem use and situational anxiety
Benzodiazepines
Can be used with panic disorder due to quick onset
benzodiazepine
Non benzodiazepine
Buspirone (Busbar)
Used for treatment of anxiety disorder, but NOT panic disorder due to its slow onset
Buspirone (Busbar)
Has sedative and muscle relaxant properties
Benzodiazepines
Lacks sedative, skeletal muscle and anti-seizure effect
Buspirone (Busbar)
Not good for pre op anxiety
Buspirone (Busbar)
Does not produce dependance
Buspirone (Busbar)
which has less of a tendency to form tolerance, benzos or barbituates?
Benzos
Which has more tendency for abuse benzos or narcotics?
Narcotics
Benzos mechanism of action
Facilitates the action of GABA by enhancing the affinity for GABA, they DO NOT effect GABA directly
How do GABA receptors work?
GABA is an inhibatory receptor that when activated passes Cl- ions that hyperpolarize the cell and meke the mebrane resistant to excitation
5 pharmacologic effects of Benzodiazepines
- Anxiolysis
- Sedation
- Anterograde Amnesia
- Anticonvulasant action
- Muscle relaxaton at the spinal level
Benzos absorbtion
- highly protein bound
- highly lipid sluable
Benzos Metabolism
Metabolized by CYP 450 system - caution in patients with liver disease
Benzos elimination
Eliminated via the kidneys
RARE CNS effect of Benzos
Paradoxical Excitement
CNS effects of Benzos
- decreased CBF and decreased CMRO2
- Preserves cerebrovascular response to CO2
- Does Not procuce isoelectric EEG
- Does not attenuate ICP response to laryngoscopy
Benzos and Respiratory Effects
- Dose dependant decrease in ventilation
- hypoxemia and hypoventilation enhanced in presence of opioids
- CO2 curve Flattens- does NOT shift
CO2 curves for benzos and narcotics
Benzos - CO2 curve flattens and does not shift
Narcotics- CO2 curve shifts to the right
Benzos Cardiovascular Effects
- At induction doses decreases SVR- so we see a drop in BP
- CO unchanged
Benzos and Laryngoscopy
Even at induction doses Benzos DO NOT attenuated the SNS response to laryngoscopy
Water soluable preperation
Midazolam/Versed
comercially prepared in organic solvents including propylene glycol and benzyl alcohol
Diazepam / Valium
Imidazole ring: pH 3.5 whith an open ring and when it comes to physiologic pH of 7.4 the ring closes speeding the effect of action and increasing lipid solubility
Midazolam/Versed
Viscous: pH 6.6-6.9
Diazepam / Valium
Very highh affininty for Benzo receptor on GABA
Midazolam / Versed
2-3 x the ptency of diazepam
Midazolam / Versed
Painful IV and IM injection
Diazepam / Vallium
90-98% protein bound
Midazolam / Versed
5-10x the potency of Diazepam
Lorazepam / Ativan
Most Potent Amnestic of the Benzos used in anesthetic practice
Lorazepam / Ativan