Anxiolytics and Hypnotics

Question 1

What 3 different groups of drugs can be classed as Anxiolytics?

Answer 1

Beta blockers
SSRIs
Benzodiazepines

Question 2

Why should benzodiazepines not be prescribed for extended periods?

Answer 2

High risk of dependency and abuse

Question 3

Why are Beta Blockers often prescribed to patients with anxiety?

Answer 3

To deal with the physiological effects of this disorder

Question 4

Which benzodiazepine is often prescribed in alcohol withdrawal?

Answer 4

Chlordiazepoxide (Librium)

Question 5

What is the onset time for midazolam?

Answer 5

15 to 30 minutes

Question 6

What is the mechanism of action of benzodiazepines?

Answer 6

Bind to Gamma-aminobutyric Acid (GABA) receptor -chloride channel molecule. They intensify the effect of GABA.

Question 7

What is GABA?

Answer 7

Gamma-aminobutyric Acid

A natural inhibitory neurotransmitter found throughout the brain

Question 8

What does GABA do in the body?

Answer 8

GABA is responsible for regulating the nerve impulses in the human body which helps in maintaining the muscle tone.

Question 9

What is a benefit of benzodiazepines over barbiturates

Answer 9

They do not cause life threatening respiratory depression or coma if taken in excessive amounts.

Question 10

What are common side effects of benzodiazepines?

Answer 10

Drowsiness, sedation, lethargy, ataxia.

Question 11

What is the mechanism of action of Beta-Blockers?

Answer 11

They are known as Beta-adrenoreceptor blockers

Block action of NE on Beta1,2,3 receptors (in heart, peripheral vasculature, bronchi, pancreas and liver.

Question 12

What is the common ending of Beta-blockers?

Answer 12

“olol”

Question 13

What is the advantage of water soluble beta-blockers over lipid soluble varieties?

Answer 13

Less likely to cross into brain and may therefore cause less sleep disturbances and nightmares.

Question 14

Max length of time to use Benzo’s for anxiety?

Answer 14

2-4 weeks to avoid dependency

Question 15

When should benzodiazepines not be used to treat insomnia or anxiety?

Answer 15

When insomnia is not severe

To treat short term mild anxiety

Question 16

What is the withdrawal period for Benzo’s?

Answer 16

Short term use should taper down over 2-4 weeks

Long term use should taper down over several months or more

Question 17

What are the characteristic signs of Benzodiazepine withdrawal syndrome?

Answer 17

Insomnia
Anxiety
Loss of appetite
Weight loss
Tremor
Perspiration
Tinnitus
Perceptual disturbances

Question 18

When can Benzodiazepine withdrawal syndrome occur?

Answer 18

Usually anytime up to 3 weeks after stopping long-acting benzo’s but may appear within a day of stopping short acting ones.

Question 19

What effects can occur if benzodiazepines are stopped abruptly?

Answer 19

Confusion
Toxic Psychosis
Convulsions
Condition resembling delirium tremens.

Question 20

What are the Z drugs?

Answer 20

Zaleplon
Zolpidem
Zopiclone

Question 21

Which is the most short acting Z drug?

Answer 21

Zaleplon

Question 22

What is the treatment for transient insomnia?

Answer 22

Short acting Hypnotic

1 or 2 doses prescribed only

Question 23

What is the treatment for short term insomnia?

Answer 23

Preferably only prescribe hypnotic for one week but no more than 3 weeks.

Question 24

How quickly can someone build up a tolerance to the effects of hypnotics with continuous use?

Answer 24

Within 3-14 days.

Question 25

Why might some benzodiazepines rather than hypnotics be useful to treat insomnia?

Answer 25

Where the cause of insomnia is related to daytime anxiety.

Question 26

Which drugs are not suitable for patients with unstable myasthenia gravis?

Answer 26

Z drugs