Anxiolytics and Hypnotics Flashcards
What 3 different groups of drugs can be classed as Anxiolytics?
Beta blockers
SSRIs
Benzodiazepines
Why should benzodiazepines not be prescribed for extended periods?
High risk of dependency and abuse
Why are Beta Blockers often prescribed to patients with anxiety?
To deal with the physiological effects of this disorder
Which benzodiazepine is often prescribed in alcohol withdrawal?
Chlordiazepoxide (Librium)
What is the onset time for midazolam?
15 to 30 minutes
What is the mechanism of action of benzodiazepines?
Bind to Gamma-aminobutyric Acid (GABA) receptor -chloride channel molecule. They intensify the effect of GABA.
What is GABA?
Gamma-aminobutyric Acid
A natural inhibitory neurotransmitter found throughout the brain
What does GABA do in the body?
GABA is responsible for regulating the nerve impulses in the human body which helps in maintaining the muscle tone.
What is a benefit of benzodiazepines over barbiturates
They do not cause life threatening respiratory depression or coma if taken in excessive amounts.
What are common side effects of benzodiazepines?
Drowsiness, sedation, lethargy, ataxia.
What is the mechanism of action of Beta-Blockers?
They are known as Beta-adrenoreceptor blockers
Block action of NE on Beta1,2,3 receptors (in heart, peripheral vasculature, bronchi, pancreas and liver.
What is the common ending of Beta-blockers?
“olol”
What is the advantage of water soluble beta-blockers over lipid soluble varieties?
Less likely to cross into brain and may therefore cause less sleep disturbances and nightmares.
Max length of time to use Benzo’s for anxiety?
2-4 weeks to avoid dependency
When should benzodiazepines not be used to treat insomnia or anxiety?
When insomnia is not severe
To treat short term mild anxiety
What is the withdrawal period for Benzo’s?
Short term use should taper down over 2-4 weeks
Long term use should taper down over several months or more
What are the characteristic signs of Benzodiazepine withdrawal syndrome?
Insomnia Anxiety Loss of appetite Weight loss Tremor Perspiration Tinnitus Perceptual disturbances
When can Benzodiazepine withdrawal syndrome occur?
Usually anytime up to 3 weeks after stopping long-acting benzo’s but may appear within a day of stopping short acting ones.
What effects can occur if benzodiazepines are stopped abruptly?
Confusion
Toxic Psychosis
Convulsions
Condition resembling delirium tremens.
What are the Z drugs?
Zaleplon
Zolpidem
Zopiclone
Which is the most short acting Z drug?
Zaleplon
What is the treatment for transient insomnia?
Short acting Hypnotic
1 or 2 doses prescribed only
What is the treatment for short term insomnia?
Preferably only prescribe hypnotic for one week but no more than 3 weeks.
How quickly can someone build up a tolerance to the effects of hypnotics with continuous use?
Within 3-14 days.
Why might some benzodiazepines rather than hypnotics be useful to treat insomnia?
Where the cause of insomnia is related to daytime anxiety.
Which drugs are not suitable for patients with unstable myasthenia gravis?
Z drugs
