Anxiolytics and hypnotics Flashcards

1
Q

In general terms, explain what anxiolytics do and when these are appropriate for use

A
  • decrease feelings of anxiety
  • appropriate when anxiety is no longer serving as a stimulus or motivator but is chronically stimulating the sympathetic nervous system leading to medical and social problems
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2
Q

In general terms, explain what hypnotics do, in relation to sedation

A
  • Sedation refers to the loss of awareness and reaction to environmental stimuli.
  • Sedation often causes drowsiness (harmful or desirable depending on life vs surgery)
  • Sedation is also anxiolytic
  • hypnotics cause extreme sedation which results in further CNS depression and sleep
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3
Q

What is the mechanism of action of Benzodiazepines?

A
  • Benzodiazepines ENHANCE the effect of GABA-an inhibitory neurotransmitter which modulates excitatory pathways in the brain.
  • Benzos increase the affinity of GABA to GABA-A receptors
  • These are found in the post-synaptic membrane and are ligand-gated receptors which open when bound, allowing Cl- ions to flow into the cell, thus hyperpolarising it
  • This inhibits the neuronal activity in areas of the brain associated with anxiety and sleep: GABA-A receptors are highly concentrated in the limbic system (and to some extent RAS-explains the sedative effects)
  • (Benzos are absorbed from the GI tract and reach peak levels between 30 minutes and 2 hours)
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4
Q

What is the mechanism of action of Hypnotics?

A
  • Same action of enhancing effects of GABA
  • main effect is in the Reticular Acitivating System (made up of CNS-spinal cord and cerebellum-mediates overall level of consiousness)
  • hence selective hypnotic over anxiolytic benefits
  • They block the brain’s response to incoming stimuli
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5
Q

Name 5 Benzodiazepines

A
  • Lozarepam
  • Diazepam
  • Clonazepam
  • Temazepam
  • Chlordiazepoxide
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6
Q

Name 2 non-benzodiazepine hypnotics

A
  • Zolpidem
  • Zopiclone
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7
Q

What are all Benzodiazepines indicated for?

A
  • Short term anxiety
  • Insomnia related to anxiety
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8
Q

What are Lorazepam and Diazepam additionally indicated for (and what is the difference between the two)?

A
  • Management of Status Epileptus
  • Lorazepam is (ironically) short acting, versus Diazepam being long acting
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9
Q

What is Chloridazepoxide additionally indicated for?

A
  • Alcohol withdrawal in cases of dependence
  • long duration of action
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10
Q

What is Temazepam additionally indicated for?

A
  • Sometimes used for its calming effect before surgeries
  • Short duration of action
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11
Q

Which patients are Non-Benzodiazepine hypnotics indicated for?

A

Patients with Insomnia (which could be as a result of MH disorder)

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12
Q

What are the contraindications of both Benzodiazepines and Non-benzodiazepine Hypnotics?

A
  • Neuromuscular respiratory weakness
  • Sleep apnoea syndrome
  • Not over 60 years old
  • Pregnancy
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13
Q

What are the side effects of Benzodiazepines?

A
  • Continued Drowsiness
  • Amnesia and Confusion
  • Ataxia
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14
Q

Tell me about Ataxia

A

Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements caused by damage to Cerebellum - Symptoms include:

  • balance and walking
  • speaking
  • swallowing
  • tasks that require a high degree of control, such as writing and eating
  • vision
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15
Q

What are the side effects of non-Benzodiazepine Hypnotics, general and specific?

A

General;

  • Continued Drowsiness
  • Increased risk of depression

Specific;

  • Taste Disturbance/metallic taste (Zopiclone)
  • Hallucinations/Nightmares (Zolpidem)
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16
Q

What patient education would be pertinent to somebody starting Benzodiazepines and non-Benzodiazepine Hypnotics?

A
  • Drowsiness may continue the next day, so avoiding/taking care when operating heavy machinery or driving-also note this drowsiness might make some stressors more difficult to manage
  • long term regular use (>6 weeks) can lead to tolerance and sometimes dependence
  • not to be combined with use of other CNS depressants such as alcohol
  • In some cases, initially see a paradoxical increase in aggression (just Benzos)
  • If stomach upset, try small meal or bowel programme if needed (just non-benzos)