Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD4001 Pharmacology > Anxiolytics and Sedatives > Flashcards

Anxiolytics and Sedatives Flashcards

1
Q

What is a barbiturate?

A
  • CNS depressant
  • Obsolete as anxiolytics
  • Associated with addiction
  • Used as IV induction (bipentone) agents and anti-convulsants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name different classes of drugs which can be used to treat anxiety [symptoms] ?

A
  • Antidepressants
  • Benzodiazepines
  • Z-drugs
  • B-blockers
  • Melatonin
  • Sedating antihistamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are properties associated with benzodiazepines?

A
  • Highly lipophilic
  • Well absorbed orally
  • Highly protein bound (95%)
  • Hepatic metabolism
  • Active metabolites
  • Excreted as glucoronide conjugate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 5 main effect of benzodiazepines?

A
  • Anxiolytic: reduce anxiety (a2 and a3)
  • Hypnotic: induce sleep (a1)
  • Reduce muscle tone
  • Anterograde amnesia (pros and cons)
  • Anticonvulsant effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the main difference between different benzodiazepines?

A

Duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can benzodiazepines be given?

A
  • Orally
  • IV
  • Intranasal or rectal
  • NOT IM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the short acting benzodiazepines?

A
  • Lorazepam
  • Temazepam
  • t1/2: 8 - 12 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the intermediate benzodiazepines?

A

Flunitrazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the long-acting benzodiazepines?

A

Diazepam

- t1/2: 20 - 100 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the structure of GABA(A) receptors?

A
  • Pentameric arrangement
  • 2 alpha sub units, 2 Beta sub units and 1 gamma sub unit
  • Central ion channel pore
  • 18 possible sub units
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do benzodiazepines bind to?

A

Act allosterically GABA receptors - increase frequency of opening
- Different part of GABA receptor to GABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can act on GABA(A) receptors?

A
  • Benzodiazepines
  • Alcohol
  • General anaesthetics
  • Z-drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What travels throught the central ion channel?

A

Cl-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is flumazenil used for clinically?

A
  • Reverse the effect of benzodiazepines
  • Competitive benzodiazepine antagonist
  • Short half-life compared with benzodiazepines
  • May precipitate agitation and seizures
  • Given IV in 100mcg increments
  • Side effects of nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are Z drugs?

A
  • Alternatives to benzodiazepines - bind to benzodiazepines on GABA receptors
  • Structurally different but have a very similar pharmacodynamic profile,slightly shorter acting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the “Z” drugs

A
  • Zopiclone
  • Zaleplon
  • Zolpidem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the definition of tolerance?

A

A physiological state characterized by a decrease in the effects of a drug with chronic administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does tolerance affect benzodiazepines?

A

Develops quickly for sedative effects, more slowly for anxiolytic and anticonvulsant effects

19
Q

What is involved in the mecahnism of tolerance in benzodiazepines?

A
  • Neuro-adaptive process
  • Desensitisation of inhibitory GABA receptors
  • Sensitisation of (excitatory) NMDA receptors
  • Adaptations take plae on different time scale
20
Q

What is associated with dependance of benzodiazepines?

A
  • Drug induces rewarding experience
  • Drug taking becomes compulsive
  • Psychological dependance
  • Physical dependance
  • Genetic factors
21
Q

What are the effects of benzodiazepine withdrawal?

A
  • Result of physcial dependance
  • Increased anxiety, onset / exacerbation of depression
  • Disturbed sleep
  • Pain, stiffness, musular aches
  • Convulsions
  • Can occur after relatively short course of treatment
22
Q

What was added to Rohypnol to make it less easy to “spike” people?

A

Blue dye

23
Q

What is a recent concern associated with benzodiazepine use?

A

Alzheimer’s

24
Q

What is the clinical role of sedative and anxiolytic agents?

A
  • To enable potentially uncomfortable diagnostic and therapeutic procedures to be carried out
  • Management of acute alcohol withdrawal
  • Management of insomnia (not first line)
  • Management of generalised anxiety states (not first line)
  • Other: anticonvulsant
25
Q

How is acute alcohol withdrawal managed?

A
  • Acute admission to hospital, supply of alcohol interrupted
  • Index of suspicion (alcohol history, severity of alcohol dependance questionnaire)
  • Assessment of withdrawal symptoms
  • Chloridiazepoxeide 1-2 week reducing regime
26
Q

What is involved in the CAGE questionnaire?

A
  • Though about Cutting down?
  • Annoyed by other people critisising your drinking
  • Guilty about drinking
  • Eye-opener - taken a drink in the morning to ease a hangover
27
Q

What are the symptoms of alcohol withdrawal?

A

May start 8 hours after drop in alcohol levels (Peak day 2)

  • Insomnia / anxiety / restlessness / agitation
  • Tremor
  • Nausea and vomiting
  • Sweating
  • Palpitations
  • Hallucinations
  • Seizures
28
Q

What investigations are suggestive of chronic alcohol consumption?

A
  • Raised MCV (FBC)
  • Pancytopenia (result of alcohol induced bone marrow suppression)
  • Folate deficiency
  • Prolonged prothrombin time
29
Q

How is insomnia managed?

A
  • Difficulty geting off or waking up early?
  • Assessment? pain/breathlessness
  • Good sleep hygiene
  • Hypnotics reserved for the acutely distressed
  • Caution in elderly (confusion, falls, slower metabolism)
30
Q

Why are hypnotics advised to not be taken every night in the community?

A
  • Tolerance and dependance (do have hangover effect)
31
Q

What is sleep hygiene?

A

Aims to make people more aware of behavioural, environmental and temporal factors that may be detrimental or beneficial to sleep

32
Q

What is associated with sleep hygiene?

A
  • Regular pattern
  • Regular exercise (not just before sleep)
  • Bedroom cool, dark, quiet
  • Caffeine, alcohol and smoking not advised within 6 hours
  • Screen time to be avoided 30 mins before bed
  • Naps to be avoided
33
Q

What is prescribed for insomnis?

A
  • Short acting benzodiazepine or z-drug
  • Lowest effective dose for shortest time
  • Inform patient no repeat prescriptions and explain why also that may want to take intermittently
34
Q

How are prolonged seizures managed?

A
  • Protect patient from injury
  • Oxygen
  • Consider / exclude hypoglycaemia
  • Longer than 5 mins - IV lorazepam
  • IV access not available consider rectal diazepam or intranasal / buccal midazolam
35
Q

If you are giving sedation for therapeutic procedure what are you aiming for?

A

Conscious sedation (sleepy but can respond to commands, can maintain own airway)

36
Q

When can spontaneous ventialtion be inadequate?

A
  • Deep sedation / analgesia (may be inadequate)

- General anaesthesia (frequently inadequate) (CV function may also be impaired)

37
Q

How is acute anxiety managed?

A
  • CBT
  • Mantras, minduflness, worrytime
  • Reduce caffeine, reduce alcohol
38
Q

When are benzodiazepines recommended?

A

Indicated for short-term (2 to 4 weeks) relief of anxiety that is severe and disabling

39
Q

What other drug besides benzodiazepines can be used to treat anxiety?

A
  • Beta blockers (usually propanolol)
  • SSRIs
  • Gabapentin and pregabalin (also chronic pain)
40
Q

What are the effects of Beta blockers on anxiety?

A
  • Somatic symptoms of anxiety
  • Sympathetic system decreased
  • Helps with tachycardia, palpitations, tremor, sweating
  • Propranolol
41
Q

What is melatonin?

A
  • Naturally occuring hormone synthesised in pineal gland
  • liscensed for insomnia of those >55
  • Used for children with neurological disability (e.g cerebral palsy)
42
Q

What is the law on driving (march 2015) in relation to prescribed drugs?

A
  • Not clear
  • If driving is impaired you arebbreaking the law
  • In relation to benzodiazepines, opioids and amphetamines
43
Q

What percentage of doctors become substance dependant in theor lifetime?

A
  • 10 - 14 % of all doctors

- ~ 2.7 times higher in anaesthetists than other physician groups

MD4001 Pharmacology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions