Anxiolytics / Hypnotics Flashcards
Benzo MOA =
GABA potentiation
Benzo Indications =
- Acute anxiety
- Panic disorder
- EtOH withdrawal
- Muscle spasm
- Sleep disorders
- Anesthesia induction
Diazepam
- Half-life =
- Onset =
- Indications
Half life = Long acting
Onset = Rapid
Indications:
- Detox from EtOH
- Seizures
- Rarely anxiety
Clonazepam
- Half-life =
- Avoid if patient has…
- Indications
Half life = Long acting
Avoid if patient has…
- Renal dysfunction
Indications:
- Anxiety
- Panic Attacks
Alprazolam
- Indications
- Half life
- Onset of action
- Anxiety and panic attacks
- Intermediate half life
- Rapid onset of action
Lorazepam
- Indications
- Half life
- Metabolism
- Panic attacks; EtOH withdrawal; agitation
- Intermediate
- Not metabolized by liver
Oxazepam
- Indications
- Metabolism
- EtOH withdrawal
- Not metabolized by liver
Triazolam
- Indications
- Issues
- Insomina in the medical setting
- Short acting, rapid onset makes it a big abuse issue
Midazolam
- Indications
- Issues
- Insomina in the medical setting
- Short acting, rapid onset makes it a big abuse issue
Benzos side effects =
- Drowsiness
- Impairment of intellectual function
- Reduced motor coordination
- Anterograde amnesia
- Withdrawal can be life threatening
- Repiratory depression
The most important non-benzo hypnotics =
- Zolpidem
- Zaleplon
- Eszopiclone
- Diphenhydramine (Benadryl)
- Chloral hydrate
- Ramelteon
Zolpidem
- MOAt
- Indications
- Tolerance / Dependence risk
- Side Effects
MOA = selective binding to benzo-1 receptor, which is responsible for sedation
Indications = Insomnia
Tolerance / Dependence risk = Low
Side Effects =
- Anterograde Amnesia
- Halluncinations
- Sleepwalking
- GI side effects
Zaleplon
- MOA
- Indications
- Tolerance / Dependence risk
- Side Effects
MOA = selective binding to benzo-1 receptor, which is responsible for sedation
Indications = Insomnia
Tolerance / Dependence risk = Low
Side Effects =
- Anterograde Amnesia
- Halluncinations
- Sleepwalking
- GI side effects
Eszopiclone
- MOA
- Indications
- Tolerance / Dependence risk
- Side Effects
MOA = selective binding to benzo-1 receptor, which is responsible for sedation
Indications = Insomnia
Tolerance / Dependence risk = Low
Side Effects =
- Anterograde Amnesia
- Halluncinations
- Sleepwalking
- GI side effects
Diphenhydramine
- MOA
- Side Effects
MOA = anti-histamine
Side Effects =
- Sedation
- Dry Mouth
- Constipation
- Urinary retention
Chloral Hydrate
- Commonly prescribed?
- Lethal? How?
- No, due to poor side effect profile
- Lethal in overdose due to hepatic failure
Ramelteon
- MOA =
MT1 and MT2 agonist (melatonin)
Buspirone
- Class
- MOA
- Indications
- Onset
- Pros
- Cons
- Non-benzo anxiolytic
- 5HT-1A partial agonist
- Anxiety (in combo with an SSRI)
- 1-2 week onset
- Does not potentiate the CNS depression of EtOH
- Slow onset
Hydroxyzine
- Class
- Indications
- Side Effects
- Antihistamine anxiolytic
- Good for quick acting anxiolysis in ptns who can’t have benzos
- Sedation, blurry vision, dry mouth, constipation, urinary retention
Barbituates
- Rarely used now because…
They are more lethal than benzos
Propanolol
- Indications
- Blocking autonomic features of anxiety
- Akathisia
Prazosin indications and MOA:
Prazosin is the first line agent for nightmares associated with PTSD.
It is an alpha-1 adrenergic antagonist
Issue with benzos and elderly patients =
elderly patients are particularly sensitive to the effects of benzos, and therefore you shouldn’t be increasing the doses of benzos in elderly patients in delirium.
Best drug to use in elderly demented patient who needs help falling asleep:
- Trazodone
This is a serotonergic agent which can be used to help patients with sleeping problems.
What to be careful of when giving trazodone to elderly patients:
Since trazodone has some anti-adrenergic properties, it can cause orthostatic hypotension.
Therefore you should be careful giving this drug to elderly patients who are at a higher risk of falling anyhow.
Quetiapine in elderly patients:
This is not recommended for elderly patients–in fact–all 2nd generation antipsychotics there is a risk of sudden death in elderly patients. Therefore they are usually avoided.
Best drug to use for middle insomnia and why?
Zaleplon, since it has a shorter half life than the other non-benzo hypnotics.
Which anxiolytics will not interact with warfarin, and are therefore relatively safe to give to patients on anticoagulation?
Benzodiazepines
