Anxiolytics/hypnotics Flashcards
Choice of benzodiazepine based on —? (3)
- Time to onset of action
- Duration of action
- Method of metabolism
What are the 4 short half-life benzos?
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Oxazepam (Serax)
- Temazepam (Restoril)
What are the 3 long half-life benzos?
- Clonazepam
- Diazepam
- Chlordiazepoxide
Which benzo is used for alcohol detoxification?
Chlordiazepoxide
Which benzos are not metabolized by the liver? (thus safe to use in chronic alcoholics or liver disease) (3)
LOT
- Lorazepam
- Oxazepam
- Temazepam
Which long half-life benzo has the fastest onset?
Diazepam
What can be used to treat benzo overdose?
Flumazenil (benzo antagonist)
Side effects of benzos (5)
- Drowsiness
- Dizziness
- Reduced motor coordination (ataxia) careful in elderly
- Cognitive impairments
- Amnesia
What are the withdrawal symptoms of benzos? (6)
anxiety, insomnia, restlessness, agitation, irritability, muscle tension
What are the 5 nonbenzo hypnotics?
- Zolpidem
- Zaleplon
- Eszopiclone
- Diphenhydramine (Benadryl)
- Ramelteon
Which nonbenzo hypnotics are GABAergic?
Zolpidem, zaleplon, eszopiclone (3 Zs)
Rank the half-lives of zolpidem, zaleplon, eszopiclone in order of increasing half lives
Zaleplon > Zolpidem > Eszopiclone
What are the side effects of the 3 Zs?
- Dizziness
2. GI side effects (nausea, vomiting, dyspepsia)
What is diphenhydramine?
antihistamine
What is the mechanism of action of Ramelteon?
Selective melatonin MT1 and MT2 agonists
What are the non-benzo anxiolytics? (3)
- Buspirone (BuSpar)
- Hydroxyzine (Atarax)
- Propranolol
Mechanism of action of Buspirone?
partial agonist of 5HT1A
What is the onset of action of buspirone?
1-2 wks for effect (slower onset of action than BDZ)
What is the indication of buspirone?
often used as an ADJUNCT for treatment of GAD or MDD
Mechanism of action of hydroxyzine?
antihistamine
Indications for hydroxyzine?
Pts who want quick-acting, short-term medication, but who cannot take benzos for various reasons
- situational anxiety
Propranolol is useful in treating –? (2)
- Autonomic effects of panic attacks or performance anxiety (ex. palpitations, sweating, tachycardia)
- Akathisia (s/e of typical antipsychotics)
