Anxiolytics/Hypnotics

Question 1

anxiolytics are the most widely prescribed psychotropic meds… name 6 indications for this class of medications

Answer 1

1) anxiety disorder
2) muscle spasms
3) alcohol withdrawal
4) seizures
5) anesthesia induction
6) sleep disorders

Question 2

How do benzodiazepenes (BZDs) reduce anxiety?

Answer 2

They increase levels of GABA (inhibitory neurotransmitter)

Question 3

BZDs are split up into groups based on half-life… which are long-acting (>20hrs)? (2)

Answer 3

1) Diazepam (valium)

2) Clonazepam (klonopin)

Question 4

What does diazepam usually treat?

Answer 4

used for detox from alcohol and for seizures… less often for anxiety

Question 5

What does clonazepam usually treat and what do you need to check before/while prescribing it/

Answer 5

treats anxiety including panic attacks; avoid use with renal dysfunction!

Question 6

What are the intermediate-acting (6-20hrs) BZDs? (4)

Answer 6

"ALOT"
Alprazolam
Lorazepam
Oxazepam
Temazepam

Question 7

Even though commonly used in treating chronic alcoholics… 3 BZDs in particular should be used because they are NOT metabolized by the liver… which (3) are they?

Answer 7

1) Lorazepam
2) Oxazepam
3) Temazapam “LOT”

Question 8

Why should patients be warned about not drinking alcohol while taking BZDs?

Answer 8

Together they combine to decrease respiratory drive… can lead to death

Question 9

What is alprazolam useful for treating?

Answer 9

this is xanax, its useful for anxiety, specific phobias, and panic attacks

Question 10

What is the treatment for OD on BZDs?

Answer 10

Flumazenil… however don’t induce withdrawal too quickly as this can be life-threatening (they reverse BZD receptor agonists)

Question 11

What are the 2 short-acting (

Answer 11

1) Triazolam
2) Midazolamm (versed)

They are typically used in medical and surgical settings

Question 12

What are the 4 “non-benzo” hypnotics?

Answer 12

1) Zolpidem (aka ambien)
2) diphenhydramine (benadryl)
3) chloral hydrate
4) Ramelteon

Question 13

What is the MOA of zolpidem?

Answer 13

basically the same as a benzo… its just simply chemically different but still acts at the same receptor to cause sedation (benzodiazepene receptor 1)… except these have no risk of tolerance or dependence… it is a very safe drug

Question 14

What are the “4” non-benzo anxiolytics?

Answer 14

1) buspirone
2) hydroxyzine
3) Barbituates
4) propranolol

Question 15

What is the MOA of buspirone?

Answer 15

it binds 5-HT 1A (partial agonist)… It actually is not as effective as benzos so it is typically used as an adjunct to like an SSRI for anxiety

Question 16

Why is buspirone a better choice for an alcoholic with anxiety?

Answer 16

Because it does not potentiate CNS depression if combined with alcohol!… also has a low abuse/addition potential

Question 17

MOA of hydroxyzine?

Answer 17

Useful for pts who want quick-acting, short-term medication but cannot take benzos for whatever reason (prior abuse or alcohol abuse)

Question 18

Why are barbituates (phenobarbitol etc) rarely used now?

Answer 18

very lethal in overdose and induce cyp450

Question 19

how does propranolol work?

Answer 19

it blocks autonomic effects of panic attacks… thus helping with “heart beating out of chest” performance anxiety… often used to treat akathisia.

Question 20

Random: What are the drugs that can treat ADHD?

Answer 20

1) dextroamphetamine
2) Methylphenidate (ritalin, concerta)
3) atomoxetine (presynaptic NE transporter inhibitor)
4) modafinil

Question 21

What are 5 drugs that act as Acetylcholinesterase inhibitors? what do they help to treat… and for what levels of severity?

Answer 21

1) Donepezil
2) Galantamine
3) Rivastigmine
4) Tacrine
5) Memantine… this is the only one that treats moderate to severe alzheimers… all others are for mild to moderate alzheimers…

Question 22

What is the effectiveness of ECT based on?

Answer 22

length of post-ictal state… NOT length of seizure!

Recall u want to do 8-12 treatments… given 3X/week and monthly maintenance ECT to prevent relapse of symptoms