Anxiolytics/Hypnotics Flashcards
anxiolytics are the most widely prescribed psychotropic meds… name 6 indications for this class of medications
1) anxiety disorder
2) muscle spasms
3) alcohol withdrawal
4) seizures
5) anesthesia induction
6) sleep disorders
How do benzodiazepenes (BZDs) reduce anxiety?
They increase levels of GABA (inhibitory neurotransmitter)
BZDs are split up into groups based on half-life… which are long-acting (>20hrs)? (2)
1) Diazepam (valium)
2) Clonazepam (klonopin)
What does diazepam usually treat?
used for detox from alcohol and for seizures… less often for anxiety
What does clonazepam usually treat and what do you need to check before/while prescribing it/
treats anxiety including panic attacks; avoid use with renal dysfunction!
What are the intermediate-acting (6-20hrs) BZDs? (4)
"ALOT" Alprazolam Lorazepam Oxazepam Temazepam
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?
1) Lorazepam
2) Oxazepam
3) Temazapam “LOT”
Why should patients be warned about not drinking alcohol while taking BZDs?
Together they combine to decrease respiratory drive… can lead to death
What is alprazolam useful for treating?
this is xanax, its useful for anxiety, specific phobias, and panic attacks
What is the treatment for OD on BZDs?
Flumazenil… however don’t induce withdrawal too quickly as this can be life-threatening (they reverse BZD receptor agonists)
What are the 2 short-acting (
1) Triazolam
2) Midazolamm (versed)
They are typically used in medical and surgical settings
What are the 4 “non-benzo” hypnotics?
1) Zolpidem (aka ambien)
2) diphenhydramine (benadryl)
3) chloral hydrate
4) Ramelteon
What is the MOA of zolpidem?
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
What are the “4” non-benzo anxiolytics?
1) buspirone
2) hydroxyzine
3) Barbituates
4) propranolol
What is the MOA of buspirone?
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
Why is buspirone a better choice for an alcoholic with anxiety?
Because it does not potentiate CNS depression if combined with alcohol!… also has a low abuse/addition potential
MOA of hydroxyzine?
Useful for pts who want quick-acting, short-term medication but cannot take benzos for whatever reason (prior abuse or alcohol abuse)
Why are barbituates (phenobarbitol etc) rarely used now?
very lethal in overdose and induce cyp450
how does propranolol work?
it blocks autonomic effects of panic attacks… thus helping with “heart beating out of chest” performance anxiety… often used to treat akathisia.
Random: What are the drugs that can treat ADHD?
1) dextroamphetamine
2) Methylphenidate (ritalin, concerta)
3) atomoxetine (presynaptic NE transporter inhibitor)
4) modafinil
What are 5 drugs that act as Acetylcholinesterase inhibitors? what do they help to treat… and for what levels of severity?
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…
What is the effectiveness of ECT based on?
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
