Anxiolytics & Hypnotics Flashcards
What does Narcotics refer to in medicine?
Opioids or derivatives of Opioids
Are all anxiolytics are hypnotics?
No
What is one of the worst combinations to give with narcotics?
Alcohol
What system is depressed when taking sedatives with ETOH?
Respiratory system.
An OD would be due to a respiratory death
What pharmacologic effect does a small dose of a hypnotic have?
Sedation
What pharmacologic effect do larger doses have on the body?
Hypnosis or surgical anesthesia depending on the dose
Do benzodiazepines have a wide therapeutic index?
Yes, therefore one of the most widely prescribed anti-anxiety med
What is the MOA of Benzodiazepine?
Inhibits NT by enhancing the opening of neuronal GABA-mediated chloride channels. Making them more permeable.
What happens when GABA binds to the GABA receptor on the alpha 1 subunit?
Sedation
Name the anxiolytic Benzos
chlordiazepoxide diazepam clonazepam clorazepate lorazepam oxazepam alprazolam Triazolam
What nervous system pathway do Benzos not affect?
Autonomic NS. Therefore no affect on BP
What are the indications for Benzos?
Anxiety Panic disorders Insomnia Schizo Depression Muscle spasms Seizures/epilepsy Delirium ETOH w/drawal
What is Alprazolam mostly indicated for?
Panic disorder
Anxierty
Depression associated with anxiety
** not given for insomnia
What is Diazepam work well for?
Insomnia Muscle spams Seizures Epilepsy Delirium Alcohol withdrawal
What Benzo would you give to treat Seizures, or epilepsy?
Clonazepam
Diazepam (Gold standard for status epileptic
Which Benzo has the fastest onset?
Diazepam
Which Benzo has the slowest onset?
Oxazepam
Which Benzo has the longest half-life?
Flurazepam -1st
Diazepam - 2nd
How can benzo be administered?
PO, IM, IV
Should you give diazepam or Chlordiazepoxide as IMs?
No
Becuase of variability in rate and extent of absorption
Which two Benzo are contraindicated if given together?
Lorazepam IM with Olanzapine IM
Can cause death
What are some AEs from specifically taking Benzos parenterally (IM/IV)?
Apnea, hypotension, Brady, cardiac arrest
What should you check before you give a Benzo IM with the patient?
If they have any respiratory issues as it affects the respiratory system.
Can Benzos cross the placenta?
Yes
So contraindicated with pregnancy
What effects to cigarette smoking have on Benzo effects?
It will decrease the sedative effects
What effect will ETOH have on Benzo effects?
ETOH will increase sedation if combined
What affect to anti-fungals have on Benzo effects?
Anti-fungals may increase the plasma concentration of benzos, therefore increasing its effects
What are some general AEs from taking a Benzo?
Drowsiness Sedation Psychomotor impairment Ataxia Confusion/disoriented Irritability Respiratory Depression Impaired memory/recall --> affects the hippocampus
What may be CI with taking a Benzo?
Liver disease, glaucoma, Alcoholics, any other depressants of the CNS
What type of symptoms would you see from someone going through a Benzo withdrawal?
Insomnia Anxiety Autonomic instability -->Increased vitals, tremor, sweating Muscle cramps Confusion Seizures irritability Ataxia
What are some symptoms you would see if someone overdosed on Benzos?
Somnolence Impaired coordination Slurred speech Diminished reflexes Confusion Respiratory depression Hypotension
How to you treat someone with an Benxo OD?
IV hydration Maintain airways (intubate) Gastric lavage Activated Charcoal Give Benzo antagonist
What Benzo antagonist can you give to block/reverse the symptoms in the case of an OD?
Flumazenil (IV)
What is the MOA of Fumazenil?
Competitively binds to Benzo receptor
What are you putting the patient at risk for when giving Fumazenil to a pt on Benzos?
Seizures!
Also if they are taking TCA!
What receptor does Buspirone bind to?
Serotonin type 1A receptor
What Benzo would you give for muscle spasms?
Diazepam
What are some AEs of Buspirone?
Nausea DIzzy HA Insomnia Agitation
How can someone get a serotonin syndrome if taking Buspirone?
Give them SSRIs with it
What is Buspirone metabolized by?
CYP3A4
What are some signs & symptoms one could present with if they were having a Serotonin Syndrome?
Ab cramps N/V Diarrhea Anxiety, restlessness Hyperthermia Tachy HTN Tremors sweating Myoclonis Possible seizures
What are some AEs of Zolpidem?
Nausea Dizzy HA Insomina agitation GI upset
Is there a risk of withdrawal effects with Zolpidem?
No
What is mainly effected when taking Zaleplon?
Psychomotor and cognitive functions
What Benzo receptor complex is Zolpidem specifically selective for?
Alpha 1 Subunit
What type of drug is Hydroxyzine & Diphenhydramine (Benadryl)?
Antihistamine
How can BB be helpful with anxiety?
Suppresses the sympathetic NS activity & autonomic symptoms
What are the AEs of taking a BB?
Bradycardia Hypotension Depression Nightmares Insomnia
What would you give Triazolam for?
Insomnia
How many cycles are there in sleep?
3 cycles
How many Non REM stages of sleep are there?
4 stages
How long does it take for deep sleep to kick in?
At least 90 mins.
You have to go through at least 1 cycle of sleep
What kind of wave frequencies do you produce during the drowsy phase?
Alpha waves
What stages are part of the Slow Wave sleep?
Stages 3 & 4
What frequency waves are produced in the Slow Wave sleep?
Delta waves
What frequency waves are produced during the early onset of sleep while you are still awake?
Beta waves
In stage 2 of sleep what frequency waves are produced?
Theta waves
What qualities does the ideal hypnotic Benzo drug have?
- Rapid onset
- Minimal effects on normal sleep (should not 3.Lengthen or shorten it)
- Should not give a hangover
- Minimal tolerance potential
- High therapeutic index
What are the effects of most hypnotics on sleep pattern?
Decrease onset latency
Increase NREM duration
Decrease REM duration
