ANXIOLYTICS & HYPNOTICS Flashcards
BZD
Target GABAa receptor increase frequency of potassium channels opening anticonvulsants Alpha1-GABAa anterograde amnesia Alpha1-GABAa hypnotics sedatives Alpha1-GABAa(HIGH) muscle relaxant alpha2-gabaA anti anxiety alpha2-gabaA(LOW) excreted as glucoronides
lorazepam
clonazepam
diazepam
long acting BZD
TREAT ANXIETY and relate with usually depression and schizophrenia
CROSS TOLERANCE with alcohol
int acting bzd(10-20hrs)
ALPRALOZAM
ESTAZOLAM
LORAZEPAM
TEMAZEPAM
LONG ACTING bzd
1-2 days
CLORAZEPATE CHLORDIAZEPOXIDE DIAZEPAM FLURAZEPAM QUAZEPAM
short acting BZD
OXAZEPAM
TRIAZOLAM
TEMAZEPAM
FREQUENT WAKENING effect occurs after 1-3 hrs
BZD
trialozam
results in inbound insomnia(INC REM) helps inducing sleep BZD rapid tolerance severe withdrawal symptoms
MIDAZOLAM
FACILITATE amnesia and used for anxiety reducing for difficult procedures dental,intubation,endoscopy angioplasty
prior to anesthesia
clonazepam
ADJUNTIVE TREATMENT for seizures
lorazepam and diazepam
treat status epileptics
treat alcohol withdrawal and related seizures
diazepam clorazepate lorazepam oxazepam chlordiazepoxide due to cross tolerance
diazepam
treat muscle spasticity in neurodegenertive disorders
FLUMAZENIL
treat bzd overdose
as antagonist to bz1 receptor
1 hr half life
venlafaxine
duloxentine
SNRI TREAT CHRONIC ANXIETY FIRST LINE
GAD
ESCITALOPRAM
PAROXETINE
SSRI
trreat chronic anxiety given with bzd fr 3 week after alone
buspirone
chronic treatment oF GAD NON BZD SLOW ONSET LONG ACTING mediated by 5-HT1A CAUSES NAUSEA VOMITTING
BARBITURATES
INDUCE and maintain sleep
enhance gabanergic transmission with GABA A
block glutamate NMDA
cns and respiratory depression
short acting barbiturates(3-8 hrs)
pentobarbital
secobarbitol
amobarbitol
very short acting barbiturate (20 min)
thiopental
long acting (1-2 days)
phenobarbital
dose of barbiturate
low causes sedation
higher causes hypnosis further anesthesia
suppress hypoxic and chemoreceptor response to co2
thiopental
induce anesthesia for very short time
phenobarbitol
anticonvulsants
long term tonic clonic control
treat refractory status epileptics
butalbital
suppress REM most
manage tension type migraines
adverse effects of barbiturates
mental and physical sluggishness
impaired conc
contraindicated in pt with acute intermittent porphyria
shock like symptoms cardiac arrest restlessness vomitting reduced breathing
central cardiovascular depression
ZOLPIDEM
BINDS TO BZD RECEPTOR
USED FOR MIDDLE OF THE WAKENING PROBLEM
LINGUAL SPRAY ADVERSE SIDE EFFECTS nightmares ,amnesia,daytime drowsiness
zaleplon
fewer side effects as zolpidem
non bzd hypnotic
eszoplicone
ACTS ON BZ1 receptor
effective for insomnia for 6 months
peripheral edema somnolence dry mouth unpleasant taste
ramelteon
agonist MT1 MT2
induce and promote sleep
prolactinemia
melatonin control
antihistamine
diphenylhydramine
hydroxyzine
doxylamine
doxylamine
hydroxyzine
diphenylhydramine
treat situational insomnia
doxepin
antidepressant
help treat insomnia
mitrazepine
trazodone
antidepressant
off label insomnia treatment with TCA
