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Psychiatry > Anxiolytics/Hypnotics and Psychostimulants > Flashcards

Anxiolytics/Hypnotics and Psychostimulants Flashcards

1
Q

Indications for anxiolytics and hypnotics?

A

anxiety disorders, muscle spasm, seizures, sleep disorders, alcohol withdrawal, anesthesia

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2
Q

Benzodiazepine mechanism?

A

potentiating effects of GABA

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3
Q

What benzos are long acting (half life >20 hrs)?

A

Diazepam (Valium), Clonazepam (Klonopin)

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4
Q

What benzos are intermediate acting (half life 6-20 hrs)?

A

Alprazolam (Xanax), Lorazepam (Ativan), Oxazepam (Serax), Temazepam (Restoril)

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5
Q

What benzos are short acting (half life <6 hrs)?

A

Triazolam (Halcion), Midazolam (Versed)

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6
Q

Which benzo has rapid onset?

A

Diazepam (Valium)

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7
Q

What is Diazepam (Valium) used for?

A

used during detoxification from alcohol or sedative-hypnotic anxiolytics and for seizures

less commonly prescribed to treat anxiety than previously

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8
Q

What is Clonazepam (Klonopin) used for?

A

anxiety, panic attacks

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9
Q

When should Clonazepam (Klonopin) be avoided?

A

avoid with renal dysfunction (longer half life acids once a day dosing)

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10
Q

Alprazolam (Xanax) is used for?

A

anxiety, panic attacks

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11
Q

What does one need to worry about with alprazolam (Xanax)?

A

short onset of action–>euphoria and high abuse potential

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12
Q

What is lorazepam (Ativan) used for?

A

panic attacks
alcohol and sedative-hypnotics-anxiolytic detoxification
agitation

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13
Q

What benzos are not metabolized by the liver (and thus can be used in chronic alcoholics or liver disease patients)?

A

LOT

Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)

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14
Q

What is Oxazepam (Serax) used for?

A

alcohol and sedative-hypnotic-anxiolytic detoxification

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15
Q

What is temazepam (Restoril) used for?

A

decreasingly used for insomnia treatment due to dependence

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16
Q

What is Triazolam (Halcion) used for?

A

insomnia

primarily used in medical and surgical settings

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17
Q

What is midazolam (Versed) used for?

A

primarily used in medical and surgical settings

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18
Q

What are the major side effects of benzos?

A

drowsiness, impaired intellectual func, reduced motor coordination (careful in elderly), anterograde amnesia

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19
Q

Benzo toxicity can cause…

A

respiratory depression (especially when combined with alcohol!!)

20
Q

Benzo toxicity is treated by…

A

flumazenil

21
Q

Benzo withdrawal can cause…

A

seizures! death!

22
Q

List non-benzo hypnotics

A
  • Zolpidem (Ambien)/Zaleplon (Sonata)/eszopiclone (Lunesta)
  • Diphenhydramine (Benadryl)
  • Chloral hydrate (Noctec, Somnote)
  • Ramelteon (Rozerem)
23
Q

Zolpidem (Ambien)/Zaleplon (Sonata)/eszopiclone (Lunesta) mechanism?

A

Bind to benzo receptor 1 (selective receptor binding)–>sedation

24
Q

Zolpidem (Ambien)/Zaleplon (Sonata)/eszopiclone (Lunesta) are used to treat what?

A

short term treatment of insomnia

25
Q

Put in order of half life: Zolpidem (Ambien)/Zaleplon (Sonata)/eszopiclone (Lunesta) mechanism?

A

Zaleplon (Sonata)–>Zolpidem (Ambien)–>Eszopiclone (Lunesta)

26
Q

Zolpidem (Ambien)/Zaleplon (Sonata)/eszopiclone (Lunesta) specific side effects?

A

anterograde amnesia, hallucinations, sleepwalking, GI side effects

less risk for tolerance/dependence than benzos with prolonged use (but can occur)

27
Q

Diphenhydramine (Benadryl) specific side effects?

A

associated with antihistamine

sedation, dry mouth, constipation, urinary retention, blurry vision

28
Q

Chloral hydrate (Noctec, Somnote) not commonly prescribed because…

A
  • tolerance and dependence issues

- lethal in overdose (hepatic and liver failure)

29
Q

Ramelteon (Rozerem) mechanism?

A

selective melatonin MT1 and MT2 agonist

30
Q

Ramelteon (Rozerem) major benefit?

A

No tolerance or dependence

31
Q

List Non-benzo anxiolytics

A

Buspirone (BuSpar)
Hydroxyzine (Atarax)
Barbituates (butalbitol, phenobarbitol, amobarbitol, pentobarbitol)
Propranolol

32
Q

Buspirone (BuSpar) mechanism?

A

5HT-1A receptor (partial agonist)

… similar to trazodone

33
Q

What are the pros and cons of buspirone?

A
  • slower onset of action than benzos (1-2 weeks)
  • not considered as effective–>often used in combo with other agents like SSRIs for treatment of anxiety
  • does not potentiate CNS depression of alcohol (thus, useful in alcoholics)
  • low potential for abuse/addiction
34
Q

Hydroxyzine (Atarax) mechanism? Side effects?

A

antihistamine

–>sedation, dry mouth, constipation, urinary retention, blurry vision

35
Q

Hydroxyzine (Atarax) most useful for what patients?

A

Anxiety patients that need quick-acting, short-term medication but cannot take benzos

36
Q

Propranolol mechanism?

A

beta blocker

37
Q

Propranolol is most useful for what patients?

A

treating autonomic effects of panic attacks or performance anxiety (palpitations, seating, tachycardia)

can also treat akathisia (from typical antipsychotics)

38
Q

What patients should you be careful using propranolol with?

A

Caution in people with:

  • DM and hyperthyroidism (can mask hypoglycemia)
  • PVD and Raynaud’s (can exacerbate)
  • MG may be worsened
  • Other drugs with bradycardic effects

Contraindicated in patients with:

  • Reversible airways diseases (asthma or COPD)
  • Bradycardia, Sick sinus syndrome, AV block
  • Shock
  • Severe hypotension
  • Cocaine toxicity
39
Q

List psychostimulants

A

Dextroamphetamine and amphetamines (Dexedrine, Adderall)
Methylphenidate (Ritalin, Concerta)
Atomoxetine (Strattera)
Modafinil (Provigil)

40
Q

Psychostimulants are used primarily for what disorders?

A

ADHD and refractory depression

41
Q

Which of the psychostimulants are schedule II?

A

Adderall and methylphenidate (Ritalin, Concerta)

42
Q

What should one monitor when taking dextroamphetamine and amphetamines?

A

bp, weight loss, insomnia

43
Q

What should one monitor when taking methylphenidate (Ritalin, Concerta)?

A

leukopenia, anemia, inc LFTs

bo, weight loss, insomnia

44
Q

Atomoxetine (Strattera) mechanism?

A

presynaptic NE transporter inhibitor

45
Q

What are the benefits and cons to Atomoxetine (Strattera)?

A

less appetite suppression and insomnia

rare liver toxicity, possible inc SI in children/adolescents

46
Q

Which psychostimulant is used in treating narcolepsy?

A

Modafinil (Provigil)

Psychiatry (7 decks)

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