Anxiolytics/Hypnotics and Psychostimulants

Question 1

Indications for anxiolytics and hypnotics?

Answer 1

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

Question 2

Benzodiazepine mechanism?

Answer 2

potentiating effects of GABA

Question 3

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

Answer 3

Diazepam (Valium), Clonazepam (Klonopin)

Question 4

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

Answer 4

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

Question 5

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

Answer 5

Triazolam (Halcion), Midazolam (Versed)

Question 6

Which benzo has rapid onset?

Answer 6

Diazepam (Valium)

Question 7

What is Diazepam (Valium) used for?

Answer 7

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

less commonly prescribed to treat anxiety than previously

Question 8

What is Clonazepam (Klonopin) used for?

Answer 8

anxiety, panic attacks

Question 9

When should Clonazepam (Klonopin) be avoided?

Answer 9

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

Question 10

Alprazolam (Xanax) is used for?

Answer 10

anxiety, panic attacks

Question 11

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

Answer 11

short onset of action–>euphoria and high abuse potential

Question 12

What is lorazepam (Ativan) used for?

Answer 12

panic attacks
alcohol and sedative-hypnotics-anxiolytic detoxification
agitation

Question 13

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

Answer 13

LOT

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

Question 14

What is Oxazepam (Serax) used for?

Answer 14

alcohol and sedative-hypnotic-anxiolytic detoxification

Question 15

What is temazepam (Restoril) used for?

Answer 15

decreasingly used for insomnia treatment due to dependence

Question 16

What is Triazolam (Halcion) used for?

Answer 16

insomnia

primarily used in medical and surgical settings

Question 17

What is midazolam (Versed) used for?

Answer 17

primarily used in medical and surgical settings

Question 18

What are the major side effects of benzos?

Answer 18

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

Question 19

Benzo toxicity can cause…

Answer 19

respiratory depression (especially when combined with alcohol!!)

Question 20

Benzo toxicity is treated by…

Answer 20

flumazenil

Question 21

Benzo withdrawal can cause…

Answer 21

seizures! death!

Question 22

List non-benzo hypnotics

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

short term treatment of insomnia

Question 25

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

Answer 25

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

Question 26

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

Answer 26

anterograde amnesia, hallucinations, sleepwalking, GI side effects less risk for tolerance/dependence than benzos with prolonged use (but can occur)

Question 27

Diphenhydramine (Benadryl) specific side effects?

Answer 27

associated with antihistamine sedation, dry mouth, constipation, urinary retention, blurry vision

Question 28

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

Answer 28

- tolerance and dependence issues | - lethal in overdose (hepatic and liver failure)

Question 29

Ramelteon (Rozerem) mechanism?

Answer 29

selective melatonin MT1 and MT2 agonist

Question 30

Ramelteon (Rozerem) major benefit?

Answer 30

No tolerance or dependence

Question 31

List Non-benzo anxiolytics

Answer 31

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

Question 32

Buspirone (BuSpar) mechanism?

Answer 32

5HT-1A receptor (partial agonist) ... similar to trazodone

Question 33

What are the pros and cons of buspirone?

Answer 33

- 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

Question 34

Hydroxyzine (Atarax) mechanism? Side effects?

Answer 34

antihistamine | -->sedation, dry mouth, constipation, urinary retention, blurry vision

Question 35

Hydroxyzine (Atarax) most useful for what patients?

Answer 35

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

Question 36

Propranolol mechanism?

Answer 36

beta blocker

Question 37

Propranolol is most useful for what patients?

Answer 37

treating autonomic effects of panic attacks or performance anxiety (palpitations, seating, tachycardia) can also treat akathisia (from typical antipsychotics)

Question 38

What patients should you be careful using propranolol with?

Answer 38

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

Question 39

List psychostimulants

Answer 39

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

Question 40

Psychostimulants are used primarily for what disorders?

Answer 40

ADHD and refractory depression

Question 41

Which of the psychostimulants are schedule II?

Answer 41

Adderall and methylphenidate (Ritalin, Concerta)

Question 42

What should one monitor when taking dextroamphetamine and amphetamines?

Answer 42

bp, weight loss, insomnia

Question 43

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

Answer 43

leukopenia, anemia, inc LFTs | bo, weight loss, insomnia

Question 44

Atomoxetine (Strattera) mechanism?

Answer 44

presynaptic NE transporter inhibitor

Question 45

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

Answer 45

less appetite suppression and insomnia | rare liver toxicity, possible inc SI in children/adolescents

Question 46

Which psychostimulant is used in treating narcolepsy?

Answer 46

Modafinil (Provigil)