Benzodiazepines, Other Anxiolytics, and Sleep Medications

Question 1

BENZODIAZEPINES

Answer 1

Like alcohol in a pill
GABA receptor
Used for anxiety, insominia, alcohol/benzo w/d
benzo/alcohol w/d can be life threatning vs others
inpatient dox needed at times
Used mainly for anxiety and work like alcohol in a pill. These can be addictive and so are used less in substance using patients.
Effects similar to alcohol: disinhibition, relaxation, sedation, dizziness, impaired coordination, decrease sleep quality
Extreme cases: leads to respiratory depression
Opioids do as well
Black Box warning for combo
CA law to offer naloxone if combo
Pregnancy: small possibility of cleft lip/ palate, w/d after delivery
Breastfeeding: may pass, low dose and short acting

Question 2

Lorazepam

Answer 2

Ativan
Benzo
LOT not metabolized by liver

Question 3

Clonazepam

Answer 3

Klonopin

Benzo

Question 4

Alprazolam

Answer 4

Xanax
Benzo
short half life

Question 5

Benzodiazepines

Answer 5

Valium

Question 6

Temazepam

Answer 6

Restoril
Benzo
used for sleep
LOT not metabolized by liver

Question 7

Chlordiazepoxide

Answer 7

Librium
Benzo
used for alcohol withdrawal

Question 8

Alcohol Benzo equivalents

Answer 8

1 beer = lorazepam 1mg
1 beer = alprazolam 0.5mg 
1 beer = clonazepam 0.5mg
1 beer = diazepam 10mg 
1 beer = chlordiazepoxide 251mg
1 beer = temazepam 15mg

Question 9

Hydroxyzine

Answer 9

Vistaril
‘other anxiolytics’
antihistamine
also used for sleep

Question 10

Buspirone

Answer 10

BuSpar
'other anxiolytics'
serotonin effects 
poor efficacy 
not many side effects

Question 11

Gabapentin

Answer 11

Neurontin
'other anxiolytics'
benzo lite 
some abuse 
also neuropathic pain

Question 12

Propranolol

Answer 12

Inderal 
'other anxiolytics'
beta blocker 
Generally used for hypertension 
performance anxiety 
depression se for class

Question 13

Sleep Treatment

Answer 13

First line is sleep hygiene
sleep efficiency
CBT for sleep

Question 14

Diphenhydramine

Answer 14

Benadryl
sleep medication 
antihistamine and anticholinergic 
also antiparkinsonism 
cognitive effects in elderly

Question 15

Zolpidem

Answer 15

Ambien

sleep medication

Question 16

Eszopiclone

Answer 16

Lunesta
sleep medication
s-enantiomer of zopiclone in other countries

Question 17

Zaleplon

Answer 17

Sonata

Sleep medication

Question 18

Sleep medication

Answer 18

Benzodiazepine lite

sleep walking

Question 19

Suvorexant

Answer 19

Belsomra
sleep medication 
antagonizes orexin receptors 
orexin R's promote wakefulness 
Impaired alertness/coordination 
Sleep paralysis 
Some abuse potential 
Not much used

Question 20

Ramelteon

Answer 20

Rozerem
Sleep Medication 
Binds to melatonin receptors 
sleep walking 
no e/o abuse 
similar to OTC melatonin 
Increased sleep 7.3 minutes 
Not used much