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Pharm Exam 4 - Class Review > ch 29 > Flashcards

ch 29 Flashcards

1
Q

sedative hypnotics are used primarily for 2 common disorders

A

anxiety and insomnia

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2
Q

agents given to promote sleep

A

hypnotics

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3
Q

what type of dose of sedative hypnotics to relieve anxiety

A

low dose

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4
Q

what type of dose of sedative hypnotics to promote sleep

A

high doses

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5
Q

drugs that are in the Benzodiazepine class

A 
Alprazolam (Xanax)
chlordiazepoxide (librium)
clorazepate (Tranxene-T)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam 
Estazolam 
Flurazepam
Midazolam (Versed)
Temazepam (Restoril) - insomnia only
Triazolam (Halcion) - insomnia only
Clonazepam (klonopin)
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6
Q

side effects of Benzodiazepines

A 
reduce anxiety
promote sleep
induce muscle relaxation
confusion
anterograde amnesia
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7
Q

Cardiovascular system with Benzodiazepines

A

when taken orally -> almost no heart affects

when taken IV -> profound Hypotension and cardiac arrest

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8
Q

Benzodiazepines and resp system

A

weak resp depressants

in therapeutic doses -> little to no resp depression
toxic doses -> moderate resp depression at most

if combined with alcohol, opioids, barbiturates, ect…it can be a problem

with chronic COPD -> may worsen hypoventilation and hypoxemia

in Obstructive sleep apnea -> may exacerbate apneic episodes

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9
Q

How do Benzodiazepines work

A

intensify effects of GABA

high lipid solubility -> readily cross BBB

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10
Q

What benzodiazepines undergo very little metabolic alteration and are preferred in pt with hepatic impairment

A

Oxazepam
temazepam (Restoril)
lorazepam (Ativan)

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11
Q

Benzodiazepines are drugs of first choice for

and also approved for

A

acute anxiety

insomnia
seizure disorders

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12
Q

what 4 benzodiazepines are approved for seizure disorders

A

diazepam
clonazepam
lorazepam
clorazepate

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13
Q

what benzodiazepine may be administered to ease withdrawal from alcohol

A

diazepam

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14
Q

what benzodiazepine for muscle spasm and spasticity

A

Diazepam

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15
Q

anterograde amnesia in Benzodiazepines is esp troublesome with

A

triazolam (Halcion)

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16
Q

Sleep problem with Benzodiazepines

A

Sleep driving, preparing and eating meals, making phone calls. can occur even with normal doses

should be withdrawn if sleep driving is reported

must be tapered slowly with this side effect

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17
Q

Paradoxical effects with benzodiazepines

A 
insomnia
excitation
euphoria
anxiety
rage

should be d/c

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18
Q

what type of benzodiazepines can cause resp depression

A

IV

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19
Q

abuse potential of benzodiazepines

what schedule?

A

low risk

schedule IV

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20
Q

Benzo in pregnancy

A

use during first trimester of pregnancy is associated with an increased risk for congenital malformations such as cleft lip, inguinal hernia and cardiac abnormalities.

use near time can cause CNS depression in neonate

d/c med if pregnant

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21
Q

Benzodiazepines and breastfeeding

A

NO

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22
Q

long vs short duration of action of benzo with physical dependence

A

short duration of therapy will have more intense symptoms of withdrawal (ie-Xanax)

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23
Q

prescribing a benzo that needs to help fall asleep

A

Triazolam

remember “tri to fall asleep) also tri to remember (retrograde amnesia

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24
Q

benzo and needs to prevent waking up later at night

A

estazolam would have a slower onset

remember “sta” asleep

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25
what are the benzodiazepine-like drugs and what are they approved for
Zolpidem (Ambien) zaleplon eszopiclone insomnia (act on GABA) (trying to get your zzzzzzs)
26
Benzodiazepine-like drugs are schedule
IV with low abuse potential
27
which Zolpidem (ambien) formulation would help you fall asleep and which one would help you stay asleep
All formulations will help you fall asleep Ambien CR - help you stay asleep
28
when therapy is d/c for Zolpidem (ambien), is there rebound insomnia when d/c
no
29
side effect of Zolpidem (ambien)
daytime drowsiness dizziness sleep driving small risk for angioedema and anaphylaxis
30
Zolpidem (ambien) is a schedule
IV
31
CNS and Zolpidem (ambien)
do not combine with other CNS depressants
32
Zaleplon (Sonata) is used for what part of sleep
fall asleep
33
side effects of Zaleplon (Sonata)
``` headache nausea drowsiness dizziness myalgia abd pain sleep driving mild rebound insomnia the first night after drug withdrawal ```
34
Zaleplon (Sonata) is a schedule
IV
35
Eszopiclone (Lunesta) is approved for treating
insomnia | reduces nighttime awakenings
36
adverse effect of Eszopiclone (Lunesta)
``` bitter aftertaste headache somnolence dizziness dry mouth sleep driving ``` rarely -anaphylaxis or angioedema
37
Eszopiclone (Lunesta) is a schedule
IV
38
Ramelteon is a helps with what part of sleep
melatonin agonist sleep onset
39
Ramelteon is a schedule
not regulated
40
Ramelteon onset
rapid (30 min)
41
most common side effects of Ramelteon are
``` somnolence dizziness fatigue sleep driving hallucination agitation mania amenorrhea galactorrhea reduced libido fertility problems ``` angioedema anaphylaxis
42
Ramelteon with fluvoxamine (luvox)
increase levels of Ramelteon so should be avoided
43
Ramelteon and alcohol
can intensify sedation, avoid
44
Ramelteon should be avoided in
hepatic impairment pregnancy breastfeeding
45
Suvorexant (Belsomra) is approved for
insomnia with sleep onset and/or sleep maintenance problem
46
Suvorexant (Belsomra) is a schedule
IV
47
side effects Suvorexant (Belsomra)
``` somnolence headache dizziness diarrhea dry mouth cough hallucinations sleep paralysis vivid disturbing perceptions ```
48
Suvorexant (Belsomra) used with CYP
inhibitors such as ketoconazole, clarithromycin, ect can increase levels of Suvorexant (Belsomra)
49
Suvorexant (Belsomra) and digoxin
can increase digoxin levels
50
Suvorexant (Belsomra) contraindicated in
``` COPD obstructive sleep apnea narcolepsy breastfeeding pregnancy ```
51
ultra short acting Barbiturates are used for
induction of anesthesia
52
short to intermediate acting barbiturates are used for
sedatives and hypnotics
53
long acting barbiturates are used for
primarily antiseizure drugs
54
cardiovascular effects of barbiturates
hypnotic doses -> modest reduction in BP and HR toxic doses -> profound hypotension and shock high doses -> depress the myocardium and vascular smooth muscle along with all other electrically excitable tissues
55
CNS effects of barbiturates progress from ____ to ___ to ____
sedation to sleep to general anestesia
56
barbiturates and hepatic metabolism
CPY inducer can accelerate its own metabolism and other drugs by promoting the synthesis of porphyrin which convers to heme which is incorporated into cyp450
57
tolerance and dependence of barbiturates
dose with continued treatment remains relatively constant whereas the therapeutic dose climbs higher and higher. You can knock out their resp drive
58
cross tolerance of barbiturates
barbiturates alcohol benzodiazepines general anesthetics
59
withdrawal from general CNS depressants
``` weakness restlessness insomnia hyperthermia orthostatic hypotension confusion disorientation ``` by 3rd day - seizures psychotic delirium - similar to alcoholic delirium tremens extreme cases exhaustion cardiovascular collapse death evolves over 8 days
60
long acting barbiturate may be used to facilitate withdrawal process ----whats an example
phenobarbital
61
Barbiturates and insomnia
can promote sleep but bc of the undesired effects, now replaced by benzos and related drugs for treatment of choice for insomnia
62
Barbiturates are a schedule
III | high abuse potential
63
transient insomnia is ____ term laststing
short term - 2-3 weeks
64
if tolerance occurs with barbiturates what should you do
interrupt treatment is preferred rather than increasing dose which will restore responsiveness to treatment
65
hypnotics are contraindicated for
resp disorders pregnancy breastfeeding
66
drug dependency insomnia
a condition that can lead to the inappropriate prolongation of therapy continued drug use ->low level dependence develops -> upon cessation of treatment ->mild withdrawal syndrome occurs and disrupt sleep -> failing to recognize the inability to sleep is a manifestation of drug withdrawal -> pt becomes convinced insomnia has returned and resumes drug use -> continued drug use leads to heightened physical dependence -> makes withdraw harder
67
Trazodone (oleptro) used for? physical dependence and tolerance? adverse effects?
atypical antidepressant with strong sedative action decrease sleep latency and prolong sleep duration no tolerance or physical dependence esp useful for insomnia resulting from use of antidepressants that cause cns stim adverse effects daytime grogginess posural hypotension
68
Doxepin
old TCA with strong sedative effects | increased total sleep time and maintained the affected for more than 12 weeks due to block receptor of histamine
69
Doxepin side effects
when used in low doses for sleep maintenance sedation nausea URI when used in high doses for depression hypotension dysrhythmias anticholinergic
70
Doxepin is contraindicated in
narrow angle glaucoma | severe urinary retention
71
Pt was taking a MAOI and now switching to Doxepin, how long do they have to wait
2 weeks
72
Doxepin is schedule
not regulated
73
what 2 OTC meds are approved for sleep aids by FDA
Diphenhydramine Doxylamine (unisom) anticholinergic effects
74
hormone that can be purchased used for sleep
Melatonin
75
normally, melatonin secretion is low during the day and begins to rise around ____ and reaches a peak between ___ and ____ and returns to baseline by ____
9pm 2am- 4am baseline by morning
76
short term use of large doses of Melatonin can cause
``` hangover headache nightmares hypothermia transient depression ```

Pharm Exam 4 - Class Review (14 decks)

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