ch 29 Flashcards
sedative hypnotics are used primarily for 2 common disorders
anxiety and insomnia
agents given to promote sleep
hypnotics
what type of dose of sedative hypnotics to relieve anxiety
low dose
what type of dose of sedative hypnotics to promote sleep
high doses
drugs that are in the Benzodiazepine class
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)
side effects of Benzodiazepines
reduce anxiety promote sleep induce muscle relaxation confusion anterograde amnesia
Cardiovascular system with Benzodiazepines
when taken orally -> almost no heart affects
when taken IV -> profound Hypotension and cardiac arrest
Benzodiazepines and resp system
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
How do Benzodiazepines work
intensify effects of GABA
high lipid solubility -> readily cross BBB
What benzodiazepines undergo very little metabolic alteration and are preferred in pt with hepatic impairment
Oxazepam
temazepam (Restoril)
lorazepam (Ativan)
Benzodiazepines are drugs of first choice for
and also approved for
acute anxiety
insomnia
seizure disorders
what 4 benzodiazepines are approved for seizure disorders
diazepam
clonazepam
lorazepam
clorazepate
what benzodiazepine may be administered to ease withdrawal from alcohol
diazepam
what benzodiazepine for muscle spasm and spasticity
Diazepam
anterograde amnesia in Benzodiazepines is esp troublesome with
triazolam (Halcion)
Sleep problem with Benzodiazepines
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should be withdrawn if sleep driving is reported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
Paradoxical effects with benzodiazepines
insomnia excitation euphoria anxiety rage
should be d/c
what type of benzodiazepines can cause resp depression
IV
abuse potential of benzodiazepines
what schedule?
low risk
schedule IV
Benzo in pregnancy
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
Benzodiazepines and breastfeeding
NO
long vs short duration of action of benzo with physical dependence
short duration of therapy will have more intense symptoms of withdrawal (ie-Xanax)
prescribing a benzo that needs to help fall asleep
Triazolam
remember “tri to fall asleep) also tri to remember (retrograde amnesia
benzo and needs to prevent waking up later at night
estazolam would have a slower onset
remember “sta” asleep
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)
Benzodiazepine-like drugs are schedule
IV with low abuse potential
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
when therapy is d/c for Zolpidem (ambien), is there rebound insomnia when d/c
no
side effect of Zolpidem (ambien)
daytime drowsiness
dizziness
sleep driving
small risk for angioedema and anaphylaxis
Zolpidem (ambien) is a schedule
IV