Chapter 18- Sedatives, Hypnotics, and Anxiolytics

Question 1

Overview:

Answer 1

• History: ued for anxiety and insomnia
• Properties of GABA-A receptors
• Pharmacological regulation of GABA-A receptors
• Benzos and Barbiturates as GABA-A receptor modulators (PAMs)
• Misuse potential

Question 2

Anxiety core idea

Answer 2

• involves unrealistic, irrational fears or anxiety of disabling intensity
• one of the most frequently observed mental disorders

Question 3

What are phobias?

Answer 3

• persistent, disproportionate fear of some specific object/situation w little actual danger to person

Question 4

Types of Anxiety

Answer 4

• GAD- generalized anxiety disorder
• PTSD- post traumatic stress disorder
• OCD- obssesive compulsive disorder
• Social Anxiety disorder

DSM-5 groups all under anxiety

Question 5

History of anxiety

Answer 5

• many ancient texts describe symptoms resembling anxiety (ex. worrying, panic, despair over past/future… often related to melancholia/depression)
• Before the DSM (late 1800s- early 1900s), early psychiatrists described aspects of anxiety as a disorder

Question 6

What is insomnia?

Answer 6

habitual sleeplessness; inability to sleep

Question 7

What is insomnia associated with?

Answer 7

• anxiety
• depression
• stress
• personality disorders
• bipolar disorders
• psychosis
• etc

direct cause is unknown

Question 8

History of compounds for anxiety and insomnia:

Answer 8

• self medication- often alcohol
• barbiturates
• milltown (meprobamate)
• Benzos

Question 9

Milltown (memprobamate)

Answer 9

• 1950s used as a tranquilizer in psychiatric facilityes
• high misuse potential- similar to barbituates

Question 10

Benzos history

Answer 10

• developed in the late 1950s by roche laboratories
• librium (chlordiazepoxide) replace Miltown in 1961
• Vailium (diazepam)-more potent cousin of chlordiazepoxide (1963)

Question 11

Medical use of barbiturates-sedatives/hypnotics

Answer 11

• medical use has varied considerable
• declined due to toxicity, safety, and dependence liability

Question 12

Why do barbiturates differ from one another?

Answer 12

• primarily due to their pharmacokinetics

Question 13

thiopental

Answer 13

• 15 min duration
• anesthetic

Question 14

Secobarbital

Answer 14

• duration 1.5 hours
• sleep inducer

Question 15

Pentobaribital

Answer 15

• 4 hrs
• sedative and sleep inducer

Question 16

phenobarbital

Answer 16

• duration greater than or equal to 6 hrs
• sedative or anticonvulsant

Question 17

Why do barbiturates have a small therapeutic window?

Answer 17

because there is a small difference between doses that are anxiolytic and sedative