Chapter 20-Anxiolytics/sedatives

Question 1

When do peak plasma leves occur?

Answer 1

• after several hours
• exception: diazepam after around 1 hour
• depends on the route of administration (usually taken orally)

Question 2

What contributes to sedatives long duration?

Answer 2

they are converted into active metabolites

Question 3

Ultra short-acting usage

Answer 3

• pre-anesthesis
• intra-operatively
• status epilepticus

Question 4

short acting usage

Answer 4

• insomnia, status epillepticus
• high misuse liability

Question 5

intermediate acting usage

Answer 5

• anxiety symptoms
• alcohol detoxification

Question 6

long acting usage

Answer 6

treatment of seizure disorders

Question 7

Tolerance BZs and barbiturates

Answer 7

• slow- anxiolytic effects
• fast- sedative anticonvulsant effects
• not appear to be associated with metabolism or Pavlovian conditioning

Question 8

Cross tolerance and BZ/barbiturates

Answer 8

cross tolerance seen to other sedative drugs like alcohol

Question 9

Misuse- benzos and barbs

Answer 9

• seen in individuals w/ pattern of multiple drug misuse
• BZs used to enhance effects (ex. alc and opiates) or reduce side effects (ex. cocaine)

Question 10

ER visits and benzos

Answer 10

• mostly seen for nonmedical use
• then self harm
• then therpeutic use
• then unsupervised ingestion

Question 11

dependence and withdrawal reactions- what do these result from and how long to appear?

Answer 11

• may result from chronic use
• may not appear for a week or so

Question 12

low/moderate use withdrawal reactions

Answer 12

• anxiety
• agitation
• sensitivity to light and sound
• strange sensations
• muscle cramps and twitches
• sleep disturbances
• dizziness

Question 13

high use withdrawl reaction

Answer 13

• panic
• seizures
• delirium

Question 14

issues w bzs and barbs

Answer 14

• amnesia- seen when used for trauma and pre-exam anxiety
• confusion, agitation, and psychological disturbances- common side effects w Triazolam (Halcion)- which is prescribed for insomnia

Question 15

Reinfocing effects of BZs

Answer 15

• BZs have reinforcing effects primarily in subjects with drug/alcohol misuse, anxiety, and sleep disorders
• BZs will not typically act as a reinforcer in subjects that lack these characteristics

Question 16

Atypical Anxiolytics

Answer 16

includes buspirone, MAOIs, and SSRIs

Question 17

Buspirone

Answer 17

• not a BZ- acts on serotonin system
• is an atypical anxiolytic
• originally intended as an antipsychotic
• takes 1-2 weeks before onset
• critical for people needing daytime alertness

Question 18

Insomnia

Answer 18

• a frequent complaint: usually a manifestation of some other underlying disorder
• treating cause is more likely to produce better relief
• normal sleep is cyclic between light, deep, and REM (dreaming)

Question 19

Flurazepam (Dalmane)

Answer 19

• insomnia treatment
• less ideal
• raise arousal threshold… can detect small noises but not loud
• disrupts deep sleep states

Question 20

Short acting insomnia med

Answer 20

• temazepam, triazolam (halcion)
• induces insomnia (increased wakefulness) during final sleep hours
• can cause rebound insomnia
• used as insomnia treatment

Question 21

Zolpidem(Ambien)

Answer 21

another insomnia med