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cardiovascular system 1 > CNS 2( Mental Health Disorders) > Flashcards

CNS 2( Mental Health Disorders) Flashcards

1
Q

What are hypnotics?

A

Are used during the day and help you calm down, they are long acting

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2
Q

Anxiolytics

A

Sleeping pills

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3
Q

Both hypnotics and anxiolytic leads to tolerance. Yes or No?

A

Yes

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4
Q

Use Anxiolytics and hypnotics for short term and lowest dose possible. True/false

A

True

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5
Q

What is the most commonly used hypnotics/ anxiolytics?

A

Benzodiazepam

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6
Q

MOA of hypnotics

A

They act on bZ receptors which are associated with Gamma- aminobuytric acid ( Gaba receptors)

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7
Q

State why older drugs such as meprobamate and barbiturates are not recommended as hypnotics or anxiliolytics?

A

Due to interactions, side effects and serious OD

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8
Q

List examples of hypnotics used to treat Insomnia

A

Temazepam, Diazepam, loprazolam and nitrazepam etc

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9
Q

State when short acting hypnotics are used?

A

When prescribing for the elderly
Preferred with pt with sleep onset Insomnia when sedation is undesirable the following day

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10
Q

When to use long acting hypnotics

A

For pt with poor sleep maintenance
Early waking that causes day time effects, wen anxiolytic effect is needed during the day or when sedation the following day is acceptable

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11
Q

Facts about Transient Insomnia

A

May occur in people who normally sleep well eg due to jet lag or noises.
Give hypnotics which is rapidly eliminated and only for one or Two doses if needed.

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12
Q

Facts about short term Insomnia

A

Usually related to emotional problems or serious medical illness .
May last a few weeks or may recur
Do not give hypnotics for > than 3wks.
Short acting drug is fine

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13
Q

State when to avoid Z drugs and BZ?

A

Avoid in eldery pt because they are at a greater risk of becoming ataxic and confused leading to more falls and injury

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14
Q

Hypnotics in dental pt

A

Anxious pt may be given hypnotics during dental procedures eg temazepam or Diazepam

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15
Q

State when Temazepam is preferable in Dental patients

A

When it is important to minimise any residual effects the following day

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16
Q

State eg of Hypnotics that have a prolonged action and may give rise to residual effects on the following day

A

Nitrazepam and flurazepam

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17
Q

List eg of short acting BZ with little or no hang over effect

A

Loprazolam, lormefazepam and temazepam

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18
Q

State when to use LA BZ

A

If Insomnia is associated with day time anxiety eg diazepam given as a single dose at night could be used to tx both symptoms

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19
Q

What are zolpidem and Zopiclone

A

They are non BZ hypnotics but act on BZ receptors
They are not licensed for long term use
Dependency reported in a no of pt
Both have a short duration of action

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20
Q

State why clomethiazole may be useful in elderly pt

A

They don’t cause hangover effects

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21
Q

Facts about antihistamines as an hypnotics

A

Promethazine (otc)
Has a prolonged duration of action and can cause drowsiness the following day

22
Q

State the side effect of promethazine

A

Headaches, psychomotor impairment and antimuscuranic effects

23
Q

Facts about Alcohol as an hypnotics

A

Poor hypnotics because the diuretic action interferes with sleep.
Etoh also disturb sleep pattern and can worsen sleep disorders

24
Q

A pineal hormone license for short term tx of Insomnia in over 55yrs and for short term tx of jet lag in adults is called?

A

Melatonin

25
Q

Facts about Buspirone

A

Used for short term anxiety
Response to tx may take up to 2wks
Does not alleviate symptoms of BZ withdrawal, bz should still be withdrawn slowly before starting buspirone

26
Q

What receptor does buspirone act on?

A

Acts on specific serotonin 5HT1A receptors

27
Q

What drug is used to tx severe Insomnia in pt already on it

A

Barbiturates

28
Q

Barbiturates should be avoided in which patient group?

A

Elderly

29
Q

State the short acting barbiturates used in anaesthesia?

A

Thiopental

30
Q

What indicates toxicity when using barbiturates

A

Increased hostility and aggression after barbiturates and alcohol usually indicates intoxication

31
Q

Facts about Anxiolytics

A

Alleviate anxiety stress
They do not affect psychological symptoms of anxiety but reduce autonomic symptoms such as palpitations and tremor

32
Q

Examples of Bz Anxiolytics SA

A

Midazolam
Loprazolam
Oxazepam
Temazepam
Aprozaolam
Lormetazepam

33
Q

State examples of Long acting Bz Anxiolytics

A

Diazepam
Nitrazepam
Clobazam
Chlordiazepoxide

34
Q

State example of Intermediate acting bz Anxiolytics

A

Lorazepam
Alprazolam

35
Q

Abrupt withdrawal of Bz may cause what?

A

Confusion
Toxic psychosis
Convulsions
Condition similar to delirium tremens

36
Q

What’s Bz withdrawal symptoms characterised by?

A

Insomnia
Anxiety
Loss of appetite /body weight
Tremor
Perspiration
Tinnitus
Perceptual disturbance
May continue for weeks or months after stopping bz

37
Q

Withdrawal symptoms may last for a day for SA bz . True or false?

A

True

38
Q

Short term users should taper off within….how many weeks

A

2-4 weeks

39
Q

Long term users of Bz should taper off within…

A

Several months or years

40
Q

State the protocol for withdrawal of long term BZ

A

Transfer pt to equivalent dose of Diazepam preferably at night
Reduce Diazepam dose by 1-2mg every 2-4weeks, if withdrawal symptoms occur,maintain dose until symptoms lessen
Reduce further if necessary to 500mcg towards the end of withdrawal, then stop completely
Withdrawal might take 6-18months

41
Q

State when to use bz to tx anxiety or Insomnia

A

Only when it’s severe or disabling or causing extreme distress

42
Q

State when to use short acting bz in pt

A

Elderly
Hepatic impairment but carry greater risk of withdrawal symptoms

43
Q

What are the cautions with bz

A

Avoid prolonged use
Avoid abrupt withdrawal
Pts with hx of drug/ alcohol dependence
Paradoxical effect

44
Q

What are paradoxical effects

A

Opposite effect such as
Increased hostility and aggression
Increased anxiety and perceptual disorders
Adjusting doses up and down usually reduces these impulses

45
Q

Common side effect of BZ

A

Decreased alertness
Anxiety
Ataxia and confusion
Dizziness and drowsiness
Fatigue
G.I disorder, sleep disorder
Muscle weakness, hypotension
Altered mood, tremor, suicidal thoughts

46
Q

Contraindications of BZ

A

Acute pulmonary insufficiency
Unstable myasthenia gravis
Sleep apnoea syndrome[ breathing interrupted during sleep]

47
Q

Is bz safe in pregnancy or breast feeding?

A

Risk of neonatal withdrawal symptoms when used in pregnancy
Avoid regular use
Bz present in breast milk and should be avoided if possible

48
Q

State when to give bz in pregnancy

A

Only use if there is a clear indication of eg Seizure control

49
Q

High doses of bz in pregnancy may cause what?

A

High doses of bz during late pregnancy may cause neonatal hypothermia , hypomania (decreased muscle tone) and respiratory depression

50
Q

Patient and carer advice with BZ

A

Driving impairment due to drowsiness
Avoid alcohol as effects are enhanced by alcohol

51
Q

Pt and carer advise in hepatic impairment on bz

A

Can precipitate coma
It tx necessary, use shorter half lives such as temazepam
Avoid in severe impairment but SA are considered safer

52
Q

What’s the mnemonic for short acting bz

A

LLATPOM
Lormetazepam
Loprazolam
Temazepam
Oxazepam
Midazolam
Alprazolam

cardiovascular system 1 (42 decks)

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