CNS 2( Mental Health Disorders) Flashcards
What are hypnotics?
Are used during the day and help you calm down, they are long acting
Anxiolytics
Sleeping pills
Both hypnotics and anxiolytic leads to tolerance. Yes or No?
Yes
Use Anxiolytics and hypnotics for short term and lowest dose possible. True/false
True
What is the most commonly used hypnotics/ anxiolytics?
Benzodiazepines
MOA of hypnotics
They act on bZ receptors which are associated with Gamma- aminobuytric acid ( Gaba receptors)
State why older drugs such as meprobamate and barbiturates are not recommended as hypnotics or anxiliolytics?
Due to interactions, side effects and serious OD
List examples of hypnotics used to treat Insomnia
Temazepam, Diazepam, loprazolam and nitrazepam etc
State when short acting hypnotics are used?
When prescribing for the elderly
Preferred with pt with sleep onset Insomnia when sedation is undesirable the following day
When to use long acting hypnotics
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
Facts about Transient Insomnia
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.
Facts about short term Insomnia
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
State when to avoid Z drugs and BZ?
Avoid in eldery pt because they are at a greater risk of becoming ataxic and confused leading to more falls and injury
Hypnotics in dental pt
Anxious pt may be given hypnotics during dental procedures eg temazepam or Diazepam
State when Temazepam is preferable in Dental patients
When it is important to minimise any residual effects the following day
State eg of Hypnotics that have a prolonged action and may give rise to residual effects on the following day
Nitrazepam and flurazepam
List eg of short acting BZ with little or no hang over effect
Loprazolam, lormefazepam and temazepam
State when to use LA BZ
If Insomnia is associated with day time anxiety eg diazepam given as a single dose at night could be used to tx both symptoms
What are zolpidem and Zopiclone
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
State why clomethiazole may be useful in elderly pt
They don’t cause hangover effects
Facts about antihistamines as an hypnotics
Promethazine (otc)
Has a prolonged duration of action and can cause drowsiness the following day
State the side effect of promethazine
Headaches, psychomotor impairment and antimuscuranic effects
Facts about Alcohol as an hypnotics
Poor hypnotics because the diuretic action interferes with sleep.
Etoh also disturb sleep pattern and can worsen sleep disorders
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?
Melatonin
Facts about Buspirone
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
What receptor does buspirone act on?
Acts on specific serotonin 5HT1A receptors
What drug is used to tx severe Insomnia in pt already on it
Barbiturates
Barbiturates should be avoided in which patient group?
Elderly
State the short acting barbiturates used in anaesthesia?
Thiopental
What indicates toxicity when using barbiturates
Increased hostility and aggression after barbiturates and alcohol usually indicates intoxication
Facts about Anxiolytics
Alleviate anxiety stress
They do not affect psychological symptoms of anxiety but reduce autonomic symptoms such as palpitations and tremor
Examples of Bz Anxiolytics SA
Midazolam
Loprazolam
Oxazepam
Temazepam
Aprozaolam
Lormetazepam
State examples of Long acting Bz Anxiolytics
Diazepam
Nitrazepam
Clobazam
Chlordiazepoxide
State example of Intermediate acting bz Anxiolytics
Lorazepam
Alprazolam
Abrupt withdrawal of Bz may cause what?
Confusion
Toxic psychosis
Convulsions
Condition similar to delirium tremens
What’s Bz withdrawal symptoms characterised by?
Insomnia
Anxiety
Loss of appetite /body weight
Tremor
Perspiration
Tinnitus
Perceptual disturbance
May continue for weeks or months after stopping bz
Withdrawal symptoms may last for a day for SA bz . True or false?
True
Short term users should taper off within….how many weeks
2-4 weeks
Long term users of Bz should taper off within…
Several months or years
State the protocol for withdrawal of long term BZ
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
State when to use bz to tx anxiety or Insomnia
Only when it’s severe or disabling or causing extreme distress
State when to use short acting bz in pt
Elderly
Hepatic impairment but carry greater risk of withdrawal symptoms
What are the cautions with bz
Avoid prolonged use
Avoid abrupt withdrawal
Pts with hx of drug/ alcohol dependence
Paradoxical effect
What are paradoxical effects
Opposite effect such as
Increased hostility and aggression
Increased anxiety and perceptual disorders
Adjusting doses up and down usually reduces these impulses
Common side effect of BZ
Decreased alertness
Anxiety
Ataxia and confusion
Dizziness and drowsiness
Fatigue
G.I disorder, sleep disorder
Muscle weakness, hypotension
Altered mood, tremor, suicidal thoughts
Contraindications of BZ
Acute pulmonary insufficiency
Unstable myasthenia gravis
Sleep apnoea syndrome[ breathing interrupted during sleep]
Is bz safe in pregnancy or breast feeding?
Risk of neonatal withdrawal symptoms when used in pregnancy
Avoid regular use
Bz present in breast milk and should be avoided if possible
State when to give bz in pregnancy
Only use if there is a clear indication of eg Seizure control
High doses of bz in pregnancy may cause what?
High doses of bz during late pregnancy may cause neonatal hypothermia , hypomania (decreased muscle tone) and respiratory depression
Patient and carer advice with BZ
Driving impairment due to drowsiness
Avoid alcohol as effects are enhanced by alcohol
Pt and carer advise in hepatic impairment on bz
Can precipitate coma
It tx necessary, use shorter half lives such as temazepam
Avoid in severe impairment but SA are considered safer
What’s the mnemonic for short acting bz
LLATPOM
Lormetazepam
Loprazolam
Temazepam
Oxazepam
Midazolam
Alprazolam
