CNS- HIGH

Question 1

What are anxiolytic drugs?

Answer 1

Induce sleep when given nocte

Question 2

Points to consider for anxiolytic drugs

Answer 2

• May impair judgement/slow reactions- caution driving/using machinery
• Issues with dependence, tolerance and withdrawal effects
• Ideally reserve for short courses
• Withdraw gradually- abrupt withdrawal may cause confusion, toxic psychosis
• Withdrawal syndrome can develop up to 3 weeks after stopping (reduced appetite, reduced body weight, insomnia and anxiety)
• Avoid addition of beta blockers, antidepressant, antipsychotics where possible

Question 3

What are hypnotic drugs?

Answer 3

Sedating drugs e.g. benzos and Z-drugs

Question 4

Points to consider for hypnotic drugs

Answer 4

• Short-acting preferred in sleep onset insomnia
• Long acting preferred in poor sleep maintenance
• Tolerance develops within 3-14 days
• Withdrawal can cause rebound insomnia
• Benzos and Z-drugs should be avoided in elderly due to higher risk of falls and ataxia (loss of body movement)

Question 5

Can hypnotics be used during pregnancy?

Answer 5

Yes, but high doses may cause:

• Hypothermia
• Hypotonia
• Respiratory depression

Question 6

Cautions surrounding hypnotic drug use

Answer 6

• Lower doses recommended in chronic respiratory insufficiency
• Myorelaxant (skeletal muscle relaxation) increases risk of falls and hip fractures in elderly patients
• Caution with contaminant use with CNS depressants and alcohol

Question 7

Examples of long acting hypnotic benzodiazepines

Answer 7

• Diazepam
• Nitrazepam
• Flurazepam

Question 8

Examples of shorter acting hypnotic benzodiazepines

Answer 8

• Lorazepam
• Lormetazepam
• Temazepam

Question 9

Which duration of action hypnotic benzodiazepine is safer in hepatic impairment?

Answer 9

Shorter acting

Question 10

Risks of switching between short and long acting benzodiazepines?

Answer 10

Potential withdrawal