CPTP 3.5 Hypnotics & Anxiolytics Flashcards
Pharmacodynamics of BENZODIAZEPINES
- reduces excitability of Na+ channels, prevents generation of action potential
- allosteric modulators of GABA(A) receptor –> allows more Cl through channel when GABA binds –> enhances effect of GABA
Midazolam
+ clinical use + half life
Benzodiazepine
Clinical use:
- Conscious sedative e.g. dental surgery
- Status epilepticus
Half life: Very short (2-4h)
Oxazepam (Serax)
+ clinical use + half life
Benzodiazepine
Clinical use:
-Hypnotic + anxiolytic
Half life:
Short (8-12h)
Lormetazepam
+ clinical use + half life
Benzodiazepine
Clinical use:
-Hypnotic
Half life:
Short (8-12h)
Loprazolam
+ clinical use + half life
Benzodiazepine
Clinical use:
-Hypnotic
Half life:
Short (8-12h)
Alprazolam (Xanax)
+ clinical use + half life
Benzodiazepine
Clinical use:
-Anxiolytic
Half life:
Short-intermediate (6-16h)
Lorazepam (Ativan)
+ clinical use + half life
Benzodiazepine
Clinical use:
- Anticonvulsant
- Status epilepticus
Half life:
long (8-24h)
Chlordiazepoxide (Librium)
+ clinical use + half life
Benzodiazepine
Clinical use:
- Anxiolytic
- Acute alcohol withdrawal
Note: can be addictive
Half life: Very long (20-90h)
Diazepam (Valium)
+ clinical use + half life + cautions
Benzodiazepine
Clinical use:
- Anxiolytic
- Anticonvulsant
- Status epilepticus
- Muscle spasms
- Alcohol withdrawal
- Insomnia
Half life: Very long (20-90h)
Cautions:
- hepatic impairment
- respi disease
- elderly
- dependence risk
BARBITURATES
Pharmacodynamics
Binds to barbiturate site on GABA-A receptor –> opens Cl- channel in absence of GABA
Not as safe in overdose as benzos as GABA not needed for action
BARBITURATES
Clinical use
Anxiolytic
Overdose risk (due to stimulant effect due to increased dopamine release)
Buspirone
+Pharmacodynamics
+ Clinical use
Pharmacodynamics:
5HT(1A) receptor agonist
Clinical use:
Anxiolytic
Panic disorder
recommended tx + not recommended
Recommended:
SSRI, TCAs (Imipramine, Clomipramine)
Not recommended: Benzo
Generalised anxiety disorder
recommended tx + not recommended
Recommended:
SSRI, SNRI
Not recommended: Benzo (except short term during crisis)
OCD
recommended tx + not recommended
Recommended:
SSRI
Not recommended:
TCA, SNRI, serotonin reuptake inhibitor, MAOI, Benzo
PTSD
recommended tx + not recommended
Recommended:
SSRI
+ hypnotic if sleep disturbance
Zopiclone, Zolpidem, Zalepon
Pharmacodynamics + Clinical use + side effects
Pharmacodynamics:
Positive allosteric modulators of GABA-A receptor
Clinical use:
Insomnia
Side effects:
COMMON: Taste disturbance
UNCOMMON: dizziness, respiratory failure, sleep apnoea
Note: overdose risk due to stimulant effect due to increased dopamine
Promethazine
Pharmacodynamics + Clinical use + side effects
Pharmacodynamics:
H1 antihistamine
Clinical use: insomnia
Side effects:
Weight gain, anticholinergic effects (dry mouth, bronchodilation, etc)
Acute anxiety/adjustment disorder
recommended tx
Benzos (diazepam, tamazopam)
Social anxiety disorder
recommended tx
Venlafaxine (SNRI)
Temazepam + Clinical use
Benzodiazepine
Clinical use: insomnia
