(Exam 3) Sedative-Hypnotic and Anxiolytic Medications Flashcards
what are the different classes of sedatives?
barbiturates, benzodiazepines
what is an example of a barbiturate?
phenobarbital
what do muscle relaxers do?
don’t actually relax muscles, relax person which provides secondary muscle relaxor
what can benzos be given for?
anxiety, sleep, muscle relaxants
what are some examples of benzos?
valium, xanax, klonopin, ativan
what is the MOA for barbs and benzos?
bind to specific GABA Rs in limbic system neurons; GABA R agonist; creates overall effect of sedation of cells + person
what are the amygdala, OFC, and insula associated with?
behavioral responses
when electrically stimulating the amygdala, OFC, and insula, what happens?
can cause aggression; physical/physio responses
what do PET scans show about anxiety?
there is an increased amygdalar blood flow
what do MRI scans show about anxiety?
amygdalar abnormalities in panic disorder
what happens when you block GABAergic function?
anxiety response
what happens when there is GABA A hypofunction?
sensitizes amygdala to anxiogenic responses to otherwise non-distressful stimuli (things become more anxiety inducing)
what do benzos do to the amygdala?
they “reset” the amygdala to a more normal response level
how quickly do benzos act?
immediately
what does GABA A binding cause?
sedation, anxiolysis, cognitive impairment (HC is sedated); depends on dose
during withdrawal of barbs, what happens?
REM sleep is suppressed and there are vivid/excessive dreams
what are the pharmacological effects of barbs?
cognitive impairment, overdose risk; not analgesic
what are the psychological effects of barbs in small doses?
anxiolytic, calming
what are the psychological effects of barbs in higher doses?
general behavioral depression and sleep
describe the clinical use for barbs
it’s declined bc of lethal od, narrow therapeutic window, high dependence/abuse potential, dangerous drug interactions
what do barbs do to tolerance?
it’s induced through metabolic adaptation, and neuronal down + up regulation
what do barbs do to physical dependence?
normal clinical doses can induce dependence, WD from high doses can cause psychosis
how do barbs affect pregnancy?
limited data, but possibility of developmental abnormalities; women taking barbs as AEDs should weigh risk and take lowest effective dose
which class of sedatives is most widely used?
benzos; most commonly prescribed psychotropic drug
how do benzos affect the elderly?
reduced ability to metabolize long-acting benzos and active metabolites; dementing, depressive, and decrease motor coordination
what are the side effects of benzos?
sedation, anxiolysis, aed, cognitive + psychomotor inhibition, lethargy, amnesia, physical + psychological dependence, interactions with other sedatives/alcohol
how do benzos affect pregnancy?
if there is a high maternal dose at delivery, the baby is born dependent and goes with WD; “floppy-infant syndrome” = fails APGAR test
what is a BZRA?
benzodiazepine receptor agonist; any drug that activates a BZD R
are BZRAs classified as benzos?
no; but they have a similar action at R
what are BZRAs used for?
insomnia, AEDs
what side effects do BZRAs have?
can create amnestic-like behaviors: sleep walking
when stop taking BZRAs, what happens?
can make anxiety/insomnia worse
what are “Z drugs” used for?
for insomnia: falling asleep or staying asleep
Z drugs relation to dependence?
dependence unlikely; abuse potential only at extremely high doses
what are examples of “hypnotic” effects?
sleep-related activities: sleep driving (driving while in drug-induced amnestic state), making phone calls, preparing/eating food, online activity
what is the moa of anesthetics?
GABA agonists at Rs
what effects do anesthetics have?
keep you asleep, little analgesic or euphoric activity, onset is immediate
what does volatile mean?
liquid but when hits air, it becomes a gas
anesthetic relation to dependence?
inhaled anesthetics can be subject to abuse (nitrous oxide/whippets)
what is the first choice drug for anxiety?
SSRI ADs
what is the moa for buspirone (BuSpar)?
selective 5-HT1A agonist
what are the side effects for buspirone (BuSpar)?
amnesia, mental confusion, psychomotor impairment minimal or absent
buspirone (BuSpar) relation to dependence?
little addiction/abuse potential
how quickly does buspirone (BuSpar) act?
slowly, gradually
effect of buspirone (BuSpar) on sleep onset?
ineffective unless anxiety is cause for insomnia
