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Human Diseases > HD 9 – Anxiolytics and Hypnotics > Flashcards

HD 9 – Anxiolytics and Hypnotics Flashcards

1
Q

What types of hypnotics are there?

A
  • Benzodiazepines
  • Antihistamines
  • Miscellaneous
  • (Barbiturates) = old fashioned
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2
Q

What types of insomina are there?

A
  • Initial insomnia – struggle to sleep initially

* Early morning wakening – associated with depression

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3
Q

What 2 types of sleep are there and what is there percentages?

A

75% Non-Rapid Eye Movement (NREM)

25% Rapid Eye Movement (REM)

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4
Q

What types of NREM subtypes are there?

A
  • N1 - Light sleep
  • N2 - Asleep
  • N3 - Best sleep- muscles relax, energy restored, BP, RR decrease
  • N4 Delta wave = DEEP SLEEP (signals to/from thalamus)
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5
Q

What happens to REM and NREM in drug-induced sleep?

A

Increased NREM, decreased REM

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6
Q

What happens in REM sleep?

A
  • Dreaming, body relaxed and immobile

* Provides energy and supports daytime performance

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7
Q

What are the effects of BZDs?

A
  • Hypnotic – induce sleep
  • Anxiolytic
  • Anticonvulsant – prevent seizures (i.e. epilepsy)
  • Muscle relaxant
  • Amnesic – can’t remember anything after taking
  • Fantasies
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8
Q

If patient having masseteric spasms what can be prescribed?

A

May prescribe BDZ to prevent this 2mg TDS (MAX)

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9
Q

When would temazepam be used and why?

A

Used in hospitals at night for initial insomnia due to short half life

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10
Q

When would loprazolam be used and why?

A

Used to lessen hangover, street drug due to short half life

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11
Q

When would nitrazepam be used and why?

A

Afternoon surgery inpatients for early morning wakening due to longer half life

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12
Q

When would BZDs be used in insomnia case?

A
  • Insomnia associated with daytime anxiety – diazepam given at night
  • Only when insomnia is severe
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13
Q

What is the BZD withdrawal like?

A
  • Slow = want to avoid rebound insomnia and anxiety

* Rebound effects are worst after acute withdrawal of short acting drugs – need to tail individual off it

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14
Q

What are the 3 sites of action of BZDs?

A
  • Reticular Activating System - controls conscious, alert state (hypnotic effect)
  • Limbic system in cortex - controls emotions (anxiolytic effect)
  • Other sites in cortex - anticonvulsant effect
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15
Q

What is the MOA of BZDs?

A

Influence GABA at Cl channel = increase frequency of opening of the channel

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16
Q

What are the side effects of BZDs?

A

Dependence & potentiation of other CNS depressants

17
Q

What is the effect of midazolam and methadone?

A

Midazolam (sedative) potentiated by methadone (opiate which decreases heroin /opioid withdrawals) = may induce RESPIRATORY ARREST

18
Q

What is the reversal drug for BZDs?

A

Flumazenil – antagonist, stronger binding than other benzodiazepines

19
Q

What receptor do antihistamines block?

A

H1 blockers (anti-allergy) produce CNS depression at therapeutic doses

20
Q

What antihistamines are used in children?

A

Promethazine

21
Q

What are Z drugs (hypnotics) used for and name 2?

A
  • Zolpidem
  • Zopiclone = prescribed for insomnia instead of temazepam usually due to street value/ addiction of temazepam
  • Work at BZD receptors
22
Q

Name hypnotics?

A 
•	Chlormethiazole
•	Chloral hydrate
•	Melatonin
•	Alcohol
N20 = LAUGHING GAS
  • Diazepam
  • Chlordiazepoxide
  • Lorazepam
  • Midazolam
  • Temazepam
23
Q

What is the use of anxiolytics?

A
  • Pre-med
  • Sedation
  • Muscle relaxants – TMD, dislocation
  • Severe pain e.g. MI
  • Emergency Drugs e.g. epilepsy
  • Amnesic effect – dangerous medico-legally
24
Q

What is the sedative effect of alcohol?

A

60 mins of sedation

30 mins to peak plasma levels – variation

25
Q

What effect does alcohol have on sleep?

A

Not good sleep inducing agent

26
Q

Name anxiolytics?

A

Alcohol
BZDs
Buspirone
Beta-adrenergic blockers

27
Q

What effect does chlordiazepoxide (BZD) have?

A

Reduces alcohol/drug withdrawals

28
Q

What determines how long a person stays drunk for?

A

Acetylation in the liver

29
Q

When is buspirone used?

A

Pt. needs anxiety helps short term for single occasion

30
Q

What receptor does buspirone act on? and what effect does it cause on the body?

A

Acts as a serotonin receptor agonist
Anxiolytic without sedation
No withdrawal effects

31
Q

What dental/oral problem does busprione cause?

A

Dry mouth

32
Q

What are the effects of beta-adrenergic blocking drugs?

A
  • Treats somatic anxiety e.g., tremor/ palpitations, not thoughts
  • Sympathetic over-stimulation
  • Low dose beta blocker – reduces sympathetic effect decreasing HR/ tremor

Human Diseases (17 decks)

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