Hypnotics and anxiolytics 1

Question 1

what is the difference between anxiolytics (‘sedatives’) and hypnotics?

Answer 1

1) Aanxiolytics (‘sedatives’) will induce sleep when given at night
2) Hypnotics will sedate when given during the day

Question 2

why should hypnotics and anxiolytics be reserved for short courses to alleviate acute conditions?

Answer 2

1) Dependence and tolerance occur

2) May lead to difficulty in withdrawing after taking it regularly for more than a few weeks

Question 3

Benzodiazepines are the most commonly used anxiolytics and hypnotics. What is their MoA?

Answer 3

They act at benzodiazepine receptors which are associated with gamma-aminobutyric acid (GABA) receptors

Question 4

what conditions are benzodiazepine indicated for and what should they not be used to treat?

Answer 4

1) short-term relief (2-4w only) of anxiety or insomnia that is severe, disabling, or causing unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness.
2) Their use for short-term ‘mild’ anxiety is inappropriate

Question 5

Withdrawal of a benzodiazepine should be gradual. what symptoms can abrupt withdrawal cause?

Answer 5

confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens

Question 6

When might benzodiazepine withdrawal syndrome occur if following are withdrawn?

1) long-acting benzodiazepine
2) Short-acting benzodiazepine

Answer 6

1) 3 weeks after stopping a long-acting benzodiazepine

2) within a day in a short-acting one

Question 7

list the characteristics of benzodiazepine withdrawal syndrome (7)

Answer 7

1) Insomnia
2) Anxiety
3) loss of appetite and of body-weight
4) Tremor,
5) Perspiration,
6) Tinnitus
7) Perceptual disturbances

Question 8

1) Short-term users of benzodiazepines (2–4 weeks only) can usually tapered off within how many weeks?
2) what about long term users?

Answer 8

1) usually taper off within 2–4 weeks

2) long-term users should be withdrawn over a much longer period of several months or more

Question 9

1) Withdrawal symptoms for long-term users usually resolve within how many months after the last dose of benzodiazepine?
2) which drugs should be avoided during withdrawal?

Answer 9

1) Within 6–18 months of the last dose.

2) The addition of beta-blockers, antidepressants and antipsychotics should be avoided where possible

Question 10

1) when withdrawing patients who have been on long-term benzodiazepine, which drug should they be transferred to before the dose is gradually decreased?
2) How much is the dose of benzodiazepine reduced by every 2-4 weeks?

Answer 10

1) Diazepam - Transfer patient stepwise, one dose at a time over about a week, to an equivalent daily dose of diazepam preferably taken at night
2) Then reduce diazepam dose, usually by 1–2 mg every 2– 4 weeks

Question 11

Explain which patients are short-acting hypnotics preferable in and which individuals benefit from longer acting ones

Answer 11

1) Short-acting hypnotics are preferable in patients with sleep onset insomnia, when sedation the following day is undesirable, or elderly patients
2) Long-acting indicated for patients with poor sleep maintenance (e.g. early morning waking) that causes daytime effects, when an anxiolytic effect is needed during the day, or when sedation the following day ok

Question 12

Transient insomnia may occur in those who normally sleep well and may be due to extraneous factors such as noise, shift work, and jet lag. What type of hypnotic is indicated in this case?

Answer 12

One that is rapidly eliminated and only one or two doses should be given

Question 13

Short-term insomnia is usually related to an emotional problem or serious medical illness. What type of hypnotic is indicated in this case and how much should be supplied?

Answer 13

1) A short-acting drug is usually appropriate

2) Not be given for more than 3 weeks (preferably only one week). Intermittent use is desirable

Question 14

Chronic insomnia is rarely benefited by hypnotics and is sometimes due to mild dependence caused by hypnotics. list some of the other common causes of chronic insomnia?

Answer 14

1) Psychiatric disorders such as anxiety, depression
2) Abuse of drugs and alcohol
3) Daytime cat-napping
4) Physical causes such as pain, pruritus, and dyspnoea.

Question 15

Sleep disturbance is very common in depressive illness, which symptom would usually indicate this?

Answer 15

Early wakening

Question 16

1) How many days does it take for tolerance to develop with the use of hypnotics?
2) what is a major drawback of using hypnotics?

Answer 16

1) Tolerance develops within 3 to 14 days of continuous use
2) withdrawal can cause rebound insomnia and a withdrawal syndrome in long term use

Question 17

Explain why benzodiazepines and the Z–drugs should be avoided in the elderly

Answer 17

Elderly are at greater risk of becoming ataxic and confused, leading to falls and injury

Question 18

Some anxious patients may benefit from the use of hypnotics during dental procedure. which two drugs can normally be prescribed?

Answer 18

1) Temazepam is preferred when it is important to minimise any residual effect the following day
2) Diazepam