Hypnotics and Anxiolytics

Question 1

What are the indications for Benzodiazepine?

Answer 1

• Short term relief of severe, disabling anxiety; occurring alone, with insomnia, or psychotic illness
• Severe, disabling insomnia

Question 2

What is the protocol for withdrawal for long-term prescribed benzodiazepine patients?

Answer 2

• Transfer patient stepwise, one dose at a time over a week
• Reduce diazepam dose by 1-2 mg every 2-4 weeks. If uncomfortable withdrawal symptoms occur, maintain this dose until symptoms lessen
• Complete withdrawal may vary from several months to a year or more

Question 3

Which 2 benzodiazepines are used as hypnotics, and have a prolonged action, and may give residual effects on the following day?

Answer 3

Nitrazepam and Flurazepam

Question 4

Which 3 benzodiazepines are used as hypnotics but act for a shorter time?

Answer 4

Loprazolam, Lormetazepam and Temazepam

Question 5

Is withdrawal phenomena more common with short-acting or long acting benzodiazepines?

Answer 5

Short-acting benzodiazepines

Question 6

If insomnia is associated with daytime anxiety, which long-acting benzodiazepine may effectively treat both symptoms?

Answer 6

Diazepam given as a single dose at night

Question 7

Why should you not prescribe Benzodiazepines and Z-drugs should be avoided in the elderly?

Answer 7

Because the elderly are at greater risk of becoming ataxic and confused, leading to falls and injury

Question 8

Out of temazepam and diazepam, which is preferred when it is important to minimise residual effect the following day?

Answer 8

Temazepam

Question 9

Can you name 2 non-benzodiazepine hypnotics?

Answer 9

Zolpidem tartrate and Zopiclone (sometimes referred to as Z-drugs)
But they act at the benzodiazepine receptor

Question 10

Which hypnotic can be prescribed to the elderly?

Answer 10

Clomethiazole but still undesirable

Question 11

What pineal hormone is licensed for the short-term treatment of insomnia in adults over 55 yo?

Answer 11

Melatonin

Question 12

Which 6 benzodiazepines are indicated for the short-term relief of severe anxiety?

Answer 12

Diazepam
Alprazolam 
Chlordiazepoxide hydrochloride 
Clobazam 
Lorazepam and Oxazepam

Question 13

Which 2 benzodiazepines can occasionally administered via IV for the control of panic attacks?

Answer 13

Diazepam or Lorazepam, but should only be used only when alternative measures have failed.

Question 14

What receptors does Buspirone hydrochloride act on?

Answer 14

5HT 1A