Hypnotics and anxiolytics

Question 1

What are H&A primarily used for?

Answer 1

Used for their sedative purposes

Question 2

Which are the newer hypnotics? Why are they better?

Answer 2

benzodiazepines

Fewer S/E than the barbiturates

Question 3

What are the problems with hypnotics in general?

Answer 3

Dependency and tolerant problems

withdrawal symptoms - must be converted to an equivalent dose to diazepam and tailored off it from there

Question 4

What are the withdrawal S/E someone could get on benzo’s?

Answer 4

• loss of appetite
• anxiety
• tremor
• insomnia

must be withdrawn very slowly and gradually

Question 5

What are the main two counselling points you must tell a pt on a drug that has sedative properties?

Answer 5

• caution with driving and drinking

avoid both

Question 6

Which effect occurs when a pt is on hypnotics and benzodiazapines?

Answer 6

• increases someones paradoxical effects - increases a persons aggressive and hostility

Question 7

What short term symptom can benzo’s be used for?

Answer 7

short term anxiety (usually for 2-4 weeks)

Question 8

What else can benzo’s be used for?

Answer 8

insomnia

Question 9

what are three main types of insomnia?

Answer 9

• short term (related to emotional problem)
• transient (people who do shift work or are jet-lagged)
• chronic (depressive illness)

Question 10

How long can benzo’s be used for in all three types of insomnia?

Answer 10

short -term: no more than 3 weeks

transient: only 1-2 doses are given. Choose a rapidly eliminated hypnotic
chronic: Benzo’s and hypnotics are not usually used here

Question 11

when should you avoid hypnotics? Why?

Answer 11

in the elderly

as it causes confusion and can result in falls.

Question 12

Which benzo can an elderly patient use?

Answer 12

Temazepam (dentists can also use them)

Question 13

What are other examples of hypnotics?

Answer 13

Laprazolam

nitrazapam

Question 14

What are your ‘Z’ drugs? and which category do they fall under?

Answer 14

Non-benzodiazepines
but hypnotics

Schedule 4 drugs

Zopiclone
Zolpidem
zalipron (very short acting)

Question 15

What are the benefits of laprazolam and tempazem over other benzodiazepines?

Answer 15

dont have a hang over effect

Question 16

What antihistamines can be used for sedative properties?

Answer 16

Promethazine - can be used for occasional insomnia

Question 17

What other drug can be used for insomnia?

Answer 17

Melatonin in over 55 year olds

Question 18

What class of drugs should not be primary treatment for anxiety, depression and chronic psychosis?

Answer 18

Anxiolytics

Question 19

What can be given to children if they have acute anxiety (fear)?

Answer 19

anxiolytics or beta blockers can be used like anxiolytics - as this reduces heart rate and tremor and prevents fear and worry from patient

Question 20

Which anxiolytic/hypnotics have sustained action?

Answer 20

diazepine and clobazam

Question 21

In which patient category are lorazepam and oxazepam useful in? Whats one of the risks of using them?

Answer 21

can be used in patients with hepatic impairment

carry the risk of withdrawal symptoms

Question 22

What different categories do the barbiturates come in?

Answer 22

short acting- thiopental can be used in anaesthesia
intermediate acting
long acting - phenobarbital