Hypnotics and Sedatives - NonBenzodiazepines

Question 1

Which of the following is NOT a nonbenzodiazepines that we need to know as a core drug?

1 - Lorazepam
2 - Zopiclone
3 - Zolpidem
4 - Melatonin

Answer 1

1 - Lorazepam

Question 2

Nonbenzodiazepines, are drugs which generally act as a neural depressant. What is the mechanism of action of this drug?

1 - agonist of D2 dopamine receptors
2 - antagonist of D2 dopamine receptors
3 - binds GABA-a receptors increases chloride influx
4 - binds GABA-b receptors decreasing chloride influx

Answer 2

3 - binds GABA-a receptors, increases chloride influx

• bind to the z site between the alpha-1 and gamma-2 subunits of GABA- A receptors changing shape of receptors and allowing more GABA to bind and more Cl- to flow into the cell
• same mechanism as benzodiazepines

Question 3

What is the most common indication of nonbenzodiazepines, such as Zopiclone, Zolpidem and Melatonin?

1 - depression
2 - personality disorder
3 - nausea
4 - insomnia

Answer 3

4 - insomnia

• must be distressing or debilitating

Question 4

What is the most common adverse event of daytime use of nonbenzodiazepines?

1 - drowsiness
2 - nausea
3 - blurred vision
4 - tachycardia

Answer 4

1 - drowsiness

• this is what they are used for so no great surprise

Question 5

If nonbenzodiazepines are stopped, what can happen to sleep?

1 - remains better
2 - gets worse
3 - rebound insomnia

Answer 5

3 - rebound insomnia

Question 6

Which of the following is NOT a typical neurological adverse event that can presenting patients using nonbenzodiazepines?

1 - headaches
2 - muscle tremors
3 - confusion
4 - nightmares
5 - amnesia

Answer 6

2 - muscle tremors

Question 7

Does Zopiclone or Zolpidem cause changes in taste as an adverse event?

Answer 7

• Zopiclone

Question 8

Does Zopiclone or Zolpidem cause GI upset as an adverse event?

Answer 8

• Zolpidem

Question 9

Patients using nonbenzodiazepines should not take them for a period longer than what incase of dependence and withdrawal symptoms?

1 - 4 days
2 - 4 weeks
3 - 4 months
4 - 4 years

Answer 9

2 - 4 weeks

• generally not prescribed for more than 2 weeks anyway
• can cause muscle pain, headaches and anxiety

Question 10

If a patient overdoses on nonbenzodiazepines, which of the following would NOT generally occur?

1 - coma
2 - drowsiness
3 - respiratory depression
4 - peripheral neuropathy

Answer 10

4 - peripheral neuropathy

Question 11

Nonbenzodiazepines MUST NOT be used in all of these patients except:

1 - cardiovascular disease
2 - respiratory muscle weakness
3 - respiratory depression
4 - obstructive sleep apnea

Answer 11

1 - cardiovascular disease

Question 12

Nonbenzodiazepines are known to enhance the effects of all of the following drug classes EXCEPT:

1 - benzodiazepines
2 - alcohol
3 - hypertensives
4 - anti-histamines
5 - analgesics

Answer 12

5 - analgesics

Question 13

We need to be careful about drugs that have an affect on cytochrome P450 (CYP), as nonbenzodiazepines are metabolised by CYP. What effect would a CYP inhibitor have on nonbenzodiazepines?

1 - enhance sedation
2 - no effect
3 - impair sedation

Answer 13

1 - enhance sedation

• drug is not metabolised so remains in the system for longer

Question 14

We need to be careful about drugs that have an affect on cytochrome P450 (CYP), as nonbenzodiazepines are metabolised by CYP. What effect would a CYP inducer have on nonbenzodiazepines?

1 - enhance sedation
2 - no effect
3 - impair sedation

Answer 14

3 - impair sedation

• drug is metabolised quickly so drug will be in the system for less time

Question 15

What doses should zoplicone (Z1) and zolpidem (Z-2) be prescribed generally

1 - Z1 = 7.5mg and Z2 = 7.5mg
2 - Z1 = 7.5mg and Z2 = 10mg
3 - Z1 = 10mg and Z2 = 10mg
4 - Z1 = 10mg and Z2 = 7.5mg

Answer 15

2 - Z1 = 7.5mg and Z2 = 10mg

• given orally at bedtime
• dose should be halved in elderly