hypnotics + anxiolytics Flashcards
when do anxiolytics and hypnotics have their sedating effects
anxiolytics - induce sleep when given at night
hypnotics- induce sleep when given during the day
why are anxiolytics + hypnotics reserved for short-term use
because they lead to dependence (both physical and psychological) and tolerance. It is hard to withdraw a patient if they have been taking it regularly for more than a few weeks
what is the most common class of anxiolytics + hypnotics
benzodiazepines
when would the use of benzodiazepines be indicated
- short-term relief (two to four weeks only) for severe anxiety which is disabling/severely distressing. Patient may have severe anxiety alone or with insomnia/ psychotic illness
- severe insomnia, can be disabling or causing extreme distress
Can you use benzodiazepines to treat mild anxiety
No. The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.
what can happen if you abruptly withdraw a patient from benzodiazepines
may produce confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens (a severe form of alcohol withdrawal)
- must withdraw benzodiazepines slowly to prevent this
how long does it take to withdraw benzodiazepines
- Short-term users of benzodiazepines (2–4 weeks only) can usually taper off within 2–4 weeks
- Long-term users should be withdrawn over a much longer period of several months or more
how long can it take for benzodiazepine withdrawal syndrome to develop
what are the symptoms of this
- can occur any time up to 3 weeks after stopping a long-acting benzodiazepine, but may occur within a day in the case of a short-acting one
symptoms of benzodiazepine withdrawal syndrome:
- insomnia, anxiety, loss of appetite and of body-weight, tremor, perspiration, tinnitus (ringing/noises in ear), and perceptual disturbances
- symptoms may be similar to original complaint + encourage further prescribing
- note some symptoms may continue for weeks or months after stopping benzodiazepines*
describe the steps to withdraw a patient from long-term use of benzodiazepines
1) transfer the patient to to an equivalent daily dose of diazepam preferably taken at night. This can be done one dose at a time, over a week
2) reduce diazepam dose gradually by 1-2 mg every 2-4 weeks. Towards the end can use smaller doses (e.g 500mcg) to reduce dose of diazepam then stop completely
* note the withdrawal process can take months to a year+.
name some long-acting and short-acting benzodiazepines
long acting: diazepam, clonazepam, clobazam, flurazepam, nitrazepam, chlordiazepoxide
short acting: oxazepam, temazepam, Loprazolam, lormetazepam, lorazepam
note Withdrawal phenomena are more common with the short-acting benzodiazepines.
which drugs should we avoid adding when a patient is taking benzodiazepines
The addition of beta-blockers, antidepressants and antipsychotics should be avoided where possible
what are hypnotics used for
insomina
note cause of the insomnia should be established and, where possible, underlying factors should be treated before use of hypnotics
which type of patients are Short-acting hypnotics preferred
- patients with sleep onset insomnia, when sedation the following day is undesirable
or - when prescribing for elderly patients
which type of patients are long-acting hypnotics preferred
- patients with poor sleep maintenance (e.g. early morning waking) that causes daytime effects
or - when an anxiolytic effect is needed during the day
or - when sedation the following day is acceptable.
what is transient insomnia
Transient insomnia: when patients normally sleep well and may be due to extraneous factors such as noise, shift work, and jet lag they are not sleeping well
how can a hypnotic be given for transient insomnia
if a hypnotic is needed, use one that is rapidly eliminated should be chosen, and only one or two doses should be given.
