hypnotics, sedatives, anxiolytics Flashcards
sedatives are used for which 2 disorders?
- insomnia
2. anxiety
overall MOA of sedatives
depress CNS function
what agents are used for anxiety relief?
anxiolytics
what agents are used to promote sleep?
hypnotics
describe the difference in dosing between hypnotics and anxiolytics
SMALL doses for ANXIETY relief
LARGE doses for SLEEP induction
what is the drug class of choice for hypnotics (promoting sleep)?
benzos
what is the drug class of choice for both anxiety and insomnia?
benzos
what are benzos ending in? (how can we recognize/identify them?)
“____zepam”
OR
“____zolam”
MOA of benzos (3)
- depress neuron fxn
- decrease anxiety (through limbic system)
- potentiate effects of GABA
what is the unique aspect to GABA + benzos?
benzos only work on endogenous GABA; there’s a finite amount which creates a “built in” limit to CNS depression
what is the prototype for benzos for SLEEP
triazolam
what effects on sleep will you see with triazolam? (3)
- decreased sleep onset
- fewer awakenings
- greater amt of total sleep time
what are the prototypes (3) for benzos as anxiolytics?
- lorazepam (Ativan)
- diazepam (Valium)
- alprazolam (Xanax)
“that LAD is very chill… he’s not anxious at all”
what is the benzo commonly used for procedures?
midazolam (Versed)
“this benzo puts the MIDAs touch on things to chill people out before procedures”
what schedule drug are benzos?
schedule 4
AE (3) of benzos
just the overall category of systems they affect
- CNS
- Cardiovascular
- Respiratory
re: SE of benzos, what’s happening with the CNS? (6)
- sedation
- psychomotor slowing
- confusion
- amnesia
- drowsiness
- sleep driving
out of the CNS effects r/t benzos, what 2 will improve after ~ 1 week of starting the drug?
sedation + psychomotor slowing
re: SE/AE of benzos, what’s happening with the cardiovascular system?
(PO admin + IV admin)
oral: little to no effect
IV: profound HYPOtension + cardiac arrest
give slow + through port closest to IV
re: SE/AE of benzos, what’s happening with the respiratory system?
(PO admin + IV admin)
oral: little to no effect
IV or combine w/other CNS depressants: significant respiratory depression
can we use benzos with preggos?
NOOOOO
what type of dosing with benzos will you often see withdrawal effects with? and what s+s would you see?
HIGH doses
panic, paranoia, delirium, HTN, muscle twitches, convulsions
think of HTN as a rebound HTN
how should people come off benzos?
slowlyyyyyy wean
what is the antidote for benzodiazepines? and what’s the unique thing about this antidote? how often should you administer it?
flumazenil
- only reverses SEDATION, not respiratory effects… but could have an indirect effect on respiratory*
- admin: q minute over 15 mins*
benzodiazepine-like drugs are used for what?
insomnia
benzodiazepine-like drugs ALL have a risk for what?
sleep-driving
rare!
what’s the prototype for benzodiazepine-like drugs (for insomnia)?
zolpidem (Ambien)
what’s the indication for zolpidem?
SHORT TERM management of insomnia
what are the 2 most common SE of zolpidem
daytime drowsiness + dizziness
what schedule drug is zolpidem?
schedule 4
what is our benzo prototype for anxiolytics?
diazepam (valium)
val the housewife needs her anti anxiety med
what are our 2 non-benzo/non-barbituate prototype for anxiolytics?
- busiprone
2. hydroxyzine (scheduled QID = anxiety / prn = insomnia)
buspirone (Buspar) is a “no” drug… what are the no’s?
NOT a CNS depressant NO abuse potential NO suicide risk NO increased CNS effects with other CNS drugs NOT for PRN use NO grapefruit
what’s the drug-food interaction with buspirone?
grapefruit!!
what drug class is hydroxyzine?
antihistamine (also affects serotonin)
hydroxyzine scheduled QID would be for what?
anxiety
hydroxyzine as PRN drug would be for what?
insomnia
SE of hydroxyzine
- dry mouth
- constipation
- HA
- dizziness
- fatigue
(anticholinergic SE)
what’s an AE of hydroxyzine with LONG TERM use?
prolonged QT intervals (watch for dysrhythmias)
