lecture: anxiety and insomnia drugs

Question 1

Insomnia is defined as:

Answer 1

Difficulty with falling asleep, staying asleep, or waking early.

It is also defined as
poor sleep quantity or quality

Question 2

anxiolytic

Answer 2

“seditive” - produce calm & relaxation, reduces excitement

Question 3

hypnotic

Answer 3

produce sleep

Question 4

Sedatives and hypnotics work by depressing the CNS function. They are given in a LOW dose range. They are primarily used for (2).

Answer 4

anxiety disorders and insomnia

They include benzodiazepines, benzodiazepine-like drugs, and barbiturates.

Question 5

Benzodiazepines are the drug of choice for (2).

Answer 5

insomnia and anxiety
A low dose is used to treat anxiety, and a high dose is used as a hypnotic.

They are also used to induce general anesthesia, for seizure disorders, for muscle spasms, and for alcohol withdrawal.

Question 6

Benzodiazepines reduce anxiety and produce sleep by potentiating ___.

Answer 6

GABA

They do not mimic GABA. Therefore the body is dependent on the body’s own supply of GABA, and therefore they are hard to OD on.

Question 7

Benzodiazepines are generally very well tolerated. They have (3).

Answer 7

fewer drug interactions, lower abuse potential, and drug interactions.

Question 8

Side effects of Benzodiazepines include:

Answer 8

CNS depression,
weak respiratory depression,
Preganancy D or X,
and IV use can cause profound HTN and cardiac arrest

“Ben-Zo’s bring everything LOW and SLOW!”

Question 9

Patients can develop a tolerance to Benzodizepines, especially when used as an ___.

Answer 9

anti-seizure.

Question 10

Benzodiazepines interact with ___.

Answer 10

other CNS depressants.

They can also have a cross tolerance with othe CNS depressants. ie low and slow!

Question 11

For Benzodiazepine toxicity/OD:

Answer 11

1. provide supportive care (O2)

2. Give flumazenil (Romazicon)

Question 12

Benzodiazepine suffix

Answer 12

-epam / -olam
think “Pam and Lam driving a Benz”

diazepam, lorazepam, alprazolam

Question 13

Oral Benzodiazepines can be taken ___.

Answer 13

with food, especially for GI upset.

Question 14

IV Benzodiazepines (diazepam, lorazepam) are very ___.

Answer 14

hazardous

So inject slowly, avoid intra-arterial injection and extravasation, and inject into tubing as close to the vein as possible.

Question 15

Benzodiazepine-like drugs are the preferred agent for ___ and NOT indicated for ___.

Answer 15

preferred for insomnia, NOT for anxiety.

“Get your Zzz’s”
Zolpidem (ambien), Zaleplon (sonata), esZopiclone (lunesta)

Question 16

Both Benzodiazepines and Benzodiazepine-like drugs are Schedule __ drugs.

Answer 16

IV

Question 17

The Melatonin agonist ____ is used for chronic insomnia. It is used for difficulty with ___. It is generally very well tolerated.

Answer 17

ramelteon

onset of sleep, NOT sleep maintenance. This is because it has a rapid onset (30 minutes) and a short duration.

Question 18

___ is used for chronic insomnia, both sleep onset and maintenance. It is a schedule IV drug, and has a low level of abuse/dependency.

Answer 18

suborexant (orexin antagonist)

Question 19

Barbiturates suffix

Answer 19

-bital / -xital

Question 20

___ are used for insomnia, anesthesia, and seizure disorders. They have a HIGH abuse potential, and cause tolerance and dependence.

Answer 20

Barbiturates

Question 21

Barbiturates are POWERFUL ___ that potentiate and mimic GABA.

Answer 21

respiratory depressants

Question 22

Methohexital, an ultrashort acting barbiturate is used for ___.

Answer 22

inducing anesthesia

Question 23

Secobarbital and pentobarbital, short to intermediate barbiturates are used for ___.

Answer 23

insomnia.

Question 24

Phenobarbital, a long acting barbiturate is used for ___.

Answer 24

seizures.

Question 25

Adverse effects of barbiturates include:

Answer 25

respiratory depression,
suicide,
abuse,
toxicity (respiratory depression, coma, pinpoint pupils)

Question 26

Treatment of insomnia is with hypnotic drugs such as: (7)

Answer 26

benzodiazapines,
benzodiazapine-like drugs,
ramelteon,
suborexant,
antidepressants,
antihistamines,
and herbals (melatonin, chamomile, etc)

Question 27

Generalized anxiety disorder (GAD) is treated with:

Answer 27

benzodiazepines,
buspirone,
and antidepressants (SNRI’s)

Question 28

Panic disorder is treated with:

Answer 28

CBT (cognitive behavioral therapy),
Antidepressants (SSRI, Tricyclic, MOAI),
Benzodiazepines

Question 29

OCD is treated with:

Answer 29

CBT 9Cognitive behavioral therapy),
SSRI (citalopram, escitalopram, sertraline),
TCA,
Deep Brain Stim

Question 30

Social anxiety disorder is treated with:

Answer 30

Psychotherapy + drugs,
Antidepressants - (SSRIs),
Benzodiazepines, propranolol [Inderal]

Question 31

PTSD is treated with:

Answer 31

Psychotherapy + drugs,

antidepressants (SSRI, SNRI’s)