Miscellaneous

Question 1

Hypnotics

Answer 1

• Short term treatment for insomnia
• Second line to sleep hygiene measures
• Benzodiazepines – temazepam, diazepam
• Z drugs – zopiclone, zolpidem, zalepon – similar to benzodiazepines, act on GABA-A complex. Shorter half-life and less potential for dependence.
• Can have residual effects of drowsiness in the day time.
• Potentiated by alcohol.

Question 2

Psychostimulants

Answer 2

• Caffeine falls into this class.
• Amphetamine
• Methylphenidate
• Increase the release and block the reuptake of dopamine
• Could be useful in treatment resistant depression.
• Side effects include restlessness, insomnia, poor appetite, dizziness, tremor, palpitations and cardiac arrhythimias

Question 3

Alcohol detox

Answer 3

• Psychiatric and medical inpatients
• Alcohol should not be withdrawn suddenly
• Symptoms – anxiety, insomnia, agitation, risk of convulsions and death.
• Chlordiazepoxide – long acting benzodiazepine, regular dosing
• Multivitamins/Pabrinex
• Maintaining abstinence – acamposate, naltrexone – opiate partial agonist-antagonist – reduce craving, disulfiram disrupts alcohol metabolism, leading to an unpleasant physical reaction.

Question 4

Opioid dependence

Answer 4

• Methadone

* Buprenorphine