Non BZD Anxiolytics and Non-BZD hypnotics Flashcards

1
Q

What are the non BZD anxiolytics

A

Barbiturates
Buspirone
SSRIs
SNRIs - venlafaxine, duloxetine

ie this topic is about the barbiturates and buspirone

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2
Q

List the barbiturates, shortest to longest acting

A

Thiopental - ultra short, onset 1 min action 5-10 minutes

Amobarbital - mid acting 6-8 hours

Pentobarbital
Phenobarbital - from 4 hours thru 2 days.
Primadone
- prodrug that generates phenobarbital

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3
Q

Phenobarbitral indications

A

1st line for seizures in neonates. Not much else

Can be used to stop seizures or SE, but second line to Diazepam Lorazepam

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4
Q

Phenobarbital side effectss

A

Significant cardiac and respiratory depression

Significant CNS depression, Coma.

Very risky in elderly. POtentially lethal CNS and cardiorespiratory suppression.

Long duration and ‘hangover’ effect for a couple days after use.

Tolderance, dependance, and addiction

Potent CYP INDUCER. increases warfarin, statin metabolism, decreasing concentration.

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5
Q

Primadone indications

A

1st line for essential tremor along with a beta blocker

2nd line antiseizure prophylaxis

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6
Q

Thiopental indications

A

Induction anesthetic. Not 1st line

Reduction of Intracranial pressure, constrictor of CNS vessels.

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7
Q

Busipirone mechanism and indication

A

PARTIAL AGONIST of 5HT1A

slow onset anxiolytic, used for GAD.

often used with bridging therapy of short term benzos for a few weeks, then Busipirone continued alone.

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8
Q

What antidepressants are used as anxiolytics?

A

SNRIs: venlafaxine duloxetine

SSRIs: Fluoxetine, Sertraline, Citalopram, Escitalopram.

NRIs: Reboxetine in some countries for panic disorder.

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9
Q

What are the non-benzo hypnotics?

A

The Z’s, the Melatonins, and Suvorexant.

The Z’s
Zolpidem
Zaleplon (Zales, dream of diamonds)
Eszopiclone

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10
Q

What are the melatonin agonists

A

Ramelteon

Tasimelteon

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11
Q

What is Suvorexant

A

Orexin receptor ANTAGONIST.

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12
Q

Half life of the Z’s

A

Zaleplon duration 1 hour, least hangover effect. good at promoting sleep but not maintaining it.

Zolpidem 3 hours

Esopiclone ~6 hours. best at maintenance but also hangover.

Note: ELDERLY patients have DRASTICALLY increased half life for these drugs, and should be careful using them. sedation, falls,

abs. contraindication for use with other depressants.

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13
Q

How do the Z’s act?

A

Bind specifically to the BZ1 receptor, alpha subunit of the BZ receptor.

Only have sedative/hypnotic effects and not anxiolytic.

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14
Q

Side effects of Suvoerexant

A

Strange dreams
CNS depression
Suicidal thoughts
Upper resp tract infections.

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15
Q

Side effects of the melatonin agonists

A

Not really any.
Best ones for elderly patients.

Also the only hypnotic of these drugs that don’t alter REM or sleep architecture.

mild fatigue.

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