NS: Hypnotics

Question 1

What are the most commonly used anxiolytics and hypnotics?

Answer 1

Benzodiazepines; they act at benzodiazepine receptors which are associated with gamma-aminobutyric acid (GABA) receptors.

Question 2

Benzodiazepines are indicated for the short-term relief of anxierty that is severe, disabling etc. How long is ‘short-term’?

Answer 2

2-4 weeks.

Question 3

A suggested protocol for withdrawal for prescribed long-term benzodiazepine patients involes transfering the patient stepwise, one dose at a time over about a week, to an equivalent daily dose of what?

Answer 3

Diazepam preferably taken at night.

Then reduce by 1-2mg every 2-4 weeks.

Question 4

Benzodiazepine withdrawal symptoms for long-term users usually resolve within how long of the last dose?

Answer 4

6-18 months.

Question 5

Benzodiazepines used as hypnotics include which two that have a prolonged action and may give rise to residual effects on the following day, with repeated doses tending to be cumulative?

Answer 5

Nitrazepam and flurazepam have a prolonged action.

Question 6

Loprazolam, lormetazepam and temazepam act for how long?

Answer 6

Loprazolam, lormetazepam, and temazepam act for a shorter time and they have little or no hangover effect. Withdrawal phenomena are more common with the short-acting benzodiazepines.

Question 7

What are the Z drugs? (3)

Answer 7

Zaleplon
Zolpidem
Zopiclone

Question 8

How do the Z drugs work?

Answer 8

They are non-benzodiazepine hypnotics which act at the benzodiazepine receptor.

Question 9

What Z drugs have a short duration of action?

Answer 9

Zolpidem and zopiclone have a short duration of action.

Question 10

What Z drugs have a long duration of action?

Answer 10

Zaleplon

Question 11

Melatonin is a pineal hormone, it is licensed for what?

Answer 11

The short-term treatment of insomnia in adults over 55.

Question 12

How are beta-blockers used in anxiety?

Answer 12

Beta-adrenoceptor blocking drugs do not affect psychological symptoms of anxiety, such as worry, tension, and fear, but they do reduce autonomic symptoms, such as palpitation and tremor; they do not reduce non-autonomic symptoms, such as muscle tension. Beta-blockers are therefore indicated for patients with predominantly somatic symptoms; this, in turn, may prevent the onset of worry and fear.

Question 13

Buspirone is licensed for short-term use as an anxiolytic, how does it work?

Answer 13

IT is thought to act at specific serotonin (5HT1A) receptors.