Psych: Sedatives/Hypnotics

Question 1

Definition: producing relaxation, calmness, and decreased motor activity w/o LOC?

Answer 1

Sedation

Question 2

Definition: inducing drowsiness and a depressed state of consciousness resembling natural sleep, along with impaired sensory responsiveness from which a person is easily aroused

Answer 2

Hypnosis

Question 3

What schedule of drugs are barbituates and benzos?

Answer 3

Barbs: class II

Benzos: class IV

Question 4

MOA of alpazolam, clonazepam, diazepam?

Answer 4

GABAa agonists

-increase frequency of Cl channel opening

Question 5

MOA of lorazepam, midazolam, and temazepam?

Answer 5

GABAa agonists

-increase frequency of Cl channel opening

Question 6

MOA of eszopiclone and zolpidem

Answer 6

Binds selectively to BZ1 receptors, located on GABA-a receptors

Question 7

MOA of flumazenil

Answer 7

Antagonist at benzo binding site of GABAa

-reverse adverse effects and OD of benzos

Question 8

MOA of ramelteon

Answer 8

Melatonin agonist at MT1 and MT2 receptors

Question 9

What are the high potency benzodiazepines?

Answer 9

Clonazepam, alprazolam, lorazepam

Question 10

MOA of suvorexant

Answer 10

Blocks binding of orexins

-orexins produce wakefulness, so if they are blocked=ZZZ (promotes sleep)

Question 11

MOA of doxepin

Answer 11

H1 antagonist and inhibits reuptake of NE and 5HT

Question 12

Who is most susceptible to the side effects of benzodiazepines and who is resistant?

Answer 12

Elderly are most, alcoholics and barbiturate drug users are resistant

Question 13

How do benzos change sleep patterns?

Answer 13

More stage II, less stage I, III, and REM

Question 14

What side effect is more common with the short acting benzos?

Answer 14

Amnesia

Question 15

How is diazepam metabolised?

Answer 15

CYP3A4 is major contrbuter

Question 16

What is the black box warning for taking benzos with opiates?

Answer 16

Major sedation, respiratory depression, coma and death

Question 17

Clinical use of benzos?

Answer 17

Anxiolytic and sedation

Question 18

Do eszopiclone and zolpidem reduce anxiety?

Answer 18

No

Question 19

ROI of eszopiclone and zolpidem

Answer 19

IR, sublingual tablets, and oral spray

Question 20

Clinical use of eszopiclone and zolpidem

Answer 20

Insomnia patients with difficulty with onset of sleep

-eszopiclone can be used for maintenance too

Question 21

Black box warning of eszopiclone and zolpidem

Answer 21

Complex sleep disorders

-sleep walking, sleep driving, and other activities

Question 22

What is the black box warning of flumazenil?

Answer 22

Seizures, espcially in those with TCA use

-contraversal use due to the fact that benzos are relatively safe

Question 23

What is the black box warning of flumazenil?

Answer 23

Seizures, espcially in those with TCA use

-contraversal use due to the fact that benzos are relatively safe

Question 24

Which group of sedatives are classic inducers of CYP3A4?

Answer 24

Barbituates

-monitor doses of other meds

Question 25

Clinical use of the barbituates?

Answer 25

Sedation and anxiolytic

Question 26

MOA of buspirone?

Answer 26

Partial agonist at 5HT

-mostly unsure of mechanism

Question 27

Clinical use of buspirone?

Answer 27

Nonbenzodiazepine anxiolytic

Question 28

Does buspirone cause sedation? What about when combined with alcohol?

Answer 28

Nope

-nor does it make sedation worse with alcohol

Question 29

Clinical use of doxepin?

Answer 29

-causes sedation and anxiolytic

Question 30

What should you do when taking patients off benzos?

Answer 30

Taper

-25-50% every 1 to 2 weeks over 6-10 weeks