Psych: Sleep and Anxiety Disorders Flashcards
1
Q
Barbiturate Drugs?
A
- Phenobarbital
- Thiopental
2
Q
Phenobarbital (Luminal)
A
- Barbituate – long half life
- Binds directly to the GABAA receptor
- Increases the efficacy of endogenous GABA signaling
- Increases Cl- channel openings –> membrane Hyperpolarization and decreased Excitability
- Suppresses Reticular activating system –> suppresses Seizures at low levels that do not induce Hypnosis
- Tx: Tonic-clonic and Partial seizures (preferred Pregnant women)
- SEx: Sedation, Inducer of CYP450 system
3
Q
Thiopental (Pentothal)
A
- GABAergic – short half life
- Binds directly to the GABAA receptor
- Increases the efficacy of endogenous GABA signaling
- Increases Cl- channel openings –> membrane Hyperpolarization and decreased Excitability
- Suppresses Brainstem Reticular activating system; Sedation, Amnesia, LOC, Reflex suppression
- Tx: Pre-anesthetic sedative, Adjunct to Local anesthesia, Sedative-hypnotic
- Hepatic metabolism by CYP450 sys. and Potent CYP450 inducer
4
Q
Benzodiazepines
A
- Binds directly to GABAA receptor and increases potency of endogenous GABA signaling
- Increases Cl- channel openings –> membrane Hyperpolarization and decreased Excitability
- Suppresses Brainstem Reticular activating system; Sedation, Amnesia, LOC, Reflex suppression
- Inhibitory neurotransmission –> Anticonvulsant and Muscle relaxant
- Indirectly activate GABA –> Larger therapeutic index than Barbituates
- Tx: Sedative-hypnotic, Anxiolytic: short-term management, Status Epilepticus, Prophylaxis against Ethanol withdrawal, Muscle relaxant, Anesthesia induction
- SEx: Drowsiness, Impaired judgement, Decreased Motor skills
- Tolerance and High potential for Dependence
- Concomitmant –> Fatal CNS depression
5
Q
Short half-life Benzodiazepines? ( < 8 hours)
(M O T)
A
- Midazolam
- Oxazepam
- Triazolam
6
Q
Medium half-life Benzodiazepines? (8 – 16 hours)
(A E L T)
A
- Alprazolam
- Estazolam
- Lorazepam
- Temazepam
7
Q
Long half-life Benzodiazepines? ( > 16 hours)
(CCC D F Q)
A
- Chlordiazepoxide
- Clonazepam
- Clorazepate
- Diazepam
- Flurazepam
- Quazepam
8
Q
Benzodiazepine Drugs?
(M O T – A E L T – CCC D F Q)
A
- Midazolam
- Oxazepam
- Triazolam
- Alprazolam
- Estazolam
- Lorazepam
- Temazapam
- Chlordiazepoxide
- Clonazepam (also Spasmolytic)
- Clorazepate
- Diazepam (also Spasmolytic)
- Flurazepam
- Quazepam
9
Q
Non-benzodiazepines?
(E - ZZ)
A
- Eszopiclone (Lunesta)
- Zolpidem (Ambien)
- Zoleplon (Sonata)
10
Q
Eszopiclone (Lunesta)
Zolpidem (Ambien)
Zoleplon (Sonata)
A
- GABAergic
- Nonbenzodiazepine Sedative-hypnotic
- Selectively stimulates the w1 subtype of GABAA receptor
- Produces Sedation and Anxiolysis – very little Muscle relaxant or Anticonvulsant activity
- Tx: Insomnia, Restless leg syndrome
- SEx: Drowsiness, Dizziness, and Fatigue
- Additive w/ other CNS depressors
11
Q
Benzodiazapine Antagonist?
A
- Flumazenil
12
Q
Flumazenil (Romazicon)
A
- Benzodiazepine Analog Antagonist
- Competitively inhibits the actions of Benzodiazepine
- Rapidly-reverse Benzodiazepine overdose but MAY precipitate withdrawal Seizures, espcially in Alcoholics or Chronic Benzodiazepine users
13
Q
Ramelteon (Rozerem)
A
- Weak Non-benzodiazepine Sedative-hypnotic
- Selectively Stimulates Melatonin Type 1 and Melatonin Type 2 receptors
- Melanonin is a hormone secreted by the Pineal gland that regulates the Sleep-wake cycle
14
Q
Buspirone (BuSpar)
A
- Selective Partial Agonist of 5-HT1A serotonin receptors
- Tx: Anxiolytic w/out sedation
- Cannot be used to treat Benzodiazepine withdrawal
- SEx: Tachycardia, palpatations, GI distress, Less abuse potential than Benzodiazepines, No rebound anxiety or withdrawal symptoms with Discontinuation
- Contraindicated w/ Hepatic or Renal impairment
- Hepatic oxidation to active metabolite
- Use w/ MAOIs may lead to Hypertensive crisis
- Cocomitant consumption of Grapefruit joice can lead to markedly increased levels of Buspirone because of inhibition of CYP3A4
15
Q
TCA Sedatives Drugs?
A
- Amitryptaline
- Doxepin
