Sedative, Alcohol, Durgs Of Abuse And Dementia

Question 1

3 families of sedative hypnotics?

Answer 1

Benzos (short acting, intermediate acting and long acting)
Barbs (ultra action, short action and long action)
Misc agents

Question 2

Good definition of sedative and hypnotic?

Answer 2

Drug that decreases CNS activity, moderates excitement, and calms the recipient

Produces drowsiness and facilitates the onset and maintenance of sleep

Question 3

5 clinical uses of sedative hypnotics?

Answer 3

Anxiety, insomnia, surgery/anesthesia, epilepsy, muscle relaxation

Question 4

MOA of benzos and 5 clinical effects?

Answer 4

GABA A agonist, so increases chloride influx causing hyper-polarization and decreased number of APs
Sedation, hypnotic effects, muscle relaxation, anti anxiety, anti convulsants

Question 5

MOA of barbiturates and spectrum of clinical effects?

Answer 5

GABA A agonist

Mild sedation to anesthesia

Question 6

What drug is used to reverse benzo overdose?

Answer 6

Flumazenil

Question 7

What is the metabolism and elimination of benzos?

Answer 7

CYP3a4 for phase 1

Glucuronidation for phase 2

Question 8

1/2 life, active metabolites, pathway of metabolism, and rate on onset for the following benzos?
Diazepam
Oxazepam
Lorazepam
Alprazolam
Clonazepam

Answer 8

Over 100, yes, oxidation, and very fast
5-15, none, conjugation, slow
10-20, none, conjugation, intermediate
12-15, insignificant, oxidation, fast
20-50, insignificant, ox/red, intermediate

Question 9

Half life and rate of onset of the following benzos?
Chlordiazepoxide
Flurazepam
Clorazepate
Triazolam

Answer 9

Over 100 and intermediate
Over 100 and fast
Over 100 and fast
1.5-5 and intermediate

Question 10

Big difference between the general idea of barb effects and benzo effects?

Answer 10

Benzos sort of hit a ceiling where no matter how much more you increase the dose, the effect plateaus.
Not the case for barbs. Their effect will go all the way to coma if you keep increasing the dose.

Question 11

Prototype ultra short acting barb and typical indication?
Prototype short acting barb and typical indication?
Prototype long acting barb and typical indication?

Answer 11

Thiopental anesthesia
Secobarbital, insomnia
Phenobarbital seizures

Question 12

2 problems with using benzos for insomnia?

Answer 12

Day time sedation and anterograde amnesia

Question 13

Clinical use of Zolpidem, Zaleplon, and Eszopiclone?
MOA?
3 advantageous features?
Unique feature of zolpidem and exzopiclone?
What are they not used for?

Answer 13

Insomnia
GABA a agonist
Highly effective, rapid onset, and minimal hangover effects
Biphasic release for sustained sleep
Longer half life
Only used for sleep aids, none of the anxiety, anesthetic, convulsants stuff.

Question 14

MOA of ramelteon?

Clinical use?

Answer 14

Agonist at melatonin 1 and 2 receptors

Insomnia

Question 15

MOA of buspirone?

Metabolism of it?

Answer 15

Anxiety

CYP3a4

Question 16

What is considered excessive drinking and heavy drinking for a man and woman?

Answer 16

Excessive
Women 4 or more in one setting
Men 5 or more in one setting

Heavy
Women 8 or more per week
Men 15 or more per week

Question 17

5 step process of alcohol metabolism?

What order kinetics is alcohol and what does that mean?

Answer 17

Alcohol to acetaldehyde by ADH, to acetic acid by aldehyde dehydrogenase, to CO2 by oxygen, water and energy

Zero, meaning rate remains constant and is independent of concentration or amount

Question 18

3 key pieces of information to consider for pharmacology of alcohol?

Answer 18

Ethanol undergoes extensive first pass metabolism by GI and liver ADH
Zero order kinetics
Typical adult can metabolize 1 drink per hour on average

Question 19

3 things to do to treat acute alcohol intoxication?

Answer 19

Monitor respiratory depression and aspiration of vomit
Glucose can treat hypoglycemia or ketosis
Thiamine to protect against wernickes

Question 20

What is the major pharmacological objective for acute withdrawal syndrome of alcohol and what two things to treat it?

Answer 20

Prevent seizures, delirium, arrhythmias, electrolyte imbalances
Benzos and thiamine

Question 21

What is the primary treatment for alcohol dependence and what two other conditions are associated with alcoholism?

Answer 21

Psychosocial therapy

Depression and anxiety

Question 22

Overdose effects of stimulants, cocaine?

Withdrawal symptoms of stimulants, cocaine?

Answer 22

Agitated, HTN, tachycardia, seizures, hallucinations, hyperthermia, delusions

Apathy, irritable, depression, increased sleep

Question 23

Overdose effects of barbs, benzos, alcohol?

Withdrawal symptoms?

Answer 23

Dilated pupils, slurred speech, drunken behavior and basically depression of everything

Tremors, anxiety, insomnia, delirium

Question 24

Overdose effects of heroin, strong opioids?

Withdrawal symptoms?

Answer 24

Constricted pupils, nausea and everything depressed

Nausea, chills, cramps, lacrimation,

Question 25

Effect of ACHE blockers at muscarinic receptors and nicotinic receptors?

Answer 25

Stimulate muscarinic receptors

Stimulate then depress at nicotinic

Question 26

4 therapeutic uses for ACHe inhibitors?

Answer 26

Diseases of the eye
GI an urinary tract problems
NMJ problem
Alzheimer’s