Sedative- Hypnotic Drugs

Question 1

Benzodiazepines

Answer 1

(pam or am) alprazolam (xanax), clonazepam (klonipin), diazepam (valium), lorazepam (ativan), midazolam (versed)

Question 2

Benzodiazepines are DOC to treat

Answer 2

insomnia and anxiety

Question 3

Benzodiazepines are used

Answer 3

to induce general anesthesia, to manage seizure disorders, muscle spasm, panic disorder, or withdrawal from alcohol

Question 4

most familiar member of Benzodiazepines

Answer 4

diazepam (valium)

Question 5

diazepam (valium) is

Answer 5

safer than general CNS depressants, lower potential for abuse; produce less tolerance and physical dependence, fewer drug interactions

Question 6

paradoxical effects

Answer 6

opposite effect then what you would expect (happens to some ppl on Benzodiazepines) – insomnia - excitement, euphoria - heightened anxiety or rage

Question 7

Benzodiazepines pharmacological effects of CNS

Answer 7

reduce anxiety (anxiolytic), promote sleep, induce muscle relaxation, monitor for confusion and anterograde amnesia

Question 8

Benzodiazepines pharmacological effects of cardio system

Answer 8

parenteral doses can cause profound hypotension and cardiac arrest, so give slowly, dilute it, and use a small amount!

Question 9

Benzodiazepines pharmacological effects of respiratory system

Answer 9

respiratory depression usually occurs when combined with other CNS depressants

Question 10

Benzodiazepines MOA

Answer 10

potentiates action of gamma-aminobuttyric acid (GABA - inhibitory neurotransmitter)

Question 11

Benzodiazepines therapeutic uses

Answer 11

anxiety, insomnia, seizure disorder, muscle spasm, alcohol withdrawal, panic disorder, preoperative applications

Question 12

Benzodiazepines adverse effects

Answer 12

CNS depression, anterograde amnesia, paradoxical effects

Question 13

anterograde amnesia

Answer 13

(adverse effect) especially with triazolam (halcion) no recall of events after the drug is taken (date rape drug)

Question 14

Benzodiazepines abuse

Answer 14

low abuse potential

Question 15

Benzodiazepines use in pregnancy/lactation

Answer 15

category D, some are category X (if used in 1st trimester increased risk of congenital malformations- cleft palate, cardiac anomalies)

Question 16

if have IV toxicity (overdose or too much general anesthesia)

Answer 16

profound hypotension, respiratory and cardiac arrest

Question 17

to treat overdose**

Answer 17

IV flumazenil (Ramazicon***), a Benzodiazepine receptor antagonist

Question 18

may see convulsions in pts using Benzodiazepines for

Answer 18

treatment of epilepsy

Question 19

inject flumazenil (Ramazicon

Answer 19

slowly over 30 seconds, may repeat every minute as needed

Question 20

Benzodiazepine like drugs

Answer 20

Zolpidem (Ambien) and Eszopiclone (Lunesta)

Question 21

Zolpidem (Ambien)

Answer 21

most widely used, sedative-hypnotic (lacks anxiolytic, muscle relaxant, and anticonvulsant effects), for short term management of insomnia, S/E: drowsiness, hangover, irritability, n/v, has been associated with sleep driving/sleep related complex behaviors

Question 22

Eszopiclone (Lunesta)

Answer 22

used in canada/europe for years, binds to GABA receptors enhancing GABA effects; for treating insomnia, no limitation on how long it can be used; bitter aftertaste; rebound insomnia

Question 23

Barbiturates classification

Answer 23

ultraschort acting (thipental), short to long acting (secobartial), long acting (phenobarbital)

Question 24

Barbiturates MOA

Answer 24

binds to the GABA receptor chloride channel complex

Question 25

Barbiturates pharmacologic effects

Answer 25

CNA depression, decreased blood pressure and heart rate, induction of hepatic drug - metabolizing enzymes- accelerating own metabolism and that of other drugs; lipid solubility has a significant impact; rapid onset and brief duration

Question 26

Barbiturates tolerance and physical dependence

Answer 26

develops to many, but not all - CNS effects; very little tolerance develops to respiratory depression

Question 27

Barbiturates therapeutic uses

Answer 27

seizures disorders, induction of anesthesia insomnia and other uses

Question 28

Barbiturates adverse effects

Answer 28

respiratory depression, suicide (low therapeutic index overdose can lead to death); popular drug of abuse (produces desirable side effects); do not use in pregnancy - leads to drug dependence in baby; hangover (secondary to long half life); paradoxical excitement; hyperalgesia - intensify sensitivity to pain, can cause muscle, joint, and nerve pain

Question 29

Barbiturates acute toxicity symptoms

Answer 29

respiratory depression, coma, pinpoint pupils

Question 30

Barbiturates acute toxicity treatment

Answer 30

removal of Barbiturate form the body- gastric lavage (stomach pumped) or hemodialysis; maintenance of an adequate oxygen supply to the brain

Question 31

Barbiturates administration

Answer 31

oral IV or IM

Question 32

Sleep phases

Answer 32

rapid eye movement, non rapid eye movement

Question 33

NREM phases

Answer 33

I - relatively light sleep II - relatively light sleep III - deep sleep IV - deep sleep

Question 34

basic management principles of sleep

Answer 34

find cause and treat insomnia (pain, anxiety, depression, physical disorders); nondrug therapy - avoid caffeine at night, relaxation techniques; therapy with hynoptic drugs (short term 2-3 weeks)

Question 35

the cycle

Answer 35

1. insomnia motivates treatment of hypnotics 2. with continuous use, physical dependence develops 3. upon cessation of treatment, a mild withdrawal occurs, disrupting sleep 4. pt fails to understand that insomnia is due to withdrawal, resumes hypnotic 5. leads to heightened physical dependence