Sedative-hypnotics Flashcards
Exam 3
What are the 5 classes of sedative-hypnotics?
- Benzodiazepines - Diazepam, Midazolam
- Barbituates - Phenobarbital
- Sleep aids - Zolpidem (non-benzodiazepine)
- Anxiolytics - Buspirone
- Ethanol
GABAa receptors are activated by what?
GABA
How do sedative-Hypnotics potentiate inhibition at all levels of CNS via GABAa receptors?
- Increased flow through channel
- Increased channel opening time
Sedation vs hypnosis
Sedation - calming, anxiolytic
Hypnosis - encourages sleep
Differentiate between desirable and less desirable effects of hypnotics on sleep?
Desirable:
- Decreased time to fall asleep
- Increased stage 2 NREM (non-rapid eye movement) sleep
Less Desirable:
- Decreased REM (rapid eye movement) sleep
- Decreased stage 4 NREM slow-wave sleep
Which sedative-hypnotics are useful anesthesia adjuncts?
Barbituates – thiopental and methohexital
Benzodiazepines - diazepam, lorazepam, and midazolam
What is the reversible agent for Benzodiazepines?
flumazenil
What class of sedative-hypnotics can contribute to a persistent postanesthetic respiratory depression?
Benzodiazepines
Where is alcohol metabolized?
Liver: 90% (remainder in lungs and stomach)
- zero-order kinetics
What are the standard alcoholic drink sizes?
Beer - 10oz
Wine - 3.5oz
Liquor - 1oz
Adults can metabolize how many alcoholic drinks per hour?
1
What are the 2 major pathways of metabolism to acetaldehyde?
Alcohol dehydrogenase pathway
Microsomal ethanol-oxidizing system (MEOS)
Differentiate between tolerance, dependence, and addiction
Tolerance – More of the drug is needed to get the same initial effect
Dependence – Body is now reliant on drug
Addiction – Behavior – will seek out drug regardless of negative consequences
What is the most common neurologic abnormality
from ethanol consumption?
Generalized symmetric peripheral nerve injury
- Distal paraesthesias of hands and feet
What are the other neurological disorders that can be induced by alcohol consumption?
- Gait disturbances, ataxia
- Optic nerve degeneration
- Dementia, demyelinating disease
Wernicke-Korsakoff Syndrome is characterized by what deficiency?
Thiamine
What are the symptoms of Wernicke-Korsakoff Syndrome?
Paralysis of the external eye muscles, ataxia, confusion, psychosis, coma, death
Differentiate between mild, severe, and extreme alcohol withdrawal syndrome
Mild (6-8 hours after consumption stops, lasts 1-2 days)
- Tachycardia, hypertension, tremor, anxiety, insomnia
Severe (lasts 1-5 days)
Withdrawal seizures – most common cause of seizures in adults
- Alcoholic hallucinations
Delirium Tremens - extreme
Delirium, agitation, autonomic system instability, low grade fever, diaphoresis
What is the most common cause of seizure in adults?
Alcohol withdrawal seizures
What are the 3 drugs used to treat alcohol withdrawl?
- Naltrexone
- Acamprosate – Adjunctive
- Disulfiram
What are the 3 non-pharmacologic treatments for sleep problems?
Proper diet and exercise
Stimulant (caffeine) avoidance
Comfortable sleep environment, routine
What are the pharmacologic treatments for sleep problems?
- Benzodiazepines, barbiturates – less effective sleep
- Zolpidem (Ambien) and Eszopiclone (Lunesta) – abuse potential
- OTC – Most are antihistamines
What are the effects of alcohol on GABA and glutamate?
- Ethanol enhances the action of GABA at GABA-A receptors
- Ethanol inhibits the ability of glutamate to open the cation channel
What is the progression of liver disease from chronic alcohol use?
- Alcoholic fatty liver
- Alcoholic hepatitis
- Cirrhosis
- Liver failure
What are the common electrolyte imbalances from alcohol intoxication?
Hypoglycemia, hypokalemia
What are the effects of alcohol on sleep?
- Induces sleepiness (GABAa potentiation)
- Suppresses REM in early sleep (deep sleep, difficult to wake)
- Increased wakefulness in later sleep
- Prolonged REM in second half
- Bizarre and intense dreams
What class of drugs are used as “Date-Rape” drugs?
benzodiazepines
Most complex focal seizures arise in the ______ lobe
Temporal
