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Pharm 2024 > Sedative-hypnotics > Flashcards

Sedative-hypnotics Flashcards

Exam 3

1
Q

What are the 5 classes of sedative-hypnotics?

A
  1. Benzodiazepines - Diazepam, Midazolam
  2. Barbituates - Phenobarbital
  3. Sleep aids - Zolpidem (non-benzodiazepine)
  4. Anxiolytics - Buspirone
  5. Ethanol
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2
Q

GABAa receptors are activated by what?

A

GABA

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3
Q

How do sedative-Hypnotics potentiate inhibition at all levels of CNS via GABAa receptors?

A
  • Increased flow through channel
  • Increased channel opening time
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4
Q

Sedation vs hypnosis

A

Sedation - calming, anxiolytic
Hypnosis - encourages sleep

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5
Q

Differentiate between desirable and less desirable effects of hypnotics on sleep?

A

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

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6
Q

Which sedative-hypnotics are useful anesthesia adjuncts?

A

Barbituates – thiopental and methohexital
Benzodiazepines - diazepam, lorazepam, and midazolam

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7
Q

What is the reversible agent for Benzodiazepines?

A

flumazenil

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8
Q

What class of sedative-hypnotics can contribute to a persistent postanesthetic respiratory depression?

A

Benzodiazepines

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9
Q

Where is alcohol metabolized?

A

Liver: 90% (remainder in lungs and stomach)
- zero-order kinetics

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10
Q

What are the standard alcoholic drink sizes?

A

Beer - 10oz
Wine - 3.5oz
Liquor - 1oz

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11
Q

Adults can metabolize how many alcoholic drinks per hour?

A

1

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12
Q

What are the 2 major pathways of metabolism to acetaldehyde?

A

Alcohol dehydrogenase pathway
Microsomal ethanol-oxidizing system (MEOS)

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13
Q

Differentiate between tolerance, dependence, and addiction

A

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

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14
Q

What is the most common neurologic abnormality
from ethanol consumption?

A

Generalized symmetric peripheral nerve injury
- Distal paraesthesias of hands and feet

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15
Q

What are the other neurological disorders that can be induced by alcohol consumption?

A
  • Gait disturbances, ataxia
  • Optic nerve degeneration
  • Dementia, demyelinating disease
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16
Q

Wernicke-Korsakoff Syndrome is characterized by what deficiency?

A

Thiamine

17
Q

What are the symptoms of Wernicke-Korsakoff Syndrome?

A

Paralysis of the external eye muscles, ataxia, confusion, psychosis, coma, death

18
Q

Differentiate between mild, severe, and extreme alcohol withdrawal syndrome

A

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

19
Q

What is the most common cause of seizure in adults?

A

Alcohol withdrawal seizures

20
Q

What are the 3 drugs used to treat alcohol withdrawl?

A
  1. Naltrexone
  2. Acamprosate – Adjunctive
  3. Disulfiram
21
Q

What are the 3 non-pharmacologic treatments for sleep problems?

A

Proper diet and exercise
Stimulant (caffeine) avoidance
Comfortable sleep environment, routine

22
Q

What are the pharmacologic treatments for sleep problems?

A
  • Benzodiazepines, barbiturates – less effective sleep
  • Zolpidem (Ambien) and Eszopiclone (Lunesta) – abuse potential
  • OTC – Most are antihistamines
23
Q

What are the effects of alcohol on GABA and glutamate?

A
  • Ethanol enhances the action of GABA at GABA-A receptors
  • Ethanol inhibits the ability of glutamate to open the cation channel
24
Q

What is the progression of liver disease from chronic alcohol use?

A
  • Alcoholic fatty liver
    • Alcoholic hepatitis
    • Cirrhosis
    • Liver failure
25
Q

What are the common electrolyte imbalances from alcohol intoxication?

A

Hypoglycemia, hypokalemia

26
Q

What are the effects of alcohol on sleep?

A
  • 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
27
Q

What class of drugs are used as “Date-Rape” drugs?

A

benzodiazepines

28
Q

Most complex focal seizures arise in the ______ lobe

A

Temporal

Pharm 2024 (32 decks)

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