Sedative Hypnotics Flashcards
receptor site of action for barbiturates
bind sites on GABA receptor, acting as a GABA agonist
receptor site of action for benzodiazepines
bind to alternate site on GABA receptor, modulate activity of GABA (has no effect unless GABA is available)
used for preoperative sedation
phenobabital
adverse effect of phenobarbital
hyperactivity in children and infants
used for short term insommnia and acute psychosis
secobarbital
MAO of benzodiazepine
modulates GABA effect (increases chloride conductance)l no potential overdose (benzo has NO direct stimulatory effect on the receptor) but can get dependence when used for prolonged periods (greater than 2-3 weeks)
benzodiazepine withdrawal
occurs when BZ are out of system
symptoms of benzodiazepine withdraw
restlessness, anxiety, weakness, and generalized seizures
appropriate withdrawal paradigm to benzodiazepines
taper 25% per week to 50% of dose then 1/8th dose every 4-7 days
zilpidem (ambien) works on and
GABAa type 1 (rapid onset)
Zaleplon works on
GABA type 1 omega 1 and may hae anxiolytic action
MAO for propofol
stimulates GABA release like EtOH
when is propofol used
abulatory surgery, monitored anesthesia care
propofol containdicated in
children (acidosis)
population in which etomidate is useful
elderly, does NOT lower BP
advantages of buspirone
effectie acute treatment of anxiety
rapid onset of action
safe in overdoses
disadvantage of benzodiazepines
cognitive impairment, psyychomotor impairment respiratory depression potentiation of CNS depressants abuse and dependence withdrawal syndrome tolerance
if switching from BZ to buspirone
NOT cross tolerant so BZ tapered down before giving it
advantages to use of ramelteon as a hypnotic agent
no rebound insomnia and no withdrawal symptoms
people who do NOT respond to one of these hypnotic drugs should
NOT be prescribed any of the others
alprazolam is used for
panic disorders
meprobamate is used for
short term anxiety and sedative hypnotics
conscious sedation
IV diazepam, midazolam, propofol
deep sedation
pt needs breathing help, difficult to arouse, IV thiopental midazolam, propofol opioid analgescis and ketamine
monitored anesthesia care
superficial, use regional or local anesthesia combined with midazolam, propofol or opioids. premidazolam IV followed by propofol or ketamine or opioids
when administered preoperatively, oral midazolam (pediatric pts)
provides sedation, light anesthesia, anterograde amnesia of perioperative events
advantage of buspirone
effective relief for persistent anxiety within 2-4 eeks
no potential for abuse, dependence, or withdrawal
can be used with alcohol and CNS agents
modulates serotonin at specific reeptors
disadvantages of buspirone
less effective in recent benzodiazepine users
gradual onset of action
not effective in panic disorder
what is the benzodiazepine that is recommended by the guideline for pain management for use with nocturanlly predominant pain
clonazepam used by many providers for nocturnally predominant pain
