Sedative Hypnotics

Question 1

receptor site of action for barbiturates

Answer 1

bind sites on GABA receptor, acting as a GABA agonist

Question 2

receptor site of action for benzodiazepines

Answer 2

bind to alternate site on GABA receptor, modulate activity of GABA (has no effect unless GABA is available)

Question 3

used for preoperative sedation

Answer 3

phenobabital

Question 4

adverse effect of phenobarbital

Answer 4

hyperactivity in children and infants

Question 5

used for short term insommnia and acute psychosis

Answer 5

secobarbital

Question 6

MAO of benzodiazepine

Answer 6

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)

Question 7

benzodiazepine withdrawal

Answer 7

occurs when BZ are out of system

Question 8

symptoms of benzodiazepine withdraw

Answer 8

restlessness, anxiety, weakness, and generalized seizures

Question 9

appropriate withdrawal paradigm to benzodiazepines

Answer 9

taper 25% per week to 50% of dose then 1/8th dose every 4-7 days

Question 10

zilpidem (ambien) works on and

Answer 10

GABAa type 1 (rapid onset)

Question 11

Zaleplon works on

Answer 11

GABA type 1 omega 1 and may hae anxiolytic action

Question 12

MAO for propofol

Answer 12

stimulates GABA release like EtOH

Question 13

when is propofol used

Answer 13

abulatory surgery, monitored anesthesia care

Question 14

propofol containdicated in

Answer 14

children (acidosis)

Question 15

population in which etomidate is useful

Answer 15

elderly, does NOT lower BP

Question 16

advantages of buspirone

Answer 16

effectie acute treatment of anxiety
rapid onset of action
safe in overdoses

Question 17

disadvantage of benzodiazepines

Answer 17

cognitive impairment, psyychomotor impairment
respiratory depression
potentiation of CNS depressants
abuse and dependence
withdrawal syndrome
tolerance

Question 18

if switching from BZ to buspirone

Answer 18

NOT cross tolerant so BZ tapered down before giving it

Question 19

advantages to use of ramelteon as a hypnotic agent

Answer 19

no rebound insomnia and no withdrawal symptoms

Question 20

people who do NOT respond to one of these hypnotic drugs should

Answer 20

NOT be prescribed any of the others

Question 21

alprazolam is used for

Answer 21

panic disorders

Question 22

meprobamate is used for

Answer 22

short term anxiety and sedative hypnotics

Question 23

conscious sedation

Answer 23

IV diazepam, midazolam, propofol

Question 24

deep sedation

Answer 24

pt needs breathing help, difficult to arouse, IV thiopental midazolam, propofol opioid analgescis and ketamine

Question 25

monitored anesthesia care

Answer 25

superficial, use regional or local anesthesia combined with midazolam, propofol or opioids. premidazolam IV followed by propofol or ketamine or opioids

Question 26

when administered preoperatively, oral midazolam (pediatric pts)

Answer 26

provides sedation, light anesthesia, anterograde amnesia of perioperative events

Question 27

advantage of buspirone

Answer 27

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

Question 28

disadvantages of buspirone

Answer 28

less effective in recent benzodiazepine users
gradual onset of action
not effective in panic disorder

Question 29

what is the benzodiazepine that is recommended by the guideline for pain management for use with nocturanlly predominant pain

Answer 29

clonazepam used by many providers for nocturnally predominant pain