Sedative-Hypnotics

Question 1

Mechanism of action for benzos??

Answer 1

Agonist at GABAa receptor
Increases frequency of Cl channel openings = increases GABA
Cross-tolerant with ETOH and barbiturates

Question 2

What is the relationship between potency and addiction for benzos?

Answer 2

Higher potency is more efficacious but more addictive

Question 3

What is the relationship between half-life, withdrawal, and addiction for benzos??

Answer 3

Shorter half-life = more withdrawal, more addictive

Question 4

What are the indications for benzos?

Answer 4

Anxiety disorder - acute panic attack, social anxiety, GAD, other psych disorders with anxiety
Epilepsy
Muscle spasms
Akithisia
Agitation

Question 5

What are the contraindications to benzos?

Answer 5

Substance use disorder

delirium (can worsen)

Question 6

What are the minor side effects of benzos?

Answer 6

Drowsiness
Dizziness/ataxia
Tolerance/dependence
Sedation --> hypnosis and coma
Addiction
Increased risk of dementia with long term use

Question 7

What are the withdrawal symptoms of benzos?

Answer 7

LETHAL
Worse with short half-life
Anxiety, insomnia
restlessness, agitation
Irritability
Muscle tension
Seizures, DTs

Question 8

What are things to consider in benzo overdose?

Answer 8

High therapeutic index
Only lethal in patients with prior cardiopulmonary disease or mixed with ETOH/other sedatives
treatment = flumazenil but it is a competitive inhibitor and if patient has a seizure you’re fucked because you can’t give a benzo!

Question 9

Which benzos are not metabolized by the liver?

Answer 9

LOT
Lorazepam (Ativan)
Oxazepam (Seraz)
Temazepam (Resteril)

Question 10

What drugs are non-benzo anxiolytics

Answer 10

Buspirone (Buspar)
Hydroxyzine (Atarax, Vistaril)
Propranolol (Inderal)

Question 11

Which drugs are non-benzo hypnotics?

Answer 11

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Diphenhydramine (Benadryl)
Ramelteon (Rozarem)