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Psych > Sedative-hypnotics > Flashcards

Sedative-hypnotics Flashcards

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1
Q

what is a short acting benzo

A

triazolam

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2
Q

what is a intermediate acting benzo

A

alprazolam

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3
Q

what is a long acting benzo

A

flurazepam

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4
Q

what is a ultra-short acting barbiturates

A

thiopental

–used for anesthesia

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5
Q

what is a short acting barbiturates

A

secobarbital

–used for insomnia

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6
Q

what is a long acting barbiturates

A

phenobarbital

–used seizures

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7
Q

list of misc agents

A

buspirone
eszopiclone
zaleplon
zolpidem

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8
Q

list of benzos

A 
alprazolam
chlordiazepoxide
clonazepam
clorazepam
diazepam
flurazepam
lorazepam
midazolam
oxazepam
triazolam
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9
Q

list of barbiturates

A

-barbital

thiopental

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10
Q

what is flumazenil

A

benzo antagonist

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11
Q

definition of a sedative

A

drugs that decreases CNS activity, moderates excitement, and calms the recipient

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12
Q

definition of hypnotic

A

drugs that produce drowsiness and facilitates the onset & maintenance of sleep & from which the recipient can be aroused easily

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13
Q

MOA of benzos

A

act on GABAa receptors

  • -increase Cl influx, cause hyperpolarization, decreased # of action potentials
  • -cause sedation, hypnotic effects, muscle relaxation, anxiolytic & anticonvulsant effects
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14
Q

MOA of barbiturates

A

act on GABAa receptors

  • -cause wide spectrum of effects: mild sedation to anesthesia
  • -increase chloride influx, causes hyperpolarization, decreased # of action potentials
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15
Q

MOA of misc sedative-hypnotics

A

act on multiple receptors: GABAa, melatonin

–used as sleep aids, tx of delirium, anxiety, seizures

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16
Q

advantages & disadvantages of using benzos for anxiety

A

advantages: high therapeutic index, antagonist available (flumazenil), low risk drug interactions, minimal CV effect
disadvantages: risk of dependence, CNS depression, amnestic effects

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17
Q

dIazepam

A

1/2 life: >100 hrs
active metabolites: yes
pathway of metabolism: oxidation
rate of onset via oral: very fast

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18
Q

alprazolam

A

1/2 life: 12-15 hrs
active metabolites: not important
pathway of metabolism: oxidation
rate of onset via oral: fast

19
Q

cumulative toxicity

A

benzos with long 1/2 lives are more likely to cause cumulative effects (excessive drowsiness) with multiple doses

20
Q

indications for alprazolam

A

management of anxiety disorder, or short-term relief of symptoms
also tx of panic disorder

warnings: dependence & withdrawal rxs including seizures

21
Q

midazolam drug profile

A
  • -given IM or IV
  • -IV for sedation/anxiolysis/amnesia prior to procedures
  • -warnings: assoc with resp depression & arrest
22
Q

diazepam drug profile

A
  • -exerts anxiolytic, sedative, muscle relaxant, anticonvulsant
  • -has distribution phase (1/2 life 48 hours) followed by terminal elimination phase (1/2 life up to 100 hrs)
  • -1/2 life increased in mild-mod cirrhosis
  • -management of anxiety disorders
  • -can be used for acute alcohol withdrawal to relieve agitation & tremor
  • -contraindicated in myasthenia gravis, sleep apnea,
  • -WARNING: not recommended for tx of psychotic pts
23
Q

When is oxazapam used

A

tx of anxiety, anxiety with depression, and acute alcohol withdrawal

24
Q

when is triazolam used

A

short term tx of insomnia (7-10 days)

BB warning: if used with opioids may result in sedation, resp depression, coma, and death

25
Q

when is chlordiazepoxide used

A

management of anxiety disorders or for short term relief of symptoms. acute alcohol withdrawal, preoperative apprehension
BB warning:if used with opioids may result in sedation, resp depression, coma, and death

26
Q

when is flurazepam used

A

long acting hypnotic used for tx of insomnia

27
Q

when is lorazepam used

A

tx of seizure disorders

can be used before surgery for anxiety

28
Q

flumazenil

A
  • -benzo receptor antagonist
  • -complete or partial reversal of sedative effects of benzos when general anesthesia has been induced or in management of benzo overdose
  • -warning: has been assoc with occurence of seizures
29
Q

what are barbiturates

A

tx of anxiety, epilepsy, to induce sleep, and as anesthetics

  • -extreme cases of insomnia
  • -seizures that are unresponsive to other, less toxic, agents
  • -induction of anesthesia
  • -in combo with acetaminophen & caffeine for tension HA
  • -counteract the stimulant effects from drugs such as cocaine & meth
30
Q

thiopental drug profile

A

administered by IV
as the sole anesthetic agent for brief 15 min procedures
for control of convulsive states during or following inhalation anesthesia, local anesthesia, or other causes
AE:
–resp depression, myocardial depression, cardiac arrhythmias, prolonged somnolence

31
Q

secobarbital drug profile

A

Indications:

  • -hypnotic, short-term tx of insomnia- loses effectiveness after 2 wks
  • -preanesthestic
32
Q

phenobarbital drug profile

A

Indications:

  • -used as a sedative or hypnotic
  • -contraindicated in those with history of porphyria
  • -administered with caution in those who are mentally depressed, have suicidal tendencies, or a hx of drug abuse
33
Q

benzos can be used for insomnia but cause what?

A

daytime sedation & pts may develop anterograde amnesia & tolerance

34
Q

What drugs are used for insomnia?

A

zolpidem, zaleplon, and eszopiclone

35
Q

MOA of newer hypnotics

A

binds to GABAa receptors that contain a1 subunit

  • -increase chloride influx, increase hyperpolarization, decrease # of action potentials
  • -only approved for sleep disorders
  • -no anxiolytic, anesthetic, anticonvulsant, muscle relaxing, resp or cv effects

DRUGS: eszopiclone, zolpidem, zaleplon

36
Q

Buspirone drug profile

A
  • -approved for tx of generalized anxiety disorder

- -anxiolytic effects may take more than 1 wk to become established

37
Q

zaleplon drug profile

A
  • -short term tx of insomnia

- -contraindicated in pt with hypersensitivity to drug

38
Q

zolpidem drug profile

A
  • -indicated for short term tx of insomnia characterized by difficulties initiating sleep
  • -warnings: severe anaphylactic reactions, worsening of depression
  • -drug interactions: CNS depressants
39
Q

ramelteon drug profile

A
  • -indicated for tx of insomnia characterized by difficulty with sleep onset
  • -melatonin receptor agonist
40
Q

eszopiclone drug profile

A
  • -indicated for tx of insomnia– decrease sleep latency & improve sleep maintenance
  • -warnings: CNS depressant effects
  • -SE: unpleasant taste, somnolence, resp infection, HA
41
Q

meprobamate drug profile

A
  • -indicated for tx of anxiety disorders or for short-term relief of symptoms of anxiety
  • -works by slowing activity in the brain to allow for relaxation
42
Q

chloral hydrate drug profile

A

–short term use as a sedative or sleep medicine

43
Q

The failure of insomnia to remit after how many days of tx may indicate the presence of a primary psychiatric &/or medical illness that should be evaluated?

A

7-10 days

Psych (8 decks)

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