Sedative-Hypnotics and Alcohol Flashcards
Side effect of Benzodiazepines
Anterograde amnesia
Decreased psychomotor skills
Unwated daytime sedation
Additive CNS depression with Ethanol
Short-acting Benzodiazepine
Midazolam (Etizolam, Brotizolam, Triazolam, Oxazepam)
Abnormal sleep pattern in Benzodiazepines
Decreased REM sleep
Intermediate acting Benzodiazepines
Lorazepam (Clonazepam, Lormetazepam, Estazolam, Alprazolam, Nitrazepam, Temazepam)
MOA of Benzodiazepines
GABA-A subunit binding, increased FREQUENCY of chloride channel opening
Long acting Benzodiazepine
Diazepam (Flunitrazepam, Flurazepam, Chlordiazepoxide, Chlorazepate)
Date-rape drugs
Ethanol
Funitrazepam
Gamma-hydroxybutirate
Benzodiazepine with longest half-life
Chlordiazepoxide
benzodiazepine overdose antidote
Flumazenil
MOA of flumazenil
Benzodiazepine GABA-A receptor antagonist
Side effect of short-acting benzodiazepine
Rebound insomnia/anxiety
Rohypnol
Flunitrazepam
Flumazenil Side effect
Benzodiazepine withdrawal syndrome
Barbiturate MOA
Bind to GABA-A receptor sites, increase DURATION of chloride channel opening
Ultrashort-acting Barbiturate
Thiopental (Methohexital, Thiamylal)
Side effect of Barbiturates
CNS depression
Tolerance/Dependence
Acute intermittent porphyria
Enzyme deficient in acute intermittent porphyria
Porphobilinogen deaminase
Most catastropic side effect of sedative-hypnotic
Rebound suicide
Class of Zolpidem
Imidazopyridine
Short/Intermediate-acting Barbiturate
Pentobarbital (-bital, -butal)
Long-acting Barbiturate
Phenobarbital (Mephobarbital, Pyrimidone)
Imidazopyridine
Zolpidem, Zaleplon, Eszopiclone
Indication for Zolpidem
Insomnia
Side effect of Zolpidem
Modest day-after psychomotor depression
Dependence
Reversal of Zolpidem side effects
Flumazenil
Buspirone MOA
Partial agonist at 5-HT1a receptors and D2 receptors
Buspirone indication
General Anxiety Disorder
Metabolism of low to moderate doses of ethanol
Alcohol dehydrogenase
Metabolism of high doses if ethanol (>100 mg/dL)
Microsomal Ethanol Oxidizing System (MEOS)
Fixed capacity for ethanol metabolism
7-10 g/h
Inhibits Acetaldehyde Dehydrogenase
Disulfiram
Blood alcohol concentration for impaired driving ability
60-80 mg/dL
Blood alcohol concentration for respiratory depssion and coma
> 500 mg/dL
Most common neurologic side effect of chronic ethanol consumption
Peripheral neuropathy
Most common complication of chronic alcohol consumption
Liver disease - cirrhosis and hepatic failure
Clinical manifestation of Wernicke-Korsakoff Syndrome
Ataxia
Confusion
Ophthalmoplegia
pathologic brain findings in Wernicke-Korsakoff syndrome
Hemorrhagic necrosis of the mamillary bodies
Cardiovascular complication of chronic alcohol consumption
Reversile dilated cardiomyopathy
Amount of ethanol intake per day to increase HDL
10-15 g/day
Most common manifestation of fetal alcohol syndrome
Mental retardation
Manifestions of Delirium Tremens
Hallucination
Autonomic disability
Delirium
Onset of Delirium Tremens
48-72 hours post-withdrawal
Alcohol Withdrawal Syndrome DOC in patients with no co-morbids
Long acting Benzodiazepine
Alcohol Withdrawal Syndrome DOC for patients with hepatic failure
Short-acting Benzodiazepine
Alcoholism treatment options
Naltrexone (opioid receptor antagonist)
Acamprosate (NMDA receptor antagonist)
Disulfiram (acetaldehyde dehydrogenase inhibitor)
Disulfiram reaction
Chlorpropamide Cefoperazone
Cefamandole Procarbazine
Metronidazole
Methanol Toxicty accumlates what?
Formic acid and Formaldehyde
Ethylene glycol toxicity accumulates what?
Oxalic acid
DOC for Methanol and Ethylene Glycol toxicity
Ethanol
Fomepizole