Sedative-Hypnotics and Anxiolytics

Question 1

Primary use of sedative-hypnotic and anxiolytic drugs

Answer 1

KEEP CALM SLEEP ON

Question 2

Adaptive anxiety disorder

Answer 2

Appropriate rxn to danger; increase sympathetic activity

Question 3

Maladaptive anxiety disorder

Answer 3

Chronic, psychological stress –> lead to organ dysfxn (GI, cardiac), physical sxs

Question 4

Ideal anti-anxiety drug

Answer 4

Relieve anxiety w/o sedation or drowsiness; no physical or psychological dependence

Question 5

DOC for enuresis

Answer 5

TCA

Question 6

Sleep disorder that the gf has

Answer 6

Kleine-Levin syndrome “Sleeping beauty”

Question 7

Tx transient or short-term insomnia

Answer 7

Sedative hypnotic

Question 8

Tx for hypersomnia, narcolepsy

Answer 8

Stimulants

Question 9

Tx for sleep apnea

Answer 9

CPAP and lifestyle changes

Question 10

Ideal sedative hypnotic

Answer 10

fall asleep quickly, stay asleep, no hangover (everything i cannot do)

Question 11

Long-term insomnia causes and tx

Answer 11

underlying psych or chronic alcohol drug abuse; treat w/ behavioral therapy and lifestyle

Question 12

GABA receptor that decreases anxiety and promotes sleep

Answer 12

GABA(a)

Question 13

Antihistamine used as anti-anxiety med and causes sedation

Answer 13

hydroxyzine

Question 14

MOA of Barbiturates

Answer 14

Binds to GABA receptor –> stimulate Cl- influx –> inhibit INDEPENDENT of GABA

Question 15

Barbiturates uses

Answer 15

Short-acting = induction of anesthesia
Long-acting = anticonvulsants

Question 16

Barb for induction of anesthesia

Answer 16

Thiopental (short-acting)

Question 17

Barb for anticonvulsant

Answer 17

Phenobarbital (long-acting)

Question 18

Barb metabolized by

Answer 18

liver

Question 19

Barbiturates side effects

Answer 19

CNS depression, paradoxical excitement, may depress vasomotor and respiratory centers in medulla

Question 20

Barbs contraindications

Answer 20

Porphyria, pulmonary insufficiency, supra-additive effects

Question 21

No “ceiling effect”; low margin of safety, supra-addictve

Answer 21

Barbiturates

Question 22

tx of barbiturates overdose

Answer 22

Supportive, clear w/ diuresis and alkalization of urine (also do not give stimulants!)

Question 23

who does not metabolize BZs as quickly

Answer 23

old people

Question 24

Benzo metabolized by

Answer 24

CYP3A4

Question 25

Benzo w/ long duration of action

Answer 25

Diazepam, flurazepam

Question 26

Benzo w/ intermediate duration of action

Answer 26

Alprazolam, oxazepam/lorazepam

Question 27

Benzo w/ short duration of action

Answer 27

Midazolam

Question 28

Ceiling effect

Answer 28

Benzo

Question 29

DOC for anxiety disorders

Answer 29

Benzo (use effective dose for shortest duration possible)

Question 30

DOC for OCD

Answer 30

SSRI

Question 31

DOC for agoraphobia

Answer 31

SSRI

Question 32

DOC for panic disorder

Answer 32

SSRI

Question 33

DOC for PTSD

Answer 33

antidepressant

Question 34

DOC for anxiety in children and adolescent

Answer 34

antidepressant

Question 35

Benzo drugs for insomnia b/c shorter-acting

Answer 35

Flurazepam and temazepam

Question 36

Benzo drug for status epilepticus

Answer 36

Diazepam and lorazepam

Question 37

Benzo drug used for anesthesia prep for short surgical procedure

Answer 37

Midazolam

Question 38

Causes anterograde amnesia

Answer 38

Midazolam

Question 39

Route for midazolam

Answer 39

IV

Question 40

Muscle relaxation benzo drug

Answer 40

Diazepam

Question 41

Drugs to provide more tapered withdrawal for alcohol and barb withdrawal

Answer 41

chlordiazepoxide, diazepam, lorazepam

Question 42

Benzo antagonist

Answer 42

Flumazenil

Question 43

Pt w/ respiratory depression due to taking midazolam for an anesthesia procedure, what you be do

Answer 43

Flumazenil

Question 44

Do not use flumazenil if pt w/

Answer 44

hx of seizure

Question 45

Them Z-drugs

Answer 45

Zolpidem, Zaleplon, Eszopiclone

Question 46

Z-drugs MOA

Answer 46

bind to GABA receptor at BZ1 --> increase GABA mediated inhibition

Question 47

Z-drugs are used for

Answer 47

insomnia

Question 48

Z-drugs have no affects on which properties

Answer 48

No anxiolytic, anticonvulsant, or muscle relaxant properties

Question 49

Which Z-drug has a long half life

Answer 49

Eszopiclone

Question 50

Do not use Suvorexant if your pt has

Answer 50

narcolepsia

Question 51

MOA of suvorexant

Answer 51

Antagonist at orexin receptor

Question 52

Melatonin analogue

Answer 52

Ramelteon

Question 53

Resets sleep-wake cycle

Answer 53

Ramelteon

Question 54

A pt w/ occasional insomnia w/ a hx of addiction. What do you give

Answer 54

knock them out with some diphenhydramine

Question 55

Chloral hydrate converts to

Answer 55

Trichloroethanol

Question 56

Chloral hydrate MOA

Answer 56

similar to barbs on GABA(a) receptor

Question 57

Long term use of chloral hydrate causes

Answer 57

liver damage and fetal intoxication

Question 58

Relieves anxiety w/o producing sedation

Answer 58

Buspirone

Question 59

MOA of Buspirone

Answer 59

Partial agonist at postsynaptic 5-HT1A receptor; full agonist for presynaptic 5-HT1A receptor

Question 60

Buspirone has no effect on which properties

Answer 60

muscle relaxant or anticonvulsant properties

Question 61

Drugs that works independently of GABA

Answer 61

Ramelteon, Buspirone, Suvorexant, Barbiturates

Question 62

Benzo Contraindication

Answer 62

Preggo, sleep apnea, elderly

Question 63

A pt comes in for scaring the shit out of their lesbian partner because they've been sleep walking, eating, and driving. You proceed to review their drugs, what are you likely to find them taking?

Answer 63

Benzos or z-drugs