Sedative-Hypnotics & Anxiolytics (Exam #1) Flashcards
The “ideal” anxiolytic (anti-anxiety) drug does what three general things?
- Relieve anxiety
- No sedation
- NO physical/psychological dependence
What class of meds is used to treat insomnia, and what time frame?
Sedative-Hypnotics
- Short-term only
What is the DOC for enuresis?
TCAs
The “ideal” sedative-hypnotic drug does what three general things?
- Fall asleep quickly
- STAY asleep
- No “hangover” effect = wears off early in morning
What is the MOA for most sedative-hypnotic and anxiolytic drugs?
CNS depressant
- Activate GABA receptors, stimulate Cl influx
What SH/anxiolytic class does NOT have a ceiling effect, and what does this mean?
Barbs = NO ceiling effect (bc independent of GABA)
- Less safe → overdose/toxicity are major issue
What SH/anxiolytic drug is known as THE inducer of CYP450s? What is another (more common) use for this drug?
Phenobarbital
- Also an anticonvulsant
In what population are Benzos NOT recommended, and why (not CI though)?
Elderly
- Do not metabolize Benzos as quickly = effects last longer
What two Benzos have a LONG duration of action? Which two have an INTERMEDIATE duration of action? Which has a SHORT duration of action?
- Long: Diazepam, Flurazepam
- Intermediate: Alprazolam, Lorazepam/Oxazepam
- Short: Midazolam
Which four anxiety disorders/populations are Benzos NOT used for (CI)?
- OCD
- Panic
- PTSD
- Anxiety in children, adolescents
When choosing a Benzo, what should be considered most?
Duration of action of the drug
What are three uses of Benzos, and what are some examples for each (2, 2, 1)?
- Insomnia: Flurazepam, Temazepam
- Epilepsy/Seizures: Diazepam, Lorazepam
- Sedation/Anesthesia: Midazolam
What are three common AEs seen with Benzos?
- Paradoxical excitement (stimulation/aggression - more common in elderly)
- Supra-additive effects
- Sleep-related behaviors
What can be seen with Benzo withdrawal?
Rebound insomnia and anxiety
- Need to taper slowly
What is the MOA of Flumazenil, and what is its primary use (example)? What is the one CI?
Benzo antagonist
- Reverse effects of Benzos (ex. reverse effects of Midazolam if respiratory depression occurs)
- Do NOT use if hx of seizures