Sedative-Hypnotics & Anxiolytics (Exam #1) Flashcards

1
Q

The “ideal” anxiolytic (anti-anxiety) drug does what three general things?

A
  • Relieve anxiety
  • No sedation
  • NO physical/psychological dependence
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2
Q

What class of meds is used to treat insomnia, and what time frame?

A

Sedative-Hypnotics

- Short-term only

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3
Q

What is the DOC for enuresis?

A

TCAs

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4
Q

The “ideal” sedative-hypnotic drug does what three general things?

A
  • Fall asleep quickly
  • STAY asleep
  • No “hangover” effect = wears off early in morning
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5
Q

What is the MOA for most sedative-hypnotic and anxiolytic drugs?

A

CNS depressant

- Activate GABA receptors, stimulate Cl influx

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6
Q

What SH/anxiolytic class does NOT have a ceiling effect, and what does this mean?

A

Barbs = NO ceiling effect (bc independent of GABA)

- Less safe → overdose/toxicity are major issue

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7
Q

What SH/anxiolytic drug is known as THE inducer of CYP450s? What is another (more common) use for this drug?

A

Phenobarbital

- Also an anticonvulsant

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8
Q

In what population are Benzos NOT recommended, and why (not CI though)?

A

Elderly

- Do not metabolize Benzos as quickly = effects last longer

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9
Q

What two Benzos have a LONG duration of action? Which two have an INTERMEDIATE duration of action? Which has a SHORT duration of action?

A
  • Long: Diazepam, Flurazepam
  • Intermediate: Alprazolam, Lorazepam/Oxazepam
  • Short: Midazolam
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10
Q

Which four anxiety disorders/populations are Benzos NOT used for (CI)?

A
  • OCD
  • Panic
  • PTSD
  • Anxiety in children, adolescents
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11
Q

When choosing a Benzo, what should be considered most?

A

Duration of action of the drug

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12
Q

What are three uses of Benzos, and what are some examples for each (2, 2, 1)?

A
  • Insomnia: Flurazepam, Temazepam
  • Epilepsy/Seizures: Diazepam, Lorazepam
  • Sedation/Anesthesia: Midazolam
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13
Q

What are three common AEs seen with Benzos?

A
  • Paradoxical excitement (stimulation/aggression - more common in elderly)
  • Supra-additive effects
  • Sleep-related behaviors
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14
Q

What can be seen with Benzo withdrawal?

A

Rebound insomnia and anxiety

- Need to taper slowly

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15
Q

What is the MOA of Flumazenil, and what is its primary use (example)? What is the one CI?

A

Benzo antagonist
- Reverse effects of Benzos (ex. reverse effects of Midazolam if respiratory depression occurs)

  • Do NOT use if hx of seizures
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16
Q

What are the three “Z” drugs, and what is their primary use?

A

INSOMNIA ONLY

  • Zolpidem
  • Zaleplon
  • Eszopiclone
17
Q

What is the duration of action for “Z” drugs, and what is the one exception - how does this change its use?

A

Short duration of action

- Eszopiclone = LONG DOA = can be used long-term

18
Q

What are the two primary AEs associated with “Z” drugs?

A

VERY safe

  • Sleep-related behaviors
  • Rebound insomnia
19
Q

What is the MOA of Suvorexant, and in what population is it often used for? What is its primary use?

A

Orexin receptors antagonist

  • Good for alcoholics bc NOT GABA
  • Insomnia only
20
Q

What is the MOA of Ramelteon, and what is its primary use?

A
Melatonin analogue (ind. of GABA)
- Insomnia only
21
Q

What is the MOA of Buspirone, and in what population is it often used for? What is its primary use?

A

Modulates serotonin (ind. of GABA)

  • Good for anxiety in recovering alcoholics/addicts (low addiction potential)
  • Relieve anxiety WITHOUT sedation