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Neuropharmacology > Sedatives and Hypnotics > Flashcards

Sedatives and Hypnotics Flashcards

1
Q

What is the optimum number of hours for a healthy sleep?

A

7-9 hours

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2
Q

What are the 2 main types of sleep?

A
  • rapid eye movement (REM)
  • non rapid eye movement (NRRM)
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3
Q

How long does each sleep cycle last?

A

90-120 minutes i.e. in a typical night there are 2-3 cycles

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4
Q

Describe the 4 stages of the sleep cycle

A
  1. light transitional sleep - drowsiness
  2. mores stable sleep - chemicals block senses making it difficult to be woken
  3. deep sleep - GH released
  4. revitaliser memory - intense dreams occur
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5
Q

How can human brain activity be measured?

A

electroencephalogram (EEG)

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6
Q

What happens in stage 1 of NREM?

A
  • hypnagogic and hypnopompic hallucinations
  • muscles twitches
  • theta waves
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7
Q

What happens in stage 2 of NREM?

A
  • theta waves
  • K complexes and sleep spindles
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8
Q

What happens in stages 3 and 4 of NREM?

A
  • delta waves
  • night terrors
  • deep sleep
  • GH released
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9
Q

What happens in REM?

A
  • muscle paralysis
  • brainwaves resembling awake state
  • dreaming
  • nightmares
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10
Q

When does REM duration increase?

A

towards the ends of the night

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11
Q

What is memory consolidation?

A

when short-term memory is converted to long-term memory

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12
Q

What can one night of bad sleep cause?

A

an accumulation of toxic beta amyloid in the brain

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13
Q

Give examples of sleep disorders

A
  • snoring
  • obstructive sleep apnoea
  • insomnia
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14
Q

What does GABA binding to its receptor cause?

A

hyperpolarisation

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15
Q

What does the GABA receptor consist of?

A

19 subunits

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16
Q

Where does GABA bind?

A

at the interface of the alpha and beta subunits

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17
Q

What are GABA α1 subunits involved in and where are they highly expressed?

A

sleep expressed in ventrolateral preoptic nucleus

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18
Q

What are GABA α2 and 3 subunits involved in and where are they highly expressed?

A

anxiety expressed in amygdala

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19
Q

What are sedatives and hypnotics?

A

a class of drugs used to induce and/or maintain sleep, for example benzodiazepines and non-benzodiazepines (Z-drugs)

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20
Q

What are the sleep and wake promoters in the hypothalamus?

A
  • sleep - VLPO
  • wake - TMN
21
Q

What is the mechanism of action of benzodiazepines?

A
  1. nerve impulse causes release of GABA from storage sites on neuron 1
  2. GABA released into the synapse
  3. GABA reacts with receptors on neuron 2 which allows chloride ions to enter the neuron
  4. further progress of the nerve impulse is inhibited
  5. benzodiazepines react with booster sites on GABA receptors
  6. this enhances the inhibitory effects of GABA, and the ongoing nerve impulse may be completely blocked
22
Q

What are therapeutic actions of benzodiazepines in short-term use?

A
  • anxiolytic
  • hypnotic
  • myorelaxant
  • anticonvulsant
  • amnesia
23
Q

What do benzodiazepines do?

A

increase frequency of channel opening and non-selectively bind to alpha subunits 1-6 to induce sedation, anxiolytic, muscle relaxation and alcohol potentiation actions

24
Q

Give examples of benzodiazepines in order of increasing lengths of action

A
  • midazolam (very short)
  • temazepam (short)
  • lorazepam (medium)
  • diazepam (long)
25
Q

What are side effects of benzodiazepines?

A
  • sedation
  • muscle relaxation
  • drowsiness
  • dizziness
  • decreased alertness and concentration
  • impairment of motor coordination
26
Q

What are the adverse side effects of benzodiazepines?

A
  • oversedation
  • memory impairments
  • depression
  • tolerance
  • dependence
27
Q

What does oversedation cause?

A

‘hangover’ effects due to a tolerance developing over 1-2 weeks and symptoms include drowsiness, poor concentration, incoordination, muscle weakness, dizziness and mental confusion

28
Q

What is memory impairment by benzodiazepines characterised by and when is it induced?

A

lack of coordination and attention used to relieve from the stress of catastrophic disasters

29
Q

How can prolonged use of benzodiazepines cause depression?

A

they can reduce the brain’s output of serotonin and noradrenaline and cause emotional anaesthesia due to the inhibitory effect on activity of brain emotional centres

30
Q

How can tolerance to benzodiazepines arise?

A

compensatory changes occur in the GABA and benzodiazepine receptors which become less response i.e. inhibitory actions of GABA and benzodiazepines are decreased and activity of excitatory neurotransmitters tends to be restored due to decreased GABA activity

31
Q

What can withdrawal symptoms of benzodiazepines cause?

A

rebound insomnia, restlessness, agitation and irritability

32
Q

What do Z-drugs do?

A

bind between the alpha and gamma subunits of the GABA receptor to have an anti-anxiety and sedative effect without altering REM sleep

33
Q

Give examples of Z-drugs in order of increasing lengths of action

A
  • zolpidem (very short)
  • zopiclone (short)
34
Q

What are side effects of Z drugs?

A

memory loss, daytime sedation and impairment of motor function

35
Q

What are the overall effects of benzodiazepines on sleep?

A
  • decreased sleep latency
  • increased time in stage 2
  • increased total sleep time
  • decreased REM
36
Q

What are the overall effects of Z drugs on sleep?

A
  • decreased sleep latency
  • increased time in stage 2
  • increased total sleep time
  • no effect on REM
37
Q

What do barbiturates do?

A

increase ion channel opening duration and at high doses, mimic GABA and directly activate the receptor

38
Q

What is meant by barbiturates having a low therapeutic index?

A

a small overdose can result in coma or death due to respiratory depression

39
Q

Give examples of barbiturates

A

pentobarbital, phenobarbital and secobarbital

40
Q

Why are barbiturates no longer used as sedatives?

A
  • they have a narrow therapeutic-to-toxic dosage range
  • they suppress REM sleep
  • tolerance develops relatively quick
  • they have a high potential for physical dependence and abuse
41
Q

How do melatonin levels fluctuate?

A

they rise and fall in circadian fashion in the suprachiasmatic nucleus

42
Q

What are the 2 GPCRs for melatonin and what do they do?

A
  • MT1 receptors promote the onset of sleep
  • MT2 receptors shift the timing of circadian system
43
Q

What is ramelteon?

A

a melatonin agonist and binds to both MT1 and MT2 receptors with high affinity

44
Q

What is melatonin used for?

A

to treat transient and chronic insomnia

45
Q

What are side effects of melatonin?

A

dizziness, fatigue, infertility, endocrine changes as well as decreases in testosterone and increases in prolactin

46
Q

What is suvorexant?

A

an orexin receptor antagonist that blocks binding of wake-promoting orexin A and B neuropeptides

47
Q

How does suvorexant work?

A

by turning off wakefulness rather than by inducing sleep

48
Q

What do drugs with shorter half-lives in the body do?

A

body reduce the incidence of hangover the next morning

Neuropharmacology (7 decks)

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