Sedatives and Hypnotics

Question 1

What class of drugs are used for sedation?

Answer 1

Benzodiazepine
-zepam

(Midazolam–>short acting IV less than 6 hrs)
(Oxazepam, temazepam–>short acting 6hrs-12)
(Diazepam–>long acting 24 hrs)

Question 2

What should you be aware of if patient already taking a sedative?

Answer 2

-Any you prescribe will add on it’s effect

Question 3

What are the adverse effects of benzodiazepams?

Answer 3

• Drowsiness, fatigue
• Imparied motor function: do NOT let patient drive
• Respiratory depression (risk of those with respiratory disease)–>can be fatal
• Opioid interaction (added sedative effect)–>can be fatal
• Can enter brain very quickly with IV–>be careful
• Paradoxical excitation
• Retrograde amnesia (forget what happens after taking meds)
• Fantasy
• Risk of dependancy

Question 4

What can you do if you suspect patient with dependancy trying to goad you into prescribing more?

Answer 4

• Prescribe 2 tablets
• Means patient will have to pay full price for 2 tablets
• Then tell them you can’t prescribe anymore legally

Question 5

What are some non-benzodiazepine drugs?

Answer 5

-Zopiclone, zolpidem

Not on pharmaceutical benefits scheme

Question 6

What is a common medication prescribed for epilepsy? What should you keep in mind?

Answer 6

• Valproate
• Hepatically cleared
• Enzyme inhibitor–>drug interactions
• Half life 9-15 hours

Phenytoin

• Enzyme inducer–>induces metabolism of other drugs
• Gingival hypertrophy
• Carbamazepine
• Hepatically cleared
• Potent inducer of other drugs and it’s own metabolism–>may need to increase dose of other drugs
• Half life 15-30hours

Question 7

Which of hte antiepileptics is also commonly prescribed for trigeminal neuralgia?

Answer 7

Carbamazepine

Question 8

What are the general side effects of antiepileptics to be aware of?

Answer 8

Dizziness
Nausea
Fatigue
Headache
(CNS)

Question 9

What should you keep in mind with dementia drugs?

Answer 9

-Acetylcholineresterase inhibitor–>drooling

Question 10

How do antidepressants work?

Answer 10

• Inhibit reuptake of serotonin or noradrenaline into neuron

- Inhibit MAO enzyme which breaks down serotonin/noradrenaline

Question 11

What adverse effects are relevant to you re. tri-cyclinc antidepressants?

Answer 11

• Narrow therapeutic index
• Dry mouth
• Hypotension
• Sedative

Question 12

What should be kept in mind re. SSRI and SNRI?

Answer 12

• Dry mouth
• Postural hypertension
• Some may inhibit metabolism of other drugs
• If taking with other serotonin releasing drugs (pethidine, tremadol) can cause serotonin syndrome (agitation, confusion, altered muscle tone, high temperature, diarrhoea, death)

Question 13

What are the issues to keep in mind with antipsychotics?

Answer 13

• sedative
• dry mouth
• problems keeping still

Question 14

What should you keep in mind for drugs for Parkinson’s Disease?

Answer 14

-They are serotonergic e.g. tramadol, pethidine (do not prescribe anotehr serotonergic drug)

Question 15

Adverse effects of corticosteroids?

Answer 15

• Delayed wound healing
• Increased susceptibility to infection
• Masking signs of infection