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NSG 323 (mcp) > Sedatives/Anxiolytics > Flashcards

Sedatives/Anxiolytics Flashcards

1
Q

What is the purpose of Sedative/Hypnotic Drugs?

A

To promote/induce sleep

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2
Q

What is the purpose of Anxiolytic Drugs?

A

Anxiety relief

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3
Q

Sedatives/Hypnotics can be used to treat both Anxiety and Insomnia. How do they differ?

A

Difference in dosage!
Anxiety = lower dose
Insomnia = higher dose

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4
Q

Which of the following drug classes include the most commonly prescribed treatment choices for insomnia? Select all that apply

a) SSRI
b) Benzodiazepines
c) Benzodiazepine-like drugs
d) Barbituates
e) Antihistamines

A

b) Benzodiazepines

c) Benzodiazepine-like drugs

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5
Q

Which two classes of drugs are used most for anxiety disorders? Select all that apply

a) Benzodiazepines
b) Barbituates
c) SSRI
d) Tricyclic antidepressants

A

a) Benzodiazepines

c) SSRI (discussed later in the semester)

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6
Q

What is the DOC for Insomnia & Anxiety?

A

Benzodiazepines

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7
Q

What is the main MOA of Benzodiazepines?

A

Potentiate GABA (inhibitory neurotransmitter)

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8
Q

Describe what is meant by a “built-in limit” of effects Benzodiazepines can produce.

A

Only work on endogenous GABA

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9
Q

How do Benzodiazepines function to treat Insomnia?

A

CNS Depression

With ↑ed doses → ↑ed progressive effects from sedation → hypnosis → stupor

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10
Q

How do Benzodiazepines function to treat Anxiety?

A

Decrease anxiety through effects on the limbic system (hippocampus)

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11
Q

All Benzodiazepines produce similar responses, but how do they differ? (3)

A

1) Clinical application
2) Onset
3) Duration/Accumulation

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12
Q

Benzodiazepine Prototype to treat Insomnia:

A

Triazolam (Halcion)

“Hal is Tri-ying to sleep”

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13
Q

Benzodiazepine Prototype(s) to treat Anxiety:

A

1) lorazepam (Ativan)
2) diazepam (Valium)
3) alprazolam (Xanax)

“Pam and Al have anxiety”

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14
Q

What Drug Schedule are Benzodiazepines?

A

Schedule IV Drugs

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15
Q

Benzodiazepine Routes (2)

A

1) PO

2) IV

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16
Q

Benzodiazepines produce ADRs in what 3 body systems?

A

1) CNS
2) Cardiovascular (CV)
3) Respiratory system (RS)

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17
Q

Benzodiazepines:
What route produces little to no effect on the CV & RS?
What’s the one exception to this?

A

PO route

EXCEPT:
PO Benzos in combo with other CNS depressants can cause significant respiratory depression

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18
Q

Benzodiazepine ADRs related to CNS Effects:

A

1) Sedation/Drowsiness
2) Confusion
3) Anterograde amnesia
4) Sleep-driving

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19
Q

IV Benzodiazepine ADRs related to CV system:

A
  1. HYPOTENSION (profound)

2. Cardiac Arrest!

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20
Q

IV Benzodiazepine ADRs related to Respiratory System (RS):

A
  1. significant Respiratory DEPRESSION
21
Q

What patients shouldn’t receive IV Benzodiazepine due to ADRs related to Respiratory System (RS):

A
  1. COPD
  2. Obstructive Sleep apnea (OSA)
    - can worsen airway obstruction!!
22
Q

Benzodiazepines’ Major Contraindication:

A

PREGNANCY
-Category D or X
“No Benzos w/ eggos”

23
Q

Do Benzodiazepines result in Tolerance &/or Physical Dependence?

A

Yes–BOTH
Tolerance: develops slowly
Withdrawal Syndrome: can be severe with high doses

24
Q

S/S of Benzodiazepine Withdrawal Syndrome:

A

1) Panic
2) Paranoia
3) Delirium
4) HTN*
5) Muscle twitching
6) Convulsions*

25
Q

Antidote for Benzodiazepine Toxicity:
What does it do? What doesn’t it do?
How do we administer it?

A

Flumazenil (Romazicon)–1 hr duration
DOES reverse sedative effects
DOESN’T reverse respiratory depression!

Administration:
IV over 15 seconds
Repeat doses q1 minute

26
Q

What major patient teaching do we need to provide related to benzodiazepines + withdrawal?

A

NEED TO WEAN!

“reduce benzoooos slooooowly”

27
Q

What patient teaching would we provide related to Benzodiazepine ADRs Sedation/Psychomotor depression?

A

1) Avoid hazardous activities (driving) while adjusting
2) These ADRs should lessen after ~1 week or so.
3) Avoid other CNS depressants (ETOH)

28
Q

Benzodiazepine-like Drug Prototype(s) to treat Insomnia:

A

1) zolpidem (Ambien)**
2) zaleplon (Sonata)
3) eszopiclone (Lunesta)

“Eszter ‘likes’ to take away “Zoom-Zoom” in her sleep”

29
Q

Prototype & Drug Schedule for Benzodiazepine-like Drugs to treat insomnia:

A

zolpidem (Ambien)

Schedule IV

30
Q

zolpidem (Ambien) MOA:

A

Act as agonists at the benzodiazepine receptor site on the GABA receptor-chloride channel

31
Q

How does zolpidem (Ambien) aid with insomnia?

A

Helpful with falling asleep

XR: helps with staying asleep

32
Q

zolpidem (Ambien) ADRs:

A

1) Daytime Sedation/Drowsiness
- “Hang-over Effect” –> MOST COMMON SE
2) Sleep-driving

33
Q

Does zolpidem (Ambien) result in Tolerance &/or Physical Dependence?

A

Nope

34
Q

zolpidem (Ambien) Patient Teaching:

A

1) Avoid hazardous activities (driving) while adjusting
2) Avoid other CNS depressants (ETOH)
3) Teach family about sleep-driving risk

35
Q

Name the 2 Non-Benzo/Non-Barbituates used to treat Anxiety:

A

1) buspirone (BuSpar)

2) hydroxyzine

36
Q

buspirone (BuSpar) is not a 1) ___ __________ and is not used 2) ___.

A

1) CNS depressants

2) PRN

37
Q

What are some other benefits of buspirone (BuSpar)?

A

NO abuse potential
NO suicide risk
NO increased CNS effecrs with other drugs (ETOH, benzos, etc.)

38
Q

Why can’t we use buspirone (BuSpar) PRN?

A

Takes weeks to develop peak effects!

-May require a PRN Anxiolytic while therapeutic effects develop

39
Q

What is the major Contraindication with buspirone (BuSpar)?

A

GRAPEFRUIT!

40
Q

How do we switch from a Benzodiazepine to buspirone (BuSpar)?

A 
Give buspirone (BuSpar) 2-4 wks before stopping the benzo
-Need to Wean Benzo slowly!!
41
Q

Does buspirone (BuSpar) result in Tolerance &/or Physical Dependence?

A

Nope

42
Q

What class of drug is Hydroxyzine?

A

Antihistamine

43
Q

What can we use Hydroxyzine for?

A

1) Anxiety (effects on serotonin)

2) Insomnia (anticholinergic effect)

44
Q

Is Hydroxyzine a Scheduled Drug?

A

Nope

45
Q

Hydroxyzine route and dosing:

A

1) PO

Dosing:

1) Routine: anxiety QID (4x/day)
2) PRN: insomnia

46
Q

Hydroxyzine SEs:

A

ANTICHOLINERGIC SEs!!

1) Dry mouth
2) Constipation
3) Confusion
4) Dizziness
5) Headache
6) Fatigue

47
Q

What serious ADR can occur with prolonged use of Hydroxyzine?

A

Prolonged QT-Interval!

48
Q

Does Hydroxyzine result in Tolerance &/or Physical Dependence?

A

Nope

NSG 323 (mcp) (14 decks)

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