Sedatives, Anxiolytics and Hypnotics Flashcards by Shaquan Moore

Sleep, Sedation for a procedure, Seizure control

Sedatives, Anxiolytics, Hypnotics

Sedatives-

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Sleep, Anxiety, Seizures, Sedation for a procedure

Sedatives, Anxiolytics, Hypnotics

Anxiolytics-

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Purely intended for Sleep

Sedatives, Anxiolytics, Hypnotics

Hypnotics-

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phenobarbital/methohexital ◦

Barbiturates, Benzodiazepines, Other Sedatives:

Barbiturates

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Primidone

Barbiturates, Benzodiazepines, Other Sedatives

Barbiturates

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diazepam, temazepam

Barbiturates, Benzodiazepines, Other Sedatives

Benzodiazepines

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midazolam

Barbiturates, Benzodiazepines, Other Sedatives

Benzodiazepines

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Chlordiazepoxide

Barbiturates, Benzodiazepines, Other Sedatives

Benzodiazepines

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Opioids (Fentanyl), Propofol, Ketamine

Barbiturates, Benzodiazepines, Other Sedatives

Other Sedatives:

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1 risk >Respiratory depression

Barbiturates, Benzodiazepines, Other Sedatives

Barbiturates

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USED TO TREAT
◦ Seizures
Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”

Phenobarbital

Primidone

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Anesthesia

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”

Methohexital

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Alcohol withdrawal

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”

◦ “Phenobarbital Coma”

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seizures only

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”

Primidone

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(precursortophenobarbital)

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Primidone

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Potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), and directly mimic GABA (prolongs duration of chloride channel opening

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Methohexital
Phenobarbital
Primidone

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ADVERSE EFFECTS
◦ Respiratory Depression
◦ #1 risk and reason why not commonly prescribed anymore.

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Methohexital
Phenobarbital
Primidone

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CNS Depression
Confusion, drowsiness

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Methohexital
Phenobarbital
Primidone

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paradoxical reactions (hyperactivity/anxiety)

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Methohexital
Phenobarbital
Primidone
diazepam, temazepam
midazolam
Chlordiazepoxide

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Cardiovascular
◦ sedative doses can cause lower BP (vasodilation) and HR
◦ toxic doses cause profound hypotension and shock

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Methohexital
Phenobarbital
Primidone
diazepam, temazepam
midazolam
Chlordiazepoxide

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Which should monitor for the following drugs- Methohexita, Phenobarbital, Primidone

MONITORING
◦ Watch respiratory rate
◦ Heart rate
◦ Blood pressure

All

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TOXICITY- can present with hypotension, respiratory depression, CNS disturbances like nystagmus, ataxia

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Phenobarbital
Primidone
Methohexital

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DRUG-DRUG INTERACTIONS
◦ These are CYP450 INDUCERS

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Phenobarbital
Primidone
Methohexital

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REDUCES REM Sleep

Phenobarbital
Primidone
Methohexital
“Phenobarbital Coma”
diazepam, temazepam
midazolam
Chlordiazepoxide
Opioids (Fentanyl), Propofol, Ketamine

Phenobarbital
Primidone
Methohexital

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commonly used for sedation for procedures Phenobarbital Primidone Methohexital

Methohexital-

commonly used for seizures and alcohol withdrawal Phenobarbital Primidone Methohexital

Phenobarbital-

only for seizures Phenobarbital Primidone Methohexital

Primidone- only for seizures

PANIC ATTACKS, PRN USAGE- NOT RECOMMENDED FOR CHRONIC THERAPY ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine ```

diazepam, temazepam midazolam Chlordiazepoxide

Anxiety, MuscleSpasms ,Seizures(DiaSTAT®) Diazepam Midazolam Temazepam Chlordiazepoxide

Diazepam

Procedural-conscious sedation, anesthesia Diazepam Midazolam Temazepam Chlordiazepoxide

Midazolam

Sleep!PRN Diazepam Midazolam Temazepam Chlordiazepoxide

Temazepam

Alcohol Withdrawal Diazepam Midazolam Temazepam Chlordiazepoxide

Chlordiazepoxide

Muscle Spasms Diazepam Midazolam Temazepam Chlordiazepoxide

Diazepam

MECHANISM OF ACTION: potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), does NOT directly mimic GABA ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine ```

diazepam, temazepam midazolam Chlordiazepoxide

induces muscle relaxation through effects on ? - premotor cortex - supraspinal motor areas - cortical areas - hippocampus

supraspinal motor areas

Hangover effect! Can see drowsiness the next day ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

diazepam, temazepam midazolam Chlordiazepoxide

is use for SEDATION for PROCEDURES ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

MIDAZOLAM

MIDAZOLAM acts on ? and cerebral cortex and this is why we see confusion, and anterograde amnesia - premotor cortex - supraspinal motor areas - cortical areas - hippocampus

hippocampus

Which are the main concerns for ALCOHOL WITHDRAWAL -DeliriumTremens(DT’s) -Seizures -Neurological Toxicity -too much Glutamate -too less Glutamate -Wernicke encephalopathy -Korsakoff Syndrome All None

- DeliriumTremens(DT’s) - Seizures - Neurological Toxicity - Wernicke encephalopathy - Korsakoff Syndrome - too much Glutamate

TREATMENT for ALCOHOL WITHDRAWAL ``` Phenobarbital Primidone Methohexital lorazepam “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

``` Phenobarbital diazepam lorazepam Chlordiazepoxide Multivitamin, Thiamine and Folic Acid ```

IV combination commonly referred to as “Banana Bag” based on its color (ironically, no potassium in it!) ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

Multivitamin, Thiamine and Folic Acid

◦ Paradoxical effects ? insomnia anxiety rage SLUDGE

insomnia, anxiety, rage

◦ cardiovascular- profound hypotension (IV) ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

diazepam, temazepam midazolam Chlordiazepoxide

respiratory depression with high dose (IV) combined with other drugs ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

diazepam, temazepam midazolam Chlordiazepoxide

Tolerance- patients may need higher doses overtime to have same effect ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

diazepam, temazepam midazolam Chlordiazepoxide

◦ Dependency!- Very real and hard to taper off ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

diazepam, temazepam midazolam Chlordiazepoxide

hangover effect, day time drowsiness (especially if long half life) ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Multivitamin, Thiamine and Folic Acid ```

diazepam, temazepam midazolam Chlordiazepoxide

◦ Sudden stoppage- Withdrawal- ^^ SEIZURES T or F

◦ Sudden stoppage of alcohol= seizures T or F

◦ Sudden stoppage of Benzodiazepines= seizures T or F

◦ Sudden stoppage of Barbiturates= seizures T or F

ANTIDOTEReversal Agent =Flumazenil for ? because of ? ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Buspirone ```

diazepam, temazepam midazolam Chlordiazepoxide Seizures

flumazenil can induce seizures due to withdrawal T or F

An acute attack (panic/anxiety) ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Buspirone ```

diazepam, temazepam midazolam Chlordiazepoxide

CHRONIC THERAPY ◦ Antidepressants ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Buspirone ```

Buspirone

USED TO TREAT: ◦ Generalized Anxiety Disorder ``` Phenobarbital Primidone Methohexital “Phenobarbital Coma” diazepam, temazepam midazolam Chlordiazepoxide Opioids (Fentanyl), Propofol, Ketamine Buspirone ```

Buspirone

Buspirone is Chronic or Acute Therapy

Chronic

High risk for Respiratory Depression ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

phenobarbital

▪ Less risk for respiratory Depression ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

temazepam

Benzodiazepine Like Agents ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem Tartrate

Melatonin Agonist Is this a controlled or not controlled substance? ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Ramelteon

HERBALS ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Kava, Valerian Root

Short term treatment of Insomnia ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

sedative hypnotic ONLY ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

hangover effect ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

Administer at bedtime (should have at least 8 hours of time set aside) ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

Take on empty stomach (do not give with or immediately after a meal) alters onset ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

Avoid alcohol, or CNS Depressants ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

Alters REMS sleep ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

SHORT TERM THERAPY ONLY ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Zolpidem

Only meant to help with Difficulty Falling Asleep ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Ramelteon

Hospital induced Delirium ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Ramelteon

Use ◦ Promotes sleep and decreases anxiety ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Kava

Associated with liver damage including liver failure ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Kava

Kava Liver or Kidney damage

Liver

◦ Promotes sleep only ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Valerian Root

Increases GABA ``` phenobarbital temazepam Zolpidem Tartrate Ramelteon Kava, Valerian Root ```

Valerian Root