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Pharma Tbilisi > Sedatives & Hypnotics > Flashcards

Sedatives & Hypnotics Flashcards

1
Q

NE levels in anxiety and depression

A

Increased in anxiety
Decreased in depression

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2
Q

Dopamine levels in schizophrenia, Parkinson’s and depression

A

Increased in schizophrenia

Decreased in Parkinson’s

Decreased in depression

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3
Q

Serotonin levels in anxiety and depression

A

Decreased in anxiety

Decreased in depression

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4
Q

Classic triad of serotonin syndrome with examples

A

Mental status changes

Autonomic hyperactivity

Neuromuscular abnormalities

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5
Q

Treatment of serotonin syndrome

A

Cyproheptadine (serotonin antagonist)

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6
Q

ACh level in REM sleep, Alzheimers and Huntington’s disease

A

Increased in REM sleep

Decreased in Alzheimers

Decreased in Huntington’s disease

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7
Q

Major excitatory neurotransmitter

A

Glutamate

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8
Q

Receptor for glutamate

A

NMDA receptor

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9
Q

Phenycyclidine

A

Antagonist to NMDA receptor

Causes stimulatory side effects

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10
Q

What is a sedative?

A

AKA anxiolytics

Reduces anxiety and exerts a calming effect

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11
Q

What is a hypnotic?

A

Produces drowsiness

Encourage onset and maintenance of a state of sleep

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12
Q

Simpler examples in the sedative-hypnotic class?

A

Ethanol

Chloral hydrate

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13
Q

Something that differentiates benzodiazepines from barbiturates and alcohol?

A

Benzodiazepines will not progress past CNS depression into coma

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14
Q

Drugs that are GABAa agonists

A

Benzodiazepines

Barbiturates

Zolpidem, zaleplon, eszopiclon

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15
Q

Action of buspiron?

A

Serotonin receptor agonist

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16
Q

Action of Ramelteon

A

Melatonin agonist

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17
Q

Action of Suvorexant

A

Orexin antagonist that improves sleep duration

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18
Q

What is unique about buspirone’s anxiolytic effect?

A

It has a pure anxiolytic affect with no other effects

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19
Q

Clinical use of Buspirone

A

GAD

Begins to take effect after 1-2 weeks

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20
Q

GABA levels in anxiety and Huntington’s disease

A

Decreased in anxiety

Decreased in Huntington’s disease

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21
Q

GABA receptor anaesthetics

A

Etomidate

Propofol

22
Q

Difference between mechanism of benzodiazepines and mechanism of barbiturates?

A

Benzodiazepines potentiate GABA thereby increasing the frequency of Cl- channels opening

Barbiturates prolong GABA activity and thereby prolong the duration of Cl- channels opening

23
Q

What receptors do benzodiazepines and Barbiturates act on and where are they?

A

Benzodiazepines bind to specific benzodiazepine binding sites that are part of the GABAa complex

Barbiturates bind to other binding sites on the GABAa complex

24
Q

How do the drugs with ‘z’ selectively cause sedation?

A

They agonise Benzodiazepine-1 receptors but select against binding to benzodiazepine-2 receptors

25
Q

How does buspirone eeduce anxiety without sedation?

A

Does not affect GABA

Partial agonist at serotonin receptors

26
Q

What is the antidote for sedative-hypnotic drugs?

A

Flumezanil

27
Q

Which sedative-hypnotics can flumezanil not antagonise?

A

Barbiturates and alcohol as they bind to sites other than benzodiazepine receptors

28
Q

Effects of sedation?

A

Decreases psychomotor and cognitive functions

Disinhibition

Anterograde amnesia

29
Q

How does hypnosis affect sleep?

A

Sleep latency decreased

Duration of stage 2 NREM sleep is increased (deep sleep)

Duration of REM sleep is Decreased

Duration of stage 3 NREM slow wave sleep is decreased

30
Q

Barbiturates used for anaesthesia?

A

Thiopental

Methohexital

31
Q

Management of generalised convulsive status epilepticus?

A

IV lorazepam, diazepam or midazolam

32
Q

Drug used in sedative-hypnotic withdrawal states

A

Diazepam

Even in bezodiaepine withdrawal

33
Q

What does orexin do and therefore what does suvorexant do?

A

Orexin causes wakefulness and therefore suvorexant enables sleep but antagonising orexin

34
Q

Earliest features of alcohol withdrawal within hours to a day?

A

Mainly tremor

35
Q

When do seizures, occur in alcohol withdrawal?

A

6 to 48 hours

36
Q

When do hallucinations occur in alcohol withdrawal?

A

12 to 48 hours

37
Q

When does delirium tremendous occur in alcohol withdrawal?

A

72 to 96 hours

38
Q

What is delirium tremens?

A

Markedly altered mental status

Autonomic hyperactivity

39
Q

FDA approved drugs for alcoholism therapy?

A

Disulfiram

Naltrexone

Acamprosate

40
Q

Why does naltrexone help alcoholics?

A

Endogenous opioids reinforce alcohol effects

When given there is no buzz

41
Q

How does acamprosate work for alcoholics?

A

Modulates NMDA receptors

42
Q

What is Wernicke-Korsakoff syndrome?

A

Wernicke: acute encephalopathy

Korsakoff: permanent neurological condition usually due to Wernicke

43
Q

Causes of Wernicke-Korsakoff syndrome?

A

Thiamine (B1) deficiency

Alcoholism

44
Q

Brain finding in Wernicke-Korsakoff syndrome?

A

Atrophy of mammilary bodies

45
Q

Features of Korsakoff syndrome?

A

Confabulation - can’t remember so make things up

Apathy

Personality changes

Amnesia, more likely anterograde

46
Q

Features of foetal alcohol syndrome?

A

Growth restriction

Midfacial hypoplasia

Microcephaly

Marked CNS dysfunction

47
Q

Diagnosis of recurrent episodes of chest pain, tachycardia, SOB, sweating and tremulousness in a young, otherwise healthy patient?

A

Panic disorder

48
Q

Best hypnotics for elderly patients?

A

Melatonin agonists like ramelteon

49
Q

How are benzodiazepines administered in status epilepticus?

A

IV

50
Q

What drugs should benzodiazepines not be used with?

A

Any drug that causes sedation

51
Q

How do GABA agonists help in cerebral palsy?

A

Improve the spasticity that results from a decrease in descending inhibitory control

Pharma Tbilisi (12 decks)

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