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Phamacology > Sedatives, Hypnotics, Anxiety. > Flashcards

Sedatives, Hypnotics, Anxiety. Flashcards

1
Q

Purely intended for Sleep
Sedatives
Hypnotics
Anxiolytics

A

Hypnotics- Purely intended for Sleep

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2
Q

Sleep, sedation for a procedure, seizure control
Sedatives
Hypnotics
Anxiolytics

A

Sedatives- sleep, sedation for a procedure, seizure control

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3
Q

Sleep, Anxiety, Seizures, Sedation for a procedure. (medication that relieves anxiety)
Sedatives
Hypnotics
Anxiolytics

A

Anxiolytics- Sleep, Anxiety, Seizures, Sedation for a procedure. (medication that relieves anxiety)

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4
Q 
Barbiturates?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates- Methohexital, Phenobarbital and Primidone

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5
Q 
Benzodiazepines?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepines- diazepam, midazolam, temazepam, chlordiazepoxide

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6
Q 
Miscellaneous Anxiety Agent?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Miscellaneous Anxiety Agent:- Buspirone

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7
Q 
Benzodiazepine- like Drugs?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepine- like Drugs- Zolpidem

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8
Q 
Melatonin Agonist?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Melatonin Agonist- Ramelteon

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9
Q 
Herbals?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Herbals- Kava, Valerian

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10
Q 
#1 risk >Respiratory depression
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates- Methohexital, Phenobarbital and Primidone

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11
Q

? = Methohexital

Seizures, Anesthesia, Alcohol withdrawal

A

Anesthesia = Methohexital

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12
Q

? = Phenobarbital

Seizures, Anesthesia, Alcohol withdrawal

A

Seizures = Phenobarbital,

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13
Q

= “Phenobarbital Coma”

Seizures, Anesthesia, Alcohol withdrawal

A

Alcohol withdrawal = “Phenobarbital Coma”

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14
Q

? - only for seizures

Primidone, Phenobarbital, Methohexital

A

Primidone- only for seizures

Barbiturates

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15
Q

? commonly used for sedation for procedures

Primidone, Phenobarbital, Methohexital

A

Methohexital commonly used for sedation for procedures

Barbiturates

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16
Q

? commonly used for seizures and alcohol withdrawaL

Primidone, Phenobarbital, Methohexital

A

Phenobarbital commonly used for seizures and alcohol withdrawaL

Barbiturates

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17
Q

? = precursor to phenobarbital

Primidone, Phenobarbital, Methohexital

A

Primidone = precursor to phenobarbital

Barbiturates

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18
Q 
Treat
Seizures , Sedatives, Anesthesia, Alcohol withdrawal
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates- Methohexital, Phenobarbital and Primidone

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19
Q 
PANIC ATTACKS, PRN USAGE- NOT RECOMMENDED FOR CHRONIC THERAPY!
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepines- diazepam, midazolam, temazepam, chlordiazepoxide

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20
Q

Anxiety (Generalized Anxiety Disorder, GAD)
Insomnia
Seizure Disorders
Muscle Spasms
Alcohol Withdrawal
Peri-Operative (anesthesia, conscious sedation)

A

Benzodiazepines- diazepam, midazolam, temazepam, chlordiazepoxide

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21
Q

? - Procedural- conscious sedation, anesthesia

Chlordiazepoxide, Diazepam (Valium), Midazolam (Versed), Temazepam (Restoril)

A

Midazolam (Versed)- Procedural- conscious sedation, anesthesia
Temazepam (Restoril)- Sleep! PRN
Chlordiazepoxide- Alcohol Withdrawal

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22
Q

?- Anxiety, Muscle Spasms, Seizures (DiaSTAT®)

A

Diazepam (Valium)- Anxiety, Muscle Spasms, Seizures (DiaSTAT®)

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23
Q

? - Alcohol Withdrawal

A

Chlordiazepoxide- Alcohol Withdrawal

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24
Q

? - Sleep! PRN

A

Temazepam (Restoril)- Sleep! PRN

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25
Q

Treat:
Generalized Anxiety Disorder
Chronic panic/anxiety attacks

Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Miscellaneous Anxiety Agent:- Buspirone

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26
Q

Treat:
Short term treatment of Insomnia

Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepine- like Drugs- Zolpidem

Melatonin Agonist- Ramelteon

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27
Q 
Treat:
Promotes sleep and decreases anxiety?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Herbals- Kava

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28
Q 
Treat:
Promotes sleep?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Herbals- Valerian

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29
Q 
MECHANISM OF ACTION
Potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), and directly mimic GABA (prolongs duration of channel opening)
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

A. Barbiturates: Methohexital, Phenobarbital and Primidone

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30
Q 
Potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), does NOT directly mimic GABA
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

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31
Q

? - can reduce anxiety, and used for Sleep/Insomnia.

MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

A

Benzo- can reduce anxiety, and used for Sleep/Insomnia.

32
Q

? is use for SEDATION for PROCEDURES- acts on hippocampus and cerebral cortex

MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

A

MIDAZOLAM is use for SEDATION for PROCEDURES- acts on hippocampus and cerebral cortex

33
Q

? - MUSCLE RELAXATION!

MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

A

DIAZEPAM ONLY- MUSCLE RELAXATION!

34
Q

? - induces muscle relaxation through effects on supraspinal motor areas

MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

A

Diazepam - induces muscle relaxation through effects on supraspinal motor areas

35
Q 
MECHANISM OF ACTION
Agonist at serotonin receptor?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Miscellaneous Anxiety Agent: Buspirone

36
Q 
this is CHRONIC therapy ONLY?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Miscellaneous Anxiety Agent: Buspirone

37
Q 
Takes several weeks to work (similar to anti-depressants)?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Miscellaneous Anxiety Agent: Buspirone

38
Q 
MECHANISM OF ACTION
Agonist at the benzodiazepine
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Zolpidem– Benzodiazepine Like Agents

39
Q 
MECHANISM OF ACTION
? binds to the Melatonin Receptor
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Ramelteon- Melatonin Agonist

40
Q

MECHANISM OF ACTION

Via GABA receptors

A

Herbals Kava

41
Q

MECHANISM OF ACTION

Increases GABA

A

Herbals Valerian

42
Q 
Respiratory Depression◦#1 risk and reason why not commonly prescribed anymore.
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

43
Q 
Cns depression Paradoxical effects- insomnia, anxiety, rage specially in children.
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

Zolpidem– Benzodiazepine Like Agents

44
Q 
ADVERSE EFFECTS
Profound sedation when given with CNS Depressants
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Herbals Kava, Valerian

45
Q 
AD E
Associated with liver damage including liver failure
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Herbals Kava

46
Q 
AD E
Caution about drowsiness
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Herbals Valerian

47
Q 
Cardiovascular◦sedative doses can cause lower BP (vasodilation) and HR
◦toxic doses cause profound hypotension and shock
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

48
Q

Which is more potent than the other ?

Barbiturates or Benzodiazepine

A

Barbiturates

49
Q 
Respiratory depression with high dose (IV) combined with other drugs
cardiovascular- profound hypotension (IV)
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

B. Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

E. Zolpidem– Benzodiazepine Like Agents

50
Q 
Tolerance- patients may need higher doses overtime to have same effect
Dependency!- Very real and hard to taper off
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

B. Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

E. Zolpidem– Benzodiazepine Like Agents

51
Q 
Hangover Effect
Sudden stoppage- Withdrawal-=? 
Sudden stoppage of alcohol= ?
Sudden stoppage of Benzodiazepines= ?
Sudden stoppage of Barbiturates= ?
A

Sudden stoppage- Withdrawal- ^^ SEIZURES
Sudden stoppage of alcohol= seizures
Sudden stoppage of Benzodiazepines= seizures
Sudden stoppage of Barbiturates= seizures
ANTIDOTE/REVERSAL AGENT◦flumazenil (Romazicon®)◦
Only used in serious situations, can induce seizures due to withdrawal

52
Q

ANTIDOTE/REVERSAL AGENT ? (Romazicon®)◦
Only used in serious situations, can induce seizures due to withdrawal

Naloxone
Protamine
Flumazenil
Diphenhydramine

A

ANTIDOTE/REVERSAL AGENT◦flumazenil (Romazicon®)◦
Only used in serious situations, can induce seizures due to withdrawal

Flumazenil

53
Q 
Which drug have an Hangover effect?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

Zolpidem– Benzodiazepine Like Agents

54
Q 
ADVERSE EFFECTS
serotonin Syndrome (similar to antidepressants?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

C. Miscellaneous Anxiety Agent: Buspirone

55
Q 
Nursing Considerations
Educate about s/s of serotonin syndrome (will discuss in depression lecture)
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

C. Miscellaneous Anxiety Agent: Buspirone

56
Q

? Melatonin Agonist (not a controlled substance)

Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

A 
Melatonin Agonist (not a controlled substance)
Ramelteon
57
Q

? Newer Agents
Less risk for respiratory Depression

Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

A

Benzodiazepines(temazepam)- Newer Agents

Less risk for respiratory Depression

58
Q

? Original Sedative/Sleep agents
High risk for Respiratory Depression

Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

A

Barbiturates (phenobarbital)- Original Sedative/Sleep agents
High risk for Respiratory Depression

59
Q

Benzodiazepine Like Agents- Stronger Hypnotic Effects vs Benzos
?

Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

A

Less risk for respiratory Depression
Benzodiazepine Like Agents- Stronger Hypnotic Effects vs Benzos
Zolpidem Tartrate (Ambien®)

60
Q 
Amenorrhea, decreased libido, infertility, and galactorrhea caused by increased levels of prolactin and reduced levels of testosterone.
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Ramelteon- Melatonin Agonist

61
Q

Ramelteon- Melatonin Agonist
Administer at bedtime ( ? minutes prior to bedtime)
Take on ? stomach (do not give with or immediately after a meal) alters onset

62
Q

What causes an Alcohol Witthdrawal Risk?
a. Duven- Hallucinations, SNS hyperstimulation
b. Delirium Tremens (DT’s)- Hallucinations, SNS hyperstimulation
c. Seizures- GABA vs Glutamate (too Much Glutamate)
d. Seizures- GABA vs Glutamate (too Less Glutamate)
e. Neurological Toxicity - Wernicke encephalopathy,
Korsakoff Syndrome( To much Thiamine)
g. Neurological Toxicity - Wernicke encephalopathy, Korsakoff Syndrome(To less Thiamine)

A

b. Delirium Tremens (DT’s)- Hallucinations, SNS hyperstimulation
c. Seizures- GABA vs Glutamate (too Much Glutamate)
g. Neurological Toxicity - Wernicke encephalopathy, Korsakoff Syndrome(To less Thiamine)

63
Q 
Which treats Alcohol withdrawal?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Lorazepam- Benzo
Temazepam
Buspirone
Vitamins- Multi V., Thiamine, Folic Acid (IV)
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A 
Chlordiazepoxide- Benzo
Diazepam- Benzo
Phenobarbital- Barbiturates
Lorazepam- Benzo
Vitamins- Multi V., Thiamine, Folic Acid (IV)
64
Q 
Which Treats Prevent seizures, Delirium Tremens (DT’s)
(Alcohol Withdrawal)
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
Lorazepam
Vitamins- Multi V., Thiamine, Folic Acid (IV)
A

Chlordiazepoxide- Benzo
Diazepam- Benzo
Phenobarbital- Barbiturates
Lorazepam- Benzo

65
Q 
Which Treats Prevent Neurological toxicity
(Alcohol Withdrawal)
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
Lorazepam
Vitamins- Multi V., Thiamine, Folic Acid (IV)
A

Vitamins- Multi V., Thiamine, Folic Acid (IV)

66
Q 
Which is a Banana Bag and does it include potassium?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
Lorazepam
Vitamins- Multi V., Thiamine, Folic Acid (IV)
A

Vitamins- Multi V., Thiamine, Folic Acid (IV)

NO!

67
Q 
DRUG-DRUG INTERACTIONS
CYP450 INDUCERS- Oral contraceptives less effective.
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

68
Q

Barbiturates: Methohexital, Phenobarbital and Primidone

Induce or Reduce REM Sleep?

69
Q 
TOXICITY
Can present with hypotension, respiratory depression, CNS disturbances like nystagmus, ataxia
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

70
Q 
Monitor blood pressure, HR, and respiratory rate.
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

71
Q 
monitor blood pressure, HR, and respiratory rate, And oxygen saturation.
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

72
Q 
Which Alter Rem
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Zolpidem Benzo Like

73
Q

Is this true about Benzos Acute us = no concern for withdrawal, Chronic usage = must be tapered

74
Q 
Do NOT combine with other CNS depressants (meds + EtOH!, benzodiazepines, opioids,) CNS Depressents!
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Barbiturates: Methohexital, Phenobarbital and Primidone

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

Zolpidem Benzo Like

75
Q 
DO not take with Grape juice?
Methohexital
Chlordiazepoxide
Primidone 
Diazepam
Valerian
Temazepam
Buspirone
Phenobarbital
Zolpidem
Ramelteon
Kava
Midazolam
A

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

C. Miscellaneous Anxiety Agent: Buspirone

76
Q

Zolpidem Benzo Like
Re-evaluate if insomnia persists after ? week
Controlled substance (tolerance and dependence)

77
Q

Zolpidem Benzo Like
Administer at bedtime (should have at least ? hours of time set aside)
Take on ? stomach (do not give with or immediately after a meal) alters onset

Phamacology (13 decks)

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