Sedatives, Hypnotics, Anxiety. Flashcards by Shaquan Moore

Purely intended for Sleep
Sedatives
Hypnotics
Anxiolytics

Hypnotics- Purely intended for Sleep

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

Sedatives- sleep, sedation for a procedure, seizure control

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

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

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

Barbiturates- Methohexital, Phenobarbital and Primidone

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

Benzodiazepines- diazepam, midazolam, temazepam, chlordiazepoxide

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

Miscellaneous Anxiety Agent:- Buspirone

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

Benzodiazepine- like Drugs- Zolpidem

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

Melatonin Agonist- Ramelteon

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

Herbals- Kava, Valerian

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

Barbiturates- Methohexital, Phenobarbital and Primidone

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? = Methohexital

Seizures, Anesthesia, Alcohol withdrawal

Anesthesia = Methohexital

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? = Phenobarbital

Seizures, Anesthesia, Alcohol withdrawal

Seizures = Phenobarbital,

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= “Phenobarbital Coma”

Seizures, Anesthesia, Alcohol withdrawal

Alcohol withdrawal = “Phenobarbital Coma”

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? - only for seizures

Primidone, Phenobarbital, Methohexital

Primidone- only for seizures

Barbiturates

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? commonly used for sedation for procedures

Primidone, Phenobarbital, Methohexital

Methohexital commonly used for sedation for procedures

Barbiturates

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? commonly used for seizures and alcohol withdrawaL

Primidone, Phenobarbital, Methohexital

Phenobarbital commonly used for seizures and alcohol withdrawaL

Barbiturates

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? = precursor to phenobarbital

Primidone, Phenobarbital, Methohexital

Primidone = precursor to phenobarbital

Barbiturates

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

Barbiturates- Methohexital, Phenobarbital and Primidone

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

Benzodiazepines- diazepam, midazolam, temazepam, chlordiazepoxide

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

Benzodiazepines- diazepam, midazolam, temazepam, chlordiazepoxide

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? - Procedural- conscious sedation, anesthesia

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

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

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

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

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? - Alcohol Withdrawal

Chlordiazepoxide- Alcohol Withdrawal

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? - Sleep! PRN

Temazepam (Restoril)- Sleep! PRN

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Treat: Generalized Anxiety Disorder Chronic panic/anxiety attacks ``` Methohexital Chlordiazepoxide Primidone Diazepam Valerian Temazepam Buspirone Phenobarbital Zolpidem Ramelteon Kava Midazolam ```

Miscellaneous Anxiety Agent:- Buspirone

Treat: Short term treatment of Insomnia ``` Methohexital Chlordiazepoxide Primidone Diazepam Valerian Temazepam Buspirone Phenobarbital Zolpidem Ramelteon Kava Midazolam ```

Benzodiazepine- like Drugs- Zolpidem | Melatonin Agonist- Ramelteon

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

Herbals- Kava

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

Herbals- Valerian

``` 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. Barbiturates: Methohexital, Phenobarbital and Primidone

``` 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 ```

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

? - can reduce anxiety, and used for Sleep/Insomnia. MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

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

? is use for SEDATION for PROCEDURES- acts on hippocampus and cerebral cortex MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

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

? - MUSCLE RELAXATION! MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

DIAZEPAM ONLY- MUSCLE RELAXATION!

? - induces muscle relaxation through effects on supraspinal motor areas MIDAZOLAM, Benzo, DIAZEPAM ONLY, Diazepam

Diazepam - induces muscle relaxation through effects on supraspinal motor areas

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

Miscellaneous Anxiety Agent: Buspirone

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

Miscellaneous Anxiety Agent: Buspirone

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

Miscellaneous Anxiety Agent: Buspirone

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

Zolpidem-- Benzodiazepine Like Agents

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

Ramelteon- Melatonin Agonist

MECHANISM OF ACTION | Via GABA receptors

Herbals Kava

MECHANISM OF ACTION | Increases GABA

Herbals Valerian

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

Barbiturates: Methohexital, Phenobarbital and Primidone

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

Barbiturates: Methohexital, Phenobarbital and Primidone Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide Zolpidem-- Benzodiazepine Like Agents

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

Herbals Kava, Valerian

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

Herbals Kava

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

Herbals Valerian

``` 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 ```

Barbiturates: Methohexital, Phenobarbital and Primidone

Which is more potent than the other ? | Barbiturates or Benzodiazepine

Barbiturates

``` 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 ```

B. Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide E. Zolpidem-- Benzodiazepine Like Agents

``` 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 ```

B. Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide E. Zolpidem-- Benzodiazepine Like Agents

``` Hangover Effect Sudden stoppage- Withdrawal-=? Sudden stoppage of alcohol= ? Sudden stoppage of Benzodiazepines= ? Sudden stoppage of Barbiturates= ? ```

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

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

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

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

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide Zolpidem-- Benzodiazepine Like Agents

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

C. Miscellaneous Anxiety Agent: Buspirone

``` 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 ```

C. Miscellaneous Anxiety Agent: Buspirone

? Melatonin Agonist (not a controlled substance) Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

``` Melatonin Agonist (not a controlled substance) Ramelteon ```

? Newer Agents Less risk for respiratory Depression Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

Benzodiazepines(temazepam)- Newer Agents | Less risk for respiratory Depression

? Original Sedative/Sleep agents High risk for Respiratory Depression Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

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

Benzodiazepine Like Agents- Stronger Hypnotic Effects vs Benzos ? Benzodiazepines, Ramelteon, Barbiturates , Zolpidem Tartrate (Ambien®)

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

``` 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 ```

Ramelteon- Melatonin Agonist

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

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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)

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)

``` 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 ```

``` Chlordiazepoxide- Benzo Diazepam- Benzo Phenobarbital- Barbiturates Lorazepam- Benzo Vitamins- Multi V., Thiamine, Folic Acid (IV) ```

``` 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) ```

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

``` 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) ```

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

``` 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) ```

Vitamins- Multi V., Thiamine, Folic Acid (IV) | NO!

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

Barbiturates: Methohexital, Phenobarbital and Primidone

Barbiturates: Methohexital, Phenobarbital and Primidone | Induce or Reduce REM Sleep?

Reduce

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

Barbiturates: Methohexital, Phenobarbital and Primidone

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

Barbiturates: Methohexital, Phenobarbital and Primidone

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

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide

``` Which Alter Rem Methohexital Chlordiazepoxide Primidone Diazepam Valerian Temazepam Buspirone Phenobarbital Zolpidem Ramelteon Kava Midazolam ```

Zolpidem Benzo Like

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

Yes

``` 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 ```

Barbiturates: Methohexital, Phenobarbital and Primidone Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide Zolpidem Benzo Like

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

Benzodiazepines:diazepam, midazolam, temazepam, chlordiazepoxide C. Miscellaneous Anxiety Agent: Buspirone

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

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

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