Sedatives & Hypnotics & Anxiolytics Flashcards
Decreasing dopamine has what effect?
promotes sleepiness
What sleep issue is MC for young adults?
difficulty falling asleep
What sleep issue is MC for middle-aged to elderly adults?
middle of the night waking
or
early morning awakening
In someone with short term sleep disorder, what is the first line therapy?
sleep hygiene and short acting Benzodiazepine receptor agonist
In someone with short term sleep disorder, what is the 2nd line treatment?
Trazodone
Sedative versus Hypnotic
Sedative - reduces anxiety and exerts calming effect
Hypnotic - produces drowsiness and encourages the onset and maintenance of sleep
-more pronounced CNS depression
What’s the difference between barbituates and benzodiazepines?
Barbituates act like GABA. Can produce coma
Benzodiazepines improve action of GABA
MC Benzodiazepines used for insomnia
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Zolpidem (Ambien)
–>These are newer GABA agonists that only do sedation
Which hypnotics DO NOT form active metabolites
Oxazepam
Lorazepam (Ativan)
Zolpidem (Ambien)*
*=used most frequently
Most traditional Benzodiazepines have what downside
they maintain hypnotic effect for 1 month, THEN develop tolerance
What drug can reverse CNS depressant effects of benzodiazepines?
Flumazenil
Newer hypnotics
- Zolpidem (Ambien)
- Zaleplon (Sonata)
- Eszopiclone (Lunesta)
–>these are not benzos
Which barbiturate was previously used as “truth serum”
Amobarbital
Barbiturates: uses
- Thiopental - anesthesia
- Secobarbital - insomnia and sedation
- Phenobarbital- seizure disorders
Between barbituates and benzos, which has a higher risk of dependence?
Barbiturates >benzodiazepines
Barbiturate Chloral hydrate (used in peds dentistry for sedation) can have what effect on bleeding?
-may displace coumarins and increase anticoagulant effects
Antihistamines used for sedation
- Diphenhydramine
- Doxylamine (Unisom)
Which antidepressant can cause daytime sedation and weight gain and is used in nursing homes for sun-downing?
Mirtazapine
Trazodone can be used for bedtime sedation to improve sleep continuity. What is a rare but serious side effect of this med?
Priaprism
Ramelteon
- melatonin-receptor agonist
- effective at treating sleep-onset difficulties in patients with COPD and sleep apnea
Valerian
- herbal remedy for sleep
- smells like old gym socks
Which -lam drugs are used for Anxiety
Alprazolam
Clonazepam
Which - lam drugs are used for sleep disorders??
Estazolam Flurazepam Triazolam Zolpidem (Ambien) Zaleplon Eszopiclone
Buspirone
- anxiolytic
- minimal CNS depressant effects (can drive on this??)
- Slow onset >1 week
- active metabolite
Treatment of Panic Disorder
- SSRIs
- Citalopram (Celexa) maximum dose is limited by QT prolongation** - SNRIs
- Benzodiazepines
- TCA
- MAOI
