Sedatives & Hypnotics & Anxiolytics

Question 1

Decreasing dopamine has what effect?

Answer 1

promotes sleepiness

Question 2

What sleep issue is MC for young adults?

Answer 2

difficulty falling asleep

Question 3

What sleep issue is MC for middle-aged to elderly adults?

Answer 3

middle of the night waking

or

early morning awakening

Question 4

In someone with short term sleep disorder, what is the first line therapy?

Answer 4

sleep hygiene and short acting Benzodiazepine receptor agonist

Question 5

In someone with short term sleep disorder, what is the 2nd line treatment?

Answer 5

Trazodone

Question 6

Sedative versus Hypnotic

Answer 6

Sedative - reduces anxiety and exerts calming effect

Hypnotic - produces drowsiness and encourages the onset and maintenance of sleep
-more pronounced CNS depression

Question 7

What’s the difference between barbituates and benzodiazepines?

Answer 7

Barbituates act like GABA. Can produce coma

Benzodiazepines improve action of GABA

Question 8

MC Benzodiazepines used for insomnia

Answer 8

• Eszopiclone (Lunesta)
• Zaleplon (Sonata)
• Zolpidem (Ambien)

–>These are newer GABA agonists that only do sedation

Question 9

Which hypnotics DO NOT form active metabolites

Answer 9

Oxazepam
Lorazepam (Ativan)
Zolpidem (Ambien)*

*=used most frequently

Question 10

Most traditional Benzodiazepines have what downside

Answer 10

they maintain hypnotic effect for 1 month, THEN develop tolerance

Question 11

What drug can reverse CNS depressant effects of benzodiazepines?

Answer 11

Flumazenil

Question 12

Newer hypnotics

Answer 12

• Zolpidem (Ambien)
• Zaleplon (Sonata)
• Eszopiclone (Lunesta)

–>these are not benzos

Question 13

Which barbiturate was previously used as “truth serum”

Answer 13

Amobarbital

Question 14

Barbiturates: uses

Answer 14

1. Thiopental - anesthesia
2. Secobarbital - insomnia and sedation
3. Phenobarbital- seizure disorders

Question 15

Between barbituates and benzos, which has a higher risk of dependence?

Answer 15

Barbiturates >benzodiazepines

Question 16

Barbiturate Chloral hydrate (used in peds dentistry for sedation) can have what effect on bleeding?

Answer 16

-may displace coumarins and increase anticoagulant effects

Question 17

Antihistamines used for sedation

Answer 17

• Diphenhydramine

- Doxylamine (Unisom)

Question 18

Which antidepressant can cause daytime sedation and weight gain and is used in nursing homes for sun-downing?

Answer 18

Mirtazapine

Question 19

Trazodone can be used for bedtime sedation to improve sleep continuity. What is a rare but serious side effect of this med?

Answer 19

Priaprism

Question 20

Ramelteon

Answer 20

• melatonin-receptor agonist

- effective at treating sleep-onset difficulties in patients with COPD and sleep apnea

Question 21

Valerian

Answer 21

• herbal remedy for sleep

- smells like old gym socks

Question 22

Which -lam drugs are used for Anxiety

Answer 22

Alprazolam

Clonazepam

Question 23

Which - lam drugs are used for sleep disorders??

Answer 23

Estazolam
Flurazepam
Triazolam
Zolpidem (Ambien)
Zaleplon
Eszopiclone

Question 24

Buspirone

Answer 24

• anxiolytic
• minimal CNS depressant effects (can drive on this??)
• Slow onset >1 week
• active metabolite

Question 25

Treatment of Panic Disorder

Answer 25

1. SSRIs
   - Citalopram (Celexa) maximum dose is limited by QT prolongation**
2. SNRIs
3. Benzodiazepines
4. TCA
5. MAOI