Wolff Crossword Flashcards
can range from 1.5-2 hr to >100 hours for individual benzodiazepines
half-life
widely used anxiolytic benzodiazepine, often in part because it has a moderate half-life, is eliminated by conjugation and lacks active metabolites
lorazepam
benzodiazepine receptor population selectively activated by the non-benzodiazepine (z-drug) agonists
BZ1
brain region at the epicenter of anxiety neural processing, site of action for anxiolytic drugs
amygdala
a word often used to describe benzodiazepines relative to barbiturates
safe
form of sleep gained at the expense of others with use of benzodiazepines, presumed reason that abrupt discontinuance of these drugs leads to rebound insomnia
stage II
important for the metabolism of many drugs including benzodiazepines and barbiturates, this is responsible for multiple drug interactions
CYP 3A4
IV benzodiazepine antagonist that rapidly reverses benzodiazepine effects after overdose or surgery; use carries a risk of seizures especially for those who have used benzodiazepines long-term so watchful waiting is preferred if patient is stabilized
flumazenil
word that can collectively describe the behaviors, speech, and movements of a person treated with a benzodiazepine or barbiturate…sometimes characterized as the first thing that is inhibited is one’s inhibitions
drunk
barbiturate with a half-life of ~10 hours, still available but was once more widely used to control tonic-clonic seizures which is why it was/remains a classic inducer of CYP3A4
phenobarbital
produced by neurons in the lateral walls of the hypothalamus, this peptide neurotransmitter stimulates several other nuclei to promote wakefulness
orexin
a separate category in DSM-5 previously included under anxiety, characterized by recurring thoughts that lead to repetitive behaviors, now treated with +/- CBT, +/- SSRI
OCD
DSM-5 anxiety disorder characterized by fear of situations that might be embarrassing or from which escape might be difficult (e.g. using public transportation, being in open spaces, enclosed spaces, standing in line, being away from home)
agoraphobia
class of insomnia drugs well tolerated by some with others experiencing a scary body paralysis phase as they are falling asleep
DORA
seen with the lowest doses of sedative-hypnotic drugs
anxiolysis
diazepam is better at relaxing this than other benzodiazepines
skeletal muscle
barbiturate with a half-life of 3-8 hours, was once widely used as a sedative-hypnotic in the clinic, veterinary medicine, and lab animal research
pentobarbital
refers to those rare occurrences in which benzodiazepines of barbiturates cause hyperactivity, rage, hostility, etc.
paradoxical
aspect of GABA-A Cl- channel opening that is enhanced by benzodiazepines
frequency
example of respiratory reflex activity that can be increased by barbiturates
hiccough
sedative-hypnotic drug class that proceeds from anxiolysis, sedation, hypnosis and anesthesia to medullary depression, coma (and death) when benzodiazepine monotherapy plateaus at anesthesia
barbiturates
for benzodiazepines, often due to a parent drug with active metabolites that have long half-lives
cumulative toxicity
form of dependence that is not common among people during prolonged use of benzodiazepines but that does occur with prolonged barbiturate use
physiological
long-time reason for use of short-acting benzodiazepines and Z-drugs, now being displaced more by other choices
insomnia
gender in which anxiety is more prevalent
females
characterizes the onset of beneficial effects of benzodiazepines relative to SSRI, consider the impact that this has on drug choice for a given purpose
rapid
form of amnesia associated with administration of some benzodiazepines (e.g. temazepam, triazolam)
anterograde
even though no longer widely used clinically, barbiturates are still frequently used for this in the US
suicide
usually the preferred starting therapy for treating an anxiety-related mental health disorder
CBT
non-benzodiazepine BZ1 agonist, was first agent approved for long-term use (e.g. 6 months vs 2-3 weeks) since no tolerance or dependence… but dependence is now a concern as it is with zolpidem
eszopiclone
GABA-A is a type of these that responds to a major inhibitory neurotransmitter in the brain
receptor operated channel
doing this while sleeping is among the manifestations of the complex sleep disorders associated with some sleep aids (Z-drugs, DORA)
driving
depraved people have taken advantage of drugs such as flunitrazepam to cause others to forget this
rape
a neurotransmitter commanding general states of consciousness and metabolism, it is released by neurons originating in the tuberomamillary nucleus in the posterior third of the hypothalamus
histamine
widely used to treat insomnia, it has formulations for immediate release and for returning to sleep after waking up in the middle of the night
zolpidem
buspirone does not do this to the sedation caused by alcohol or other CNS depressants
augment
inability to initiate and/or maintain this is widespread among the population
sleep
quickly became top selling psychiatric drug after brought to market and held onto the position for almost 20 yrs, continues to have specific indications in medicine
diazepam
drug class that causes sedation without relieving anxiety
antihistamines
our prototypical DORA (dual orexin receptor antagonist)
suvorexant
receptors stimulated by ramelteon
melatonin
aspect of GABA-A Cl- channel opening that is enhanced by barbiturates
duration
____ tranquilizers was a phrase that referred to sedative-hypnotic drugs
minor
refers to a drug-induced state of drowsiness/depressed consciousness resembling natural sleep with decreased motor activity and sensory responsiveness from which a person is easily aroused
hypnosis
time required for onset of beneficial effects of SSRIs and buspirone when treating anxiety
weeks
population that is particularly vulnerable to the adverse effects of benzodiazepines
elderly
high solubility in this is why benzodiazepines can readily enter the brain, placenta, and breast milk
lipids
characteristic of benzodiazepines that seem to work better when treating benzodiazepine use disorder
long acting
type of sleep lost when barbituates are used which is then made up when these drugs are discontinued?
REM
anxiolytic with unknown mechanism of action thought to be
due in part to its effects on 5-HT receptors, works but
generally not as well as SSRI and has same slow onset of
beneficial effects
buspirone
known to occur more frequently when pregnant women use benzodiazepines
birth defects
abuse classification for benzodiazepines
schedule IV
drug induced state of unconsciousness from which a patient cannot be aroused
anesthesia
benzodiazepam used for preoperative sedation because its acid is highly water soluble for iV or IM administration but is highly lipid soluble once injected and quickly enters the brain to exert its effects
midazolam
early benzodiazepam used for insomnia, the amnesia it causes was used in a murder defense
triazolam
acute treatment of these is a labeled indication of diazepam
seizures
diazepam has an important role of providing symptomatic relief during this
alcohol withdrawal
happens to cell membranes when the receptor operated chloride channels open in response to GABA stimulation
hyperpolarized
observed in 25% of cases when anxiety is treated with a benzodiazepine
no response
a history of this is reason to avoid using benzodiazepines for the treatment of anxiety
substance use disorder
time when an insomnia drug like zolpidem is considered safe to use unlike temazepam which causes some characteristic adverse effects
pregnancy
considered first line therapy for those having trouble falling asleep
ramelteon
characteristic of barbituates in comparison to benzodiazepines, reason they are schedule II
highly addictive
form of dependence that along with tolerance develops with benzodiazepines
psychological
unlike benzodiazepines, barbituates lack this
antidote
aspect of sleep for which dora and doxepin remain early choices in those with insomnia
maintenance
was the top psychiatric drug in 2017; used to treat generalized anxiety and related disorders, its ranking has fallen markedly over last few years, as mental health prescribers rely more CBT and SSRIs for management of anxiety, also known for its antidepressant and antipanic properties relative to other benzodiazepines
alprazolam
diazepam is used off-label to treat this form of intoxication
sympathomimetic
major inhibitory neurotransmitter in the brain, it activates receptor subtypes for which muscimol and baclofen are agonists
GABA
benzodiazepine still widely used to treat insomnia but no longer recommended
tempazepam
high potency benzodiazepine known for its rapid onset of action and longer half-life when compared to alprazolam
clonazepam
+/- dose conversion that is a key component of successful treatment for benzodiazepine use disorder
tapering
also a side effect of many drugs that are not CNS depressants it refers to a drug induced state of relaxation and calmness having reduced motor activity without a loss of consciousness
sedation
H1 blocker that also inhibits NE and 5-HT reuptake, used for sleep maintenance
doxepin
