06. Anti-anxiety sedative-hypnotics.

Question 1

What is the difference between anti-anxiety / sedative and hypnotics?

Answer 1

Often, just the dose. Ideally:
- Anti-anxiety and sedatives = relaxation
- Hypnotics = sleep
HOWEVER, the dose can make all the difference.

Question 2

Barbituates are classified as a _________, and use predominantly as a(n) ______________. Prototype = _______.

Answer 2

• Sedative-hypnotic
• Anticonvulsant
• Prototype = Phenobarbital

Question 3

Adverse effects of barbituates (4)

Answer 3

• Decreases REM sleep
• Tolerence develops rapidly
• Cross-tolerance develops rapidly
• Development of dependence and abuse (1940s)

Question 4

Two parts of the brain that effect anxiety are the (1) and the (2).

Define each.

Answer 4

1) Amygdala: Storage unit for emotional memories.

2) Hippocampus: Processes any threatening or traumatic signals and stores them as memories.

Question 5

• What is the Anti-anxiety neurotransmitter?

- What does it do?

Answer 5

• Gamma-aminobutyric acid (GABA)

- Inhibits or slows the excitement of the nerve pathways. (relaes the transmission of anxiety.

Question 6

Benzodiazepines

• How do they work?
• What is their classification
• What is the prototype?

Answer 6

• Enhance action of anti-anxiety neurotransmitter: Gamma-aminobutyric acid (GABA)
• Anti-anxiety / anxiolytic
• Prototype: Diazepam (Valium)

Question 7

Midazolam (Versed)

Answer 7

• Pre-op sedation (“used like water in hospitals”)

- Benzodiazepine

Question 8

Barbiturates, benzodiazepines and misc: ACTIONS (3)

Answer 8

• Depresses the CNS: Skeletal muscle relaxation, sedative effect, anti-convulsant.

Question 9

Barbiturates, benzodiazepines and misc:

USES (9)

Answer 9

• Promote sleep and rest
• Pre-op
• Diagnostic procedures
• Anti-anxiety
• Convulsive states
• Acute alcohol withdrawal
• CP Spasticity
• Decreases muscle spasm from injury
• Adjuvant drug with pain relief

Question 10

Barbiturates, benzodiazepines and misc:
ADEs.
- 1 Serious
- 3 common

Answer 10

• SERIOUS: Paradoxical reaction

- COMMON: Drowsiness, ataxia (wobbly gait), confusion

Question 11

Barbiturates, benzodiazepines and misc:

CONTRAINDICATIONS (4)

Answer 11

• Serious respiratory disorders
• Severe liver and or kidney disease
• Hx of allergies
• Hx of drug abuse with this class of drugs

Question 12

Barbiturates, benzodiazepines and misc: PATIENT TEACHING (7)

Answer 12

• Do not drink alcohol
• Do not drive or operate machinery
• Do not smoke
• Take the prescribed dose
• Increase fluids and fiber in diet
• If bedridden, C&DB q 2 h
• Store in secure place (to avoid theft, child consumption OR confused accidental overdose)

Question 13

C&DB q 2 h

• Meaning
• When would you do this?

Answer 13

• Coughing and deep breathing every 2 hours.

- Used on patients that are bedridden, on meds that depress CNS

Question 14

Barbiturates, benzodiazepines and misc:

TOLERENCE

Answer 14

• Mental develops first, physical develops later. This is important to know, because users will chase the “zen” feeling they had initially and overdose before their body catches up to the tolerance.

Question 15

_____ and alcohol have a synergistic effect, so they should not be taken together.

Answer 15

VALIUM (a Benzodiazepine)

Question 16

Barbiturates, benzodiazepines and misc:

4 RESPONSES TO OVERDOSE

Answer 16

• Respiratory support
• Nasogastric lavage
• IV fluids and diuretics
• Flumazenil (Romazicon) (antidote)

Question 17

What is the anecdote for a barbituate / benzodiazepine overdose? How does it work?

Answer 17

• Flumazenil (Romazicon)

- Knocks the Benzodiazepine off the receptor site. Very short-acting (2 hours), so pt may need add’l dose.

Question 18

Barbiturates, benzodiazepines and misc: SYMPTOMS OF WITHDRAWAL (6)

Answer 18

• Anxiety
• Agitation
• Psychosis
• Delirium
• Tremors
• Seizures