1B CNS : Hypnotics and Sedatives

Question 1

1. fear response due to an appropriate stimulus
2. the fear response is executed in the body by an extensive increase in what neurotransmitter release

Answer 1

anxiety

noradrenalin

Question 2

the fear response consists of 2 components

CENTRAL COMPONENT - what location?

PERIPHERAL COMPONENT - what system is involved?

Answer 2

Central- locus ceruleus of the CNS

Peripheral- the sympathetic nervous system

Question 3

a pathological fear response due to an inappropriate stimulus

Answer 3

anxiety disorder

Question 4

a pathological fear response due to an inappropriate stimulus

Answer 4

anxiety disorder

Question 5

there are 3 main types of anxiety disorders

Answer 5

1. Generalized Anxiety Disorder
2. Panic Disorder
3. Phobia

Question 6

MATCHING TYPE:
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Phobia

1. extensive repeating attacks of fear response
2. chronic fear response without any definite stimulus
3. fear response

Answer 6

GENERALIZED ANXIETY DISORDER - **chronic fear **response without any definite stimulus

PANIC DISORDER - extensive repeating attacks of fear response

PHOBIA - fear response

Question 7

A drug that subdues excitement and calms the subject without inducing sleep, though drowsiness may be produced.

Answer 7

Sedative

Question 8

refers to decreased responsiveness to any level of stimulation; is associated with some decrease in motor activity and ideation

Answer 8

Sedation

Question 9

A drug that induces and/or maintains sleep, similar to normal arousable sleep.

Answer 9

Hypnotic

Question 10

HYPNOTICS OR SEDATIVES?

quicker onset, shorter duration and steeper dose-response curves

Answer 10

hypnotics

Question 10

HYPNOTICS OR SEDATIVES?

quicker onset, shorter duration and steeper dose-response curves

Answer 10

hypnotics

Question 11

HYPNOTICS OR SEDATIVES?

**more slowly **acting drugs with **flatter dose-response **curves

Answer 11

sedatives

Question 12

SLEEP STAGES

• EEG shows θ, δ and spindle activity,
• K complexes can be evoked with** strong stimuli only. **
  * Eye movements are few; subjects are not easily arousable
  Comprises 5–8% of sleep time.

Answer 12

Stage 3

(deep sleep transition)

Question 13

SLEEP STAGES

• From** lying down to falling asleep** and occasional nocturnal awakenings;
• constitutes **1–2% **of sleep time.
• EEG shows** α activity when eyes are closed** and **β activity when eyes are open. **
• Eye movements are irregular or slowly rolling.

Answer 13

Stage 0
(awake)

Question 14

SLEEP STAGES

• α activity is interspersed with θ waves.
• Eye movements are reduced but there may be **bursts of rolling. **
• **Neck muscles relax. **
• Occupies 3–6% of sleep time

Answer 14

Stage 1
(dozing)

Question 15

SLEEP STAGES

• * θ waves with interspersed spindles,
• K complexes can be evoked on sensory stimulation;
• * little eye movement;
• subjects are easily arousable
• This comprises **40–50% **of sleep time.

Answer 15

Stage 2

(unequivocal sleep)

Question 16

SLEEP STAGE

• δ activity predominates in EEG,
• K complexes** cannot be evoked. **
• Eyes are practically fixed; subjects are difficult to arouse.
• Night terror may occur at this time.
• It comprises 10–20% of sleep time.

Answer 16

Stage 4

(cerebral sleep)

Question 17

TRUE OR FALSE

1. During stage 2, 3 and 4 heart rate, BP and respiration are steady and **muscles are relaxed. **
2. Stages 3 and 4 together are called slow wave sleep (SWS).

Question 18

Characteristics of REM sleep / paradoxical sleep

Answer 18

1. EEG has waves of all frequency,
   2.** K complexes cannot be elicited. **
   3.There are marked, irregular
   darting eye movements and irregular
   darting eye movements; dreams and nightmares occur, which may be recalled if the subject is aroused.
2. Heart rate and BP fluctuate; respiration is irregular.
3. Muscles are** fully relaxed, but irregular body movements occur occasionally.
   6. Erection occurs **in males.
4. About 20–30% of sleep time is spent in REM.

Question 19

CLASSIFICATION OF HYPNOTICS

Answer 19

1. BARBITURATES (long acting, short acting, ultra short acting)
2. Benziodiazepines (hypnotic, antianxiety, anticonvulsant)
3. Newer nonbenzodiazepines

Question 20

Drugs under Barbiturates
1. long acting
2. short acting
3. ultra short acting

Answer 20

Long acting
* Phenobarbitone

Short acting
* Butobarbitone
* Pentobarbitone

Ultra-short acting
* Thiopentone
* Methohexitone

Question 21

Drugs under Benzodiazepines that are HYPNOTICS

Answer 21

**Diazepam **
Flurazepam
Nitrazepam
Alprazolam
Temazepam
Triazolam

Question 22

Drugs under Benzodiazepines that are ANTIANXIETY

Answer 22

Diazepam
Chlordiazepoxide
Clorazepate
Oxazepam
Lorazepam
Alprazolam

Question 23

Drugs under Benzodiazepines that are ANTICONVULSANT

Answer 23

Diazepam
Lorazepam
Clonazepam
Clobazam

Question 24

Drugs under Newer nonbenzodiazepine hypnotics

Answer 24

**Zopiclone** Zolpidem Zaleplon

Question 25

Treatment of ____ is the most important use of this class of drugs.

Answer 25

insomnia

Question 26

other drug classification that can be used in treatment of insomnia

Answer 26

1. **antihistaminics** (promethazine, diphenhydramine) 2. some** neuroleptic/ antidepressants** (chlorpromazine, amitriptyline) 3. some **anticholinergic** (hyoscine) and 4. **opioids** (morphine, pethidine) have **significant sedative action**, but ar*e not reliable for treatment of insomnia.*

Question 27

* General depressants of the CNS * Largely obsolete as anxiolytic- and hypnotic drugs * Are also abuse-drugs * cause dependence

Answer 27

BARBITURATES

Question 28

4 mechanisms by which they barbiturates can cause dependence

Answer 28

1. POSITIVE REINFORCEMENT 2. CONDITIONING 3. TOLERANCE- Upregulation of the hepatic cytochrome P450 system (the enzyme system by which they are metabolize 4. NEGATIVE REINFORCEMENT- Hallucinations same as benzodiazepines

Question 29

3 groups of barbiturates

Answer 29

A) SHORT-ACTING B) INTERMEDIATE-ACTING C) LONG-ACTING

Question 29

3 groups of barbiturates

Answer 29

A) SHORT-ACTING B) INTERMEDIATE-ACTING C) LONG-ACTING

Question 30

Group of barbiturates: Short, Intermediate or long acting * Less than 1 hour * examples are METHOHEXITAL and THIOPENTAL

Answer 30

Short-acting

Question 31

Indication: Induction of general anesthesia * administered IV * lipophilic , thus accumulate in adipose tissue over time

Answer 31

METHOHEXITAL

Question 32

Side effect of Methohexital

Answer 32

* Euphoria * Drowsiness (sedation) * Respiratory depression * Cardiovascular depression * Death (if overdosed)

Question 33

Group of barbiturates: Short, Intermediate or long acting * 1-6 hours * examples are **PENTOBARBITAL** and **BUTOBARBITAL**

Answer 33

INTERMEDIATE-ACTING

Question 34

* This drug is used for treatment of **insomnia** and treatment of **anxiety** * Administered orally * **Not especially lipophilic**, thus will not accumulate in adipose tissue

Answer 34

PENTOBARBITAL

Question 35

Group of barbiturates: Short, intermediate or long acting * 6-12 hours * example is **PHENOBARBITAL**

Answer 35

LONG-ACTING

Question 36

Used for treatment of epileptic convulsions

Answer 36

PHENOBARBITAL

Question 37

to act primarily at the **GABA :BZD receptor**–**Cl¯ channel complex **and*** potentiate GABAergic inhibition*** by increasing the lifetime of Cl¯ channel opening induced by GABA

Answer 37

Barbiturates