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Pharm Final > Anti-anxiety Agents, Sedatives and Hypnotics > Flashcards

Anti-anxiety Agents, Sedatives and Hypnotics Flashcards

1
Q

Anxiolytics and Sedative Hypnotics

A

CNS depressants that have similar effects
- Produces drowsiness, sedation, possibility of respiratory depression

  • Anxiolytics promote relaxation, decreased anxiety
  • Sedatives/Hypnotics promote relaxation and induce sleep
  • Anxiolytics used for sleeping are referred to as sedative-hypnotics
  • The difference DEPENDS ON THE DOSE
  • Some of these drugs, due to their CNS depressant effects, are also used as anticonvulsants and anesthetics
  • Benzodiazepines are the main drug used to treat anxiety and insomnia
  • Antidepressants are increasingly being used
  • Barbiturates were used in the past, but due to nasty side effects and high levels of
    dependence they are no longer used
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2
Q

Anxiolytics promote

A

relaxation, decreased anxiety

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3
Q

Sedatives/Hypnotics promote

A

relaxation and induce sleep

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4
Q

Anxiolytics used for sleeping are referred to as

A

sedative-hypnotics

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5
Q

REM sleep is the MOST important for _________________ & Non REM is _______________

A

mental and emotional restoration

&

physically restorative

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6
Q

true or false: there is a wide safety margin between therapeutic and toxic doses of benzodiazepines

A

true

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7
Q

true or false: easy to overdose on benzodiazepines

A

Overdose not often fatal, unless combined with another CNS depressant

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8
Q

Benzodiazepine

A

CNS depressant used for sedation, reduce anxiety, muscle skeletal relaxation,
anticonvulsant effects

  • It does NOT SUPPRESS REM sleep
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9
Q

Benzodiazepines indications

A
  • Anti-anxiety
  • Hypnotic
  • Anticonvulsant
  • Pre-op sedation (pre-surgery)
  • Prevention of agitation and delirium tremens (DTs) in acute alcohol withdrawal
  • Anxiety/agitation associated with depression, psychosis or mania
  • Often given concurrently with anti-depressants, anti-psychotics and mood stabilizers
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10
Q

Half Life of Benzodiazepines: Diazepam

Flurazepam, and Chlordiazepoxide

A

form active metabolites that have long acting half lives (greater than 24 hours) and tend to accumulate, especially in older adults or those with impaired liver function

Diazepam: Valium = 20-100 hours

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11
Q

Half Life of Benzodiazepines: Alprazolam, Lorazepam, Clonazepam, Oxazepam, and Temazepam

A

immediate acting half lives of 6-24 hours which do not have active metabolites and generally do not accumulate

Lorazepam: Ativan = 10-20 hours

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12
Q

Half Life of Benzodiazepines: Midazolam and Triazolam

A

short acting half lives of less than 6 hours

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13
Q

why are half lives of benzodiazepines important

A
  • The drugs with the shorter half life are best when a rapid response is needed and tend to be preferred as the adverse effects do not accumulate
  • Benzos take 5-7 days to reach therapeutic effect, and side effects also tend to manifest at the 2-3 day mark
  • These effects accumulate with chronic use and persist several days after the medication is
    discontinued
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14
Q

Diazepam (Valium) used effectively in tx of?
usual dose?
max dose?

A

GAD, as a muscle relaxant, and alcohol withdrawal, IV sedation, seizures
- Usual dose is 5-60mg PO/IV, divided
- Maximum dose of 60mg per 24 hours

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15
Q

Lorazepam (Ativan) used effectively to treat?
ususal dose? Max Dose?

A

GAD, agitation, alcohol withdrawal
- Usual dose is 1-6mg SL/IV, divided
- Maximum dose of 10mg per 24 hours

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16
Q

Midazolam (Versed)
usual dose?
Max dose?

A

IV only for anesthesia and sedation.
IM for severe agitation
especially in ER
- Dosage of 0.07-0.08mg per kg
- Maximum dose of 5mg per 24 hours

17
Q

Clonazepam (Rivotril) used for?
usual dose?
max dose?

A

seizure disorder as an adjunct, panic disorder, agitation/anxiety, mood stabilizer
- Dosage of 0.5-2mg, divided
- Longer half life than Ativan, takes longer to have an effect and lasts longer
- Less dependency issues tha Ativan
- Maximum 20mg in 24 hours for seizure treatment, maximum is way lower for
anxiety

18
Q

Oxazepam (Serax) used for?
usual dose?
max dose?

A

Anxiety, alcohol withdrawal, still used for insomnia
- Dosage of 15-30mg, often divided
- Maximum 120mg per 24 hours

19
Q

Advantages of Benzodiazepines

A
  • Therapeutic doses have little effect on consciousness
  • They are relatively safe
  • There are few interactions with many other drugs (except other CNS depressants)
20
Q

Disadvantages of Benzodiazepines

A
  • Potentially habit forming and addictive
  • Limit to TWO WEEKS of use
  • DO NOT continue use after FOUR CONTINUOUS WEEKS
  • Some have long half lives and can accumulate
  • Memory and intellectual impairment
  • Hangover
  • Reduced motor coordination (driving hazard)
  • Paradoxical confusion, agitation, insomnia especially with pediatric and older adult
    clients
21
Q

Adverse Effects of Benzodiazepines (CNS)

A

CNS effects:
- Diplopia (double vision)
- Tremors
- Ataxia (impaired coordination)
- Drowsiness
- Headache
- Nausea
- Vomiting

22
Q

Adverse Effects of Benzodiazepines (Autonomic effects)

A

hanges in libido, constipation, incontinence, urinary retention, hypotension, and tachycardia, nasal congestion
- Accumulations effects: confusion, hypoactivity, intellectual impairment

23
Q

Benzodiazepine Withdrawal
- Mild symptoms

A

occur with 6-12 weeks use. Includes:
- Anxiety, panic, hand tremors, sweating, restlessness, insomnia, weakness, aches and pains, blurred vision, palpitations

24
Q

Benzodiazepine Withdrawal
- Severe symptoms

A

occur when regularly taken for 4 or more months. Includes: - Irritability, agitation, nervousness, diarrhea, vomiting, sweating
- Withdrawal symptoms are caused by the abrupt removal of benzo molecules from their receptor site resulting in an acute decrease of GABA neurotransmission
- Symptoms may occur within 24 hours with short acting, 4-5 days with long acting
- To prevent withdrawal, taper the drug by 10-25% every 1-2 weeks over 4-16 weeks

25
Q

Benzodiazepine Toxicity

& antidote

A
  • Excessive sedation
  • Respiratory depression
  • Coma
  • Treatment is flumazenil (Anexate)
  • It is an antagonist which competes for the benzo receptors and reverses toxicity**
26
Q

Non-Benzodiazepines sedative-hypnotics

A

Chloral hydrate (Noctec) and zoplicone (Imovane)

27
Q

Non-Benzodiazepines: Chloral hydrate

A
  • Oldest sedative hypnotic
  • Relatively safe, inexpensive and effective
  • Does not suppress REM sleep
  • Tolerance develops after about 2 weeks
  • Can be abused and cause physical dependence
  • Also used to reduce pre-operative and diagnostic testing anxiety
  • Dosage of 500-2000mg daily
28
Q

Non-Benzodiazepines: Zopiclone

A
  • Differs structurally from benzo’s but has similar effects, binds with benzo receptors
  • Use for symptomatic relief of transient and short term (7-10 days) insomnia,
    characterized by difficulty falling and remaining asleep, and/or early morning awakenings
  • Delayed onset of REM sleep, DOES NOT reduce the total duration of REM periods
  • Metabolized via the cytochrome P450 system (the enzymes essential for the metabolism;
    over 60 enzymes included and 6 of these enzymes metabolize all of medications)
  • Several drug interactions (erythromycin can increase plasma levels. Carbamazepine and
    phenytoin can decrease plasma levels)
  • Dosage is usually 7.5mg per 24 hours (half this dose in elderly patients)
29
Q

Zopiclone considerations

A
  • Should not be prescribed in quantities longer than one month
  • Risk of dependence
  • OD can be fatal
  • Rebound insomnia common
  • Taper slowly
  • Less side effects than other sedative hypnotics
30
Q

Non-Benzodiazepines: Antihistamines (OTC)

A
  • Antihistamine with sedative and anti-emetic properties is sometimes used to treat anxiety
  • Primarily hydroxyzine (Atarax), but also diphenhydramine (Benedryl) and dimenhydrinate (Gravol)
  • It is used for anxiety, preoperative sedation, nausea, and vomiting associated with surgery or motion sickness, pruritus and urticaria associated with allergic dermatoses
31
Q

Nursing Process: Patient Teaching

A
  • Use with caution in the elderly and pediatric populations
  • Baseline VS (including orthostatic BP)
  • Hypnotics: 15-30 minutes pre bedtime for maximum effectiveness
  • Avoid alcohol and other CNS depressants
  • Avoid grapefruit juice
32
Q

how soon do symptoms of benzodiazepine withdrawal occur
- short acting
- long acting

A

Symptoms may occur within 24 hours with short acting, 4-5 days with long acting
- To prevent withdrawal, taper the drug by 10-25% every 1-2 weeks over 4-16 weeks

Pharm Final (7 decks)

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