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Flashcards in anxiety & insomnia Deck (32):
1

sedative-hypnotics as anti-anxiety agents: kinds (3)

benzodiazepines
barbituates
benzodiazepine-like drugs

2

abuse potential barbituates vs benzodiazepines

barbiturates > benzodiazepines

3

benzodiazepines: class, use, distribution, metabolism

sedative-hypnotic
uses: sleep, anxiety
distribution: high lipid solubility, protein bound
metabolism: liver

4

benzodiazepines: moa

enhances GABA
- binds to specific receptor sites in GABA receptor-channel complex
-- finite number of GABA receptors, difficult to overdose (unless high IV doses)

5

benzodiazepines: commonly used (4)

alprazolam (xanax)
lorazepam (ativan)
clonazepam (klonopin)
diazepam (valium)

6

benzodiazepines: adverse effects

- CNS depression
- respiratory depression (VERY QUICKLY)
- anterograde amnesia
- paradoxical psychological effects
- tolerance
- dependence
- toxicity
- abuse (schedule IV)

7

benzodiazepines: toxicity

unusual, unless mixed with other antidepressant

8

benzodiazepines: rapid toxicity in babies - why?

rapid CNS toxicity because underdeveloped BBB
-- readily crosses placenta and enters breastmilk

9

benzodiazepines: drug-drug interaction

few - NOTABLY CNS DEPRESSANTS

10

benzodiazepines: advantages

rapid onset (stops seizures fast!)
well tolerated
few drug-drug interactions
little effect on CVS
generics available

11

flumazenil (romazicon)

benzodiazepine antagonist

uses:
- to reverse sedation post-anesthesia
- overdose

may result in generalized seizures with convulsions

side effects: dizziness, agitation, mood lability, confusion, n, v, ha, blurred vision

12

benzodiazepine overdose likely due to...

IV administration

13

barbituates: class + use

sedative-hypnotic (-arbitol)

use: seizure disorder, sedation (other drugs much safer)

14

barbituates: moa

effect on GABA receptor-channel complex = dose dependent
- accelerates metabolism of some drugs

15

barbituates: adverse effects

- abuse (schedule II - IV)
- respiratory depression
- increased sensitivity to pain; pain
- tolerance
- cross tolerance to all general cns depressants (except opioids)
- toxicity

16

barbituates classification

determined by duration of action related to lipid solubility
-- ultrashort, short, intermediate, long-acting

17

barbituates: tolerance nota bene

to therapeutic levels, NOT to adverse effects

18

barbituates: early toxicity

early: restlessness, insomnia, confusion

19

barbituates: late toxicity

late: convulsions, psychosis, cardiac collapse, death
overdose
VERY EASY

20

barbituates: overdose s/s

everything is shutting down!

respiratory depression, pin point pupils, coma*
*triad of overdose s/s (RED FLAG! PROB BARBITUATE OD!)

hypotension, hypothermia,

21

barbituates: overdose treatment

gastric lavage, multi-system support
- won’t see often, but when you see it, it SUCKS

22

barbituates: triad s/s of overdose, red flag!

respiratory depression, pin point pupils, coma

23

benzodiazepine-like drugs: commonly used (3)

zolpidem (ambien)
zaleplon (sonata)
eszopiclone (lunesta)

24

benzodiazepine-like drugs: use

initially, insomnia

25

benzodiazepine-like drugs: moa

selective benzodiazepine agonist qualities (GABA receptor-chloride channel)

26

benzodiazepine-like drugs: common side effects

drowsiness, dizziness, headache
dry mouth
controlled substance, schedule IV!

27

benzodiazepine-like drugs: schedule

controlled substance, schedule IV!

28

ramelteon (rozerem)

class: melatonin agonist

use: insomnia

moa: activates specific receptor subtypes of melatonin

adverse effects: drowsiness, dizziness, fatigue
- neuroendocrine effects secondary to high prolactin and low testosterone

interactions: fluvoxamine (luvox) !!!!!
increases levels 50-60x. VERY DANGEROUS

29

ramelteon (rozerem): notable interaction

fluvoxamine (luvox) !!!!!
increases levels 50-60x. VERY DANGEROUS

30

buspirone (buspar)

NOT SEDATIVE-HYPNOTIC!

class: spiro compound
moa: not clearly established
- high affinity to 5HT receptors
- low affinity to dopamine receptors
- DOES NOT BIND to GABA or benzo sites

administration: better absorbed when taken with food
- lag time to peak effectiveness (3-6 weeks)

adverse effects
dizziness, headache
nausea
nervousness, excitement

31

zolpidem (intermezzo)

use: middle-stage insomnia

route: sublingual!

schedule IV

side effects: similar to other benzo-like meds, does have anterograde side effects

32

trazodone (desyrel)

atypical antidepressant, but can be used for insomnia

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