Anxiety and sleep disorders

Question 1

Why are older drugs such as meprobamate and barbiturate not recommended anymore

Answer 1

Higher risk of SE and interactions
More dangerous in OD

Question 2

For how long can BDZ be used for

Answer 2

Short term only 2-4 weeks

Must only be for anxiety that is severe

Question 3

Withdrawal syndrome BDZ

Answer 3

• Avoid abrupt withdrawal
• Can develop 3 weeks after stopping long acting BDZ or within 1 day for short acting
• Symptoms include insomnia, loss of appetite, tremor, anxiety, perceptual disturbances

Question 4

BDZ withdrawal

Answer 4

Long term BDZ transfer patient stepwise, one dose at a time over about a week to an equivalent daily dose of diazepam (at night)

Reduce diazepam dose by 1-2mg every 2-4 weeks

If uncomfortable symptoms occur, maintain this dose until symptoms subside

At the end of the withdrawal, smaller steps of 500mcg may be neccesary

Stop all together

Question 5

When to use short acting hypnotics

Answer 5

Best for sleep onset insomnia when sedation the next day is undesirable/ in elderly

Question 6

When to use long acting hypnotics

Answer 6

Best for patients with poor sleep maintenance, when an anxiolytic effect is needed during the day or when sedation the next day is acceptable

Question 7

Why is mirtazapine used

Answer 7

Taken at night to help both sleep and depression

Question 8

Elderly and BDZ/ hypnotics

Answer 8

Avoid due to the increased risk of becoming ataxic and confused leading to falls and injury

Question 9

When can tolerance occur with hypnotics

Answer 9

within 3-14 days of continuous use

Question 10

Hypnotics and dental

Answer 10

Can benefit anxious patients during dental procedures. Temazepam preferred to diazepam due to minimal residual effect the next day

Question 11

Short acting BDZ

Answer 11

Loprazolam
Lormetazepam
Temazepam

Question 12

Long acting BDZ

Answer 12

Diazepam, Clonazepam

Question 13

BDZ and hepatic impairment

Answer 13

Use short acting

Question 14

CI of BDZ

Answer 14

-Resp disease (increased risk of respiratory depression)

Question 15

Cautions of BDZ

Answer 15

Elderly
Drug/alcohol abuse/dependence

Question 16

BDZ antidote

Answer 16

Flumazenil

Question 17

BDZ and pregnancy

Answer 17

Avoid regular use

Question 18

Z drugs CI

Answer 18

Myasthenia gravis
Resp failure
Severe sleep apnoea

Question 19

Z drugs and pregnancy

Answer 19

Avoid in preg and BF due to neonatal withdrawal symptoms an hypothermia and resp depression