Anxiolytic and Sedatives Flashcards Preview

Pharm III - Exam 4 > Anxiolytic and Sedatives > Flashcards

Flashcards in Anxiolytic and Sedatives Deck (44)
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1

Define sedative

Agent that exerts a calming effect

2

Define hypnotic

Agent that produces drowsiness and encourages onset and maintenance of sleep

3

Define anxiolytic

Agent that relieves anxiety, reduces tension and irritability

4

Define tolerance

Decreased responsiveness to repeated doses

5

Define physiologic anxiety

-Expected, normal, transient response to stress
-Necessary for adaptation and coping
-Differs from fear

6

When is anxiety pathological?

-Has no or minimal recognizable environmental trigger
-Exceeds patient's capacity to bear discomfort
-Persistent symptoms
-Results in functional impairment

7

Drugs that may induce anxiety-like symptoms

SSRIs
Bronchodilators
DA agonists
Sympathomimetics
Stimulants
Thyroid hromone
Herbals (ephedra, ginseng, St. John's wort)

8

Treatment of GAD

-SSRIs or Venlafaxine (1st)
-Buspirone
-BZDs
-Psychotherapy

9

Treatment of panic disorder

-SSRIs or Venlafaxine (1st)
-BZDs
-Psychotherapy

10

Treatment of PTSD

-SSRIs (1st)
-BZDs (not common)
-CBT

11

Treatment of OCD

-SSRIs (1st)
-Clomipramine (serotonergic TCA)
-BZDs have NO role in OCD

12

Treatment of social anxiety disorders

-B blockers (situational)
-SSRIs or Venlafaxine (generalized)
-BZDs NOT recommended

13

BZD use in OCD

NO use

14

BZD use in social anxiety disorders

NOT recommended

15

How do BZDs work?

Enhance GABA binding on Cl channel causing hyperpolarization

16

Effects of BZDs

-Anxiolytic
-Sedative and hypnotic
-Anterograde amnesia
-Anticonvulsant
-Muscle relaxant
-Cross tolerance w/alcohol

17

Therapeutic uses of BZDs

-Anxiety treatment
-Muscular disorders
-Seizures
-Sleep disorders (tolerance to sedative effects develops within 2 wks of continuous use)
-Pre-anesthetics
-Withdrawal from alcohol

18

BZD metabolism

-Hepatic
-Many have active metabolites

19

Which BZDs do NOT have active metabolites?

LOT
-Lorazepam
-Oxazepam
-Temazepam

20

BZDs ADEs

-Sedation (CNS depression)
-Amnesia
-Impaired judgment
-Diminished motor skills (driving caution)
-Resp depression at very high doses or combined w/alcohol
-Elderly more sensitive (so give lower dose)

21

Who is more likely to abuse BZDs?

Previous drug abusers

22

What agents have more potential for abuse/withdrawal?

Those with rapid onset and/or elimination

23

BZDs vs. barbiturates

BZDs are generally safer than barbiturates (esp for overdose situations)

24

Antidote for BZD overdose?

Flumazenil

25

Which BZDs are used for anxiety disorders?

LADCCC
-Lorazepam
-Alprazolam
-Diazepam
-Clonazepam
-Clorazepate
-Chlordiazepoxide

26

What is Buspirone?

5HT1A partial agonist

27

Buspirone MOAs

-Anxiolytic effects w/o marked sedation
-NO anticonvulsant or muscle relaxant properties
-NO cross tolerance w/ETOH or BZDs

28

What is Buspirone used for?

GAD (2nd line)

29

Buspirone ADEs

Dizzy
Nausea
Headaches

30

Alternative treatments for anxiety

-Non-pharm (counseling, exercise, avoid caffeine/stimulants)
-Antidepressants (SSRIs, Venlafaxine)
-Hydroxyzine

31

Difficulty falling asleep relates to:

Sleep latency

32

Difficulty staying asleep relates to:

Total sleep time

33

Agents used for insomnia

-BZDs
-Non BZD hynpotics (Z drugs, barbiturates)
-Antihistamines
-Melatonin agonist
-Sedating antidepressants
-Orexin receptor blocker (Suvorexant)

34

How do BZDs work in insomnia?

-Decrease time to fall asleep
-Decrease REM sleep
-Increase Stage 2 (non-REM) sleep

35

BZDs used in insomnia

-Triazolam
-Flurazepam
-Temazepam

36

What are non-BZD hypnotics?

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Phenobarbital

37

What is phenobarbital now primarily used to treat?

Seizure disorders

38

Phenobarbital may cause coma:

-At high doses
-In combo w/other CNS depressants
*No specific antidote

39

What agent can be used to treat insomnia in patients prone to substance abuse?

Trazodone

40

What is Doxepin and what is it used for?

-TCA (H1 blocker)
-Marketed for insomnia (initiation and maintenance of sleep) as "Silenor"

41

What is Ramelteon and what is it used for?

-Melatonin receptor agonists
-Decreases sleep latency
-NO risk of abuse
-CYP450 metabolized

42

Antihistamine use for insomnia

-Mildly effective
-Tolerance develops within 3 days of continuous use
-Anticholinergic ADEs

43

What is Suvorexant?

-Orexin receptor blocker (plays a role in keeping people awake)
-Approved for treating difficulty in falling and staying asleep
-Only placebo controlled studies have been done

44

Suvorexant ADEs

-Complex sleep behaviors
-Next day drowsiness