Anxiolytics and hypnotics Flashcards Preview

Meds Exam Uni of Surrey end of year 1 MENTHEALTHNURs (PGDip) > Anxiolytics and hypnotics > Flashcards

Flashcards in Anxiolytics and hypnotics Deck (16):
1

In general terms, explain what anxiolytics do and when these are appropriate for use

  • decrease feelings of anxiety
  • appropriate when anxiety is no longer serving as a stimulus or motivator but is chronically stimulating the sympathetic nervous system leading to medical and social problems

 

 

2

In general terms, explain what hypnotics do, in relation to sedation

  • Sedation refers to the loss of awareness and reaction to environmental stimuli.
  • Sedation often causes drowsiness (harmful or desirable depending on life vs surgery)
  • Sedation is also anxiolytic 

 

  • hypnotics cause extreme sedation which results in further CNS depression and sleep

3

What is the mechanism of action of Benzodiazepines?

  • Benzodiazepines ENHANCE the effect of GABA-an inhibitory neurotransmitter which modulates excitatory pathways in the brain. 
  • Benzos increase the affinity of GABA to GABA-A receptors
  • These are found in the post-synaptic membrane and are ligand-gated receptors which open when bound, allowing Cl- ions to flow into the cell, thus hyperpolarising it
  • This inhibits the neuronal activity in areas of the brain associated with anxiety and sleep: GABA-A receptors are highly concentrated in the limbic system (and to some extent RAS-explains the sedative effects)

 

  • (Benzos are absorbed from the GI tract and reach peak levels between 30 minutes and 2 hours)

4

What is the mechanism of action of Hypnotics?

  • Same action of enhancing effects of GABA
  • main effect is in the Reticular Acitivating System (made up of CNS-spinal cord and cerebellum-mediates overall level of consiousness)
  • hence selective hypnotic over anxiolytic benefits
  • They block the brain's response to incoming stimuli

5

Name 5 Benzodiazepines

  • Lozarepam
  • Diazepam
  • Clonazepam
  • Temazepam
  • Chlordiazepoxide

6

Name 2 non-benzodiazepine hypnotics

  • Zolpidem
  • Zopiclone

7

What are all Benzodiazepines indicated for?

  • Short term anxiety
  • Insomnia related to anxiety

8

What are Lorazepam and Diazepam additionally indicated for (and what is the difference between the two)?

  • Management of Status Epileptus
  • Lorazepam is (ironically) short acting, versus Diazepam being long acting

9

What is Chloridazepoxide additionally indicated for?

  • Alcohol withdrawal in cases of dependence
  • long duration of action

10

What is Temazepam additionally indicated for?

  • Sometimes used for its calming effect before surgeries
  • Short duration of action

11

Which patients are Non-Benzodiazepine hypnotics indicated for?

Patients with Insomnia (which could be as a result of MH disorder)

 

12

What are the contraindications of both Benzodiazepines and Non-benzodiazepine Hypnotics?

  • Neuromuscular respiratory weakness
  • Sleep apnoea syndrome
  • Not over 60 years old 
  • Pregnancy

13

What are the side effects of Benzodiazepines?

  • Continued Drowsiness
  • Amnesia and Confusion
  • Ataxia 

14

Tell me about Ataxia

Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements caused by damage to Cerebellum - Symptoms include:

  • balance and walking 
  • speaking 
  • swallowing 
  • tasks that require a high degree of control, such as writing and eating 
  • vision 

15

What are the side effects of non-Benzodiazepine Hypnotics, general and specific?

General;

  • Continued Drowsiness
  • Increased risk of depression

Specific;

  • Taste Disturbance/metallic taste (Zopiclone)
  • Hallucinations/Nightmares (Zolpidem)

16

What patient education would be pertinent to somebody starting Benzodiazepines and non-Benzodiazepine Hypnotics?

  • Drowsiness may continue the next day, so avoiding/taking care when operating heavy machinery or driving-also note this drowsiness might make some stressors more difficult to manage
  • long term regular use (>6 weeks) can lead to tolerance and sometimes dependence
  • not to be combined with use of other CNS depressants such as alcohol

 

  • In some cases, initially see a paradoxical increase in aggression (just Benzos)
  • If stomach upset, try small meal or bowel programme if needed (just non-benzos)