Anxiolytics and sedatives Flashcards
(14 cards)
features of benzodiazepines
highly lipophilic (cross BBB)
well absorbed orally (peak effect 30m-2hr)
highly protein bound (long-acting)
excreted by kidneys as glucoronide conjugate
5 major effects of benzodiazepines
anxiolytic (reduce anxiety alpha 1/2) hypnotic (induce sleep alpha 1) reduce muscle tone anterograde amnesia anticonvulsant
what R do benzodiazepines work on
and how
GABA
allosterically activate the R
increase the freq of opening Cl ion pore
what is flumazenil
competitive benzodiazepine antagonist
examples of Z drugs and where do they act
Zopiclone, Zaleplon, Zolpidem
act via benzo R
tolerance in benzos (which are more affected)
become tolerant to sedative effects quickly
slower tolerance for anxiolytic and anticonvulsant effect
criteria for dependence
drug is rewarding drug taking compulsive psychological dependence physical dependence genetic factors
symtpoms of withdrawal
anxiety, depression, disturbed sleep, pain, stiff, muscle ache, convulsions
3 scenarios to presciribe benzos
- managing acute alcohol withdrawal
- to enable uncomfortable procedures to be carried out
- anticonvulsant - for prolonged seizures
symptoms of alcohol withdrawal
insomnia/anxiety/agitation tremor N&V sweating palpitations hallucinations seizures
investigations that suggest chronic alcohol consumption
raised MCV
pancytopenia
folate deficiency
prolonged prothrombin time
prolonged seizure - give benzo?
yes! after excluded hypoglycaemia
if longer than 5 mins, give IV lorazepam
if no IV access –> rectal diazepam or intranasal/buccal midazolam
what type of anxiety symptoms might you treat with beta blockers
somatic symptoms (fight or flight sympathetic) tachycardia, palpitations, tremor, sweating propanolol (for wind musicians!)
where is melatonin synthesised
when is it secreted
pineal gland
secreted in response to input from retina
