Anxiolytics & Hypnotics

Question 1

Benzodiazepines

Answer 1

Potentiate the effect of GABA at Cl- ion channels

Question 2

Diazepam

Answer 2

-A BZD that is a pos allosteric modulator of GABA A Rs

Question 3

Propranolol

Answer 3

Helps with performance anxiety

Question 4

GABA shunt

Answer 4

Refers to alpha ketoglutarate from the Krebs Cycle, converted to glutamic acid by GABA-transaminase; then subsequently to GABA by glutamic acid decarboxylase (GAD). GABA is then metabolized to form succinic semialdehyde to succinic acid and returns to the Krebs Cycle.

Question 5

Glutamine loop

Answer 5

Glutamine is formed as GABA is transaminated and converted to glutamine. The glutamine is reconverted to glutamate; then decarboxylated by neuronal GAD to GABA

Question 6

What do BZD not do themselves?

Answer 6

open the GABA Cl- channel

Question 7

The GABA site of the GABA R is distinct from

Answer 7

the BDZ site and encompasses alpha-1 and beta-2 subunits

Question 8

Flumazenil

Answer 8

BZD antag

Question 9

Barbiturates

Answer 9

• Bind to a distinct subunit combination on the GABA receptor
• At high concentrations can open the channel on their own (without GABA).

Question 10

BZD and hepatic induction

Answer 10

Benzodiazepines do not induce hepatic microsomal enzymes

Question 11

Diazepam uses

Answer 11

anxiety, insomnia, pre-op, muscle relaxant

Question 12

Chlordiazepoxide uses

Answer 12

alcohol detox

Question 13

Flurazepam, Temazepam and Triazolam use

Answer 13

insomnia

Question 14

Clonazepam

Answer 14

• Panic
• Anxiety
• Seizure

Question 15

Alprazolam

Answer 15

• Short acting BZD
• Panic
• Anxiety
• First line treatment for panic disorder withSSRI

Question 16

Lorazepam

Answer 16

• Short acting BZD
• Anxiety
• Alcohol related seizure

Question 17

Adverse effects of BDZ

Answer 17

• Sedation
• Tolerance
• Physical dependence
• Self-admin

Question 18

Toxicity of BZD

Answer 18

• Impaired judgment
• Slurred speech
• Incoordination
• Stupor
• Respiratory depression
• Death

Question 19

Non-BDZ

Answer 19

• Anxiolytic

- Buspirone (5-HT1A R partial agonist)

Question 20

First line treatment for all anxiety disorders

Answer 20

SSRI + BZD

–provides early coverage

Question 21

Cognitive behavioral therapy (CBT)

Answer 21

Often used in conjunctive with SSRIs for anxiety

Question 22

When do we see severe respiratory depression

Answer 22

When BZD are combined with other sedatives/CNS depressants (like alcohol)

Question 23

GAD first line treatment

Answer 23

SSRI, usually venlafaxine, paroxetine or escitalopram

Question 24

Panic disorder first line treatment

Answer 24

SSRI + benzodiazepine for immediate action (alprazolam)

Question 25

PTSF (post traumatic stress disorder) first line treatment

Answer 25

SSRI, usually paroxetine or sertraline

Question 26

Which BZD are used for sleep?

Answer 26

Estazolam, flurazepam, quazepam, temazepam, triazolam

Question 27

Which drugs are typically used for sleep?

Answer 27

Eszoiclone, hydroxyzine, zolpidem, zaleplon, ramelteon

Question 28

Describe the adult sleep cycle

Answer 28

Duration of about 90 min; includes NREM and REM sleep

Question 29

Melatonin

Answer 29

produced in the pineal gland at night

Question 30

Hypnotics

Answer 30

Produce drowsiness and promote the onset and maintenance of sleep

Question 31

What are the symptoms of insomnia?

Answer 31

Difficulty falling asleep, frequent wakenings, poor quality of sleep

Question 32

What is sleep deprivation?

Answer 32

Inadequate opportunity for sleep; sleep itself is relatively normal

Question 33

What is insomnia disorder?

Answer 33

Insomnia complaint and significant daytime impairment

Question 34

Short acting BZDs

Answer 34

Alprazolam, triazolam, lorazepam, oxazepam

Question 35

Long acting BZDs

Answer 35

Flurazepam, clorazepate, prazepam

Question 36

Doxepin

Answer 36

- TCA | - low dose mechanism for insomnia is histamine H1

Question 37

Non-BZD GABA A agonists

Answer 37

Eszopiclone, zolpidem, zaleplon

Question 38

Ramelteon

Answer 38

Melatonin agonist for sleep

Question 39

Which drugs are sedating antidepressants

Answer 39

Trazodone, mirtazapine, amyitriptyline

Question 40

Zolpidem advantges

Answer 40

Shorten sleep latency, improve duration, can be used as needed, no negative effect on sleep architecture

Question 41

Zolpidem disadvantages

Answer 41

4-6 hr effect, therefore not for middle of the night awakenings, associated with parasomnias

Question 42

Traditional BZD disadvantages

Answer 42

Rebound insomnia, memory impairments, loss of coordination, abuse potential, not good for those with respiratory conditions

Question 43

Barbiturates and GABA

Answer 43

Increase duration of channel opening, powerful CNS depression; low margin of safety

Question 44

Diphenhydramine

Answer 44

Benadryl; sedating antihistamine

Question 45

Anxiety, insomnia, pre-op, muscle

Answer 45

- Long acting BZD | - insomnia

Question 46

Temazepam

Answer 46

- BDZ | - insomnia

Question 47

Triazolam

Answer 47

- Short acting BZD | - Insomnia

Question 48

Oxazepam

Answer 48

- Short acting BZD | - Alcohol detox

Question 49

Zolpidem

Answer 49

- Non-BZD GABA A agonist | - insomnia