Chapter 4 CNS Flashcards Preview

BNF > Chapter 4 CNS > Flashcards

Flashcards in Chapter 4 CNS Deck (61)
Loading flashcards...
1

Anxiolytics ('sedatives') and most hypnotics action?

Anxiolytics will induce sleep at night and most hypnotics sedate during the day

2

Dependence

Both physical and psychological

3

Acute conditions

Risk of dependence

4

Most commonly used anxiolytics and hypnotics

Benzodiazepines

5

Which are not recommended?

Meprobamate and Barbiturates - they have more side effects and interactions than benzodiazepines and are much more dangerous in overdosage

6

Benzodiazepines indications:

Short term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress

Short term mild anxiety inappropriate

Insomnia only when it is severe, disabling or causing the patient extreme distress

7

Dependence and withdrawal

Withdrawal should be gradual because abrupt withdrawal may produce confusion, toxic psychosis, convulsions

8

Benzodiazepines withdrawal syndrome

Anytime up to 3 weeks after stopping a long acting benzodiazepines, but may occur within a day in the case of short acting one

9

Before benzodiazepines use:

Cause of insomnia should be established and alcohol consumption

10

Sleep onset insomnia

Short acting hypnotic preferred, sedation following day undesirable or elderly

11

Long acting hypnotics

Poor sleep maintenance - early morning weakening that has daytime effects

When anxiolytics needed during the day

When next day sedation acceptable

12

Transient insomnia

Sleep well but other factors affect sleep - noise, work, jet lag

13

Short term insomnia

Related to emotional problems or medical illness

14

Chronic insomnia

Caused by psychiatric disorders e.g anxiety, drug abuse, depression

15

When can dependence develop?

After 3-14 days

16

Withdrawal of hypnotic

Rebound insomnia

17

Stopping hypnotic

Broken sleep with vivid dreams may persist for several weeks

18

Short acting hypnotics

Loprazolam, lormetazepam and temazepam act for short time and have little hangover effect

19

Withdrawal phenomena common with?

Short acting benzodiazepine

20

Insomnia + anxiety

Long acting benzodiazepines e.g diazepam single dose

21

Coma

Benzodiazepines can cause coma in hepatic impairment, so shorter half life benzodiazepines are safer (temazepam and oxazepam)

22

Pregnancy and breast feeding

Avoid - neonatal hypothermia, hypotonia, respiratory depression

23

Zaleplon, Zolpidem and Zopiclone

Non benzodiazepines hypnotics but act at the benzodiazepines receptor

24

Shortest duration of action

Zaleplon

25

Short duration of action

Zolpidem and Zopiclone

26

Antihistamines

Promethazine - on sale for occasional insomnia

Prolonged action - can cause drowsiness the following day

27

How long does sedative effect of antihistamine last

Reduce after a few days of continuous use

28

Side effect of antihistamines

Headache, psychomotor impairment and anti-muscarinic

29

Alcohol

Poor hypnotic as diuretic action interferes with sleep

Also disturbs sleep pattern and can worsen sleep disorders

30

Melatonin

Pineal hormone - licensed for short term treatment of insomnia

For adults over 55