(Exam 3) Sedative-Hypnotic and Anxiolytic Medications

Question 1

what are the different classes of sedatives?

Answer 1

barbiturates, benzodiazepines

Question 2

what is an example of a barbiturate?

Answer 2

phenobarbital

Question 3

what do muscle relaxers do?

Answer 3

don’t actually relax muscles, relax person which provides secondary muscle relaxor

Question 4

what can benzos be given for?

Answer 4

anxiety, sleep, muscle relaxants

Question 5

what are some examples of benzos?

Answer 5

valium, xanax, klonopin, ativan

Question 6

what is the MOA for barbs and benzos?

Answer 6

bind to specific GABA Rs in limbic system neurons; GABA R agonist; creates overall effect of sedation of cells + person

Question 7

what are the amygdala, OFC, and insula associated with?

Answer 7

behavioral responses

Question 8

when electrically stimulating the amygdala, OFC, and insula, what happens?

Answer 8

can cause aggression; physical/physio responses

Question 9

what do PET scans show about anxiety?

Answer 9

there is an increased amygdalar blood flow

Question 10

what do MRI scans show about anxiety?

Answer 10

amygdalar abnormalities in panic disorder

Question 11

what happens when you block GABAergic function?

Answer 11

anxiety response

Question 12

what happens when there is GABA A hypofunction?

Answer 12

sensitizes amygdala to anxiogenic responses to otherwise non-distressful stimuli (things become more anxiety inducing)

Question 13

what do benzos do to the amygdala?

Answer 13

they “reset” the amygdala to a more normal response level

Question 14

how quickly do benzos act?

Answer 14

immediately

Question 15

what does GABA A binding cause?

Answer 15

sedation, anxiolysis, cognitive impairment (HC is sedated); depends on dose

Question 16

during withdrawal of barbs, what happens?

Answer 16

REM sleep is suppressed and there are vivid/excessive dreams

Question 17

what are the pharmacological effects of barbs?

Answer 17

cognitive impairment, overdose risk; not analgesic

Question 18

what are the psychological effects of barbs in small doses?

Answer 18

anxiolytic, calming

Question 19

what are the psychological effects of barbs in higher doses?

Answer 19

general behavioral depression and sleep

Question 20

describe the clinical use for barbs

Answer 20

it’s declined bc of lethal od, narrow therapeutic window, high dependence/abuse potential, dangerous drug interactions

Question 21

what do barbs do to tolerance?

Answer 21

it’s induced through metabolic adaptation, and neuronal down + up regulation

Question 22

what do barbs do to physical dependence?

Answer 22

normal clinical doses can induce dependence, WD from high doses can cause psychosis

Question 23

how do barbs affect pregnancy?

Answer 23

limited data, but possibility of developmental abnormalities; women taking barbs as AEDs should weigh risk and take lowest effective dose

Question 24

which class of sedatives is most widely used?

Answer 24

benzos; most commonly prescribed psychotropic drug

Question 25

how do benzos affect the elderly?

Answer 25

reduced ability to metabolize long-acting benzos and active metabolites; dementing, depressive, and decrease motor coordination

Question 26

what are the side effects of benzos?

Answer 26

sedation, anxiolysis, aed, cognitive + psychomotor inhibition, lethargy, amnesia, physical + psychological dependence, interactions with other sedatives/alcohol

Question 27

how do benzos affect pregnancy?

Answer 27

if there is a high maternal dose at delivery, the baby is born dependent and goes with WD; "floppy-infant syndrome" = fails APGAR test

Question 28

what is a BZRA?

Answer 28

benzodiazepine receptor agonist; any drug that activates a BZD R

Question 29

are BZRAs classified as benzos?

Answer 29

no; but they have a similar action at R

Question 30

what are BZRAs used for?

Answer 30

insomnia, AEDs

Question 31

what side effects do BZRAs have?

Answer 31

can create amnestic-like behaviors: sleep walking

Question 32

when stop taking BZRAs, what happens?

Answer 32

can make anxiety/insomnia worse

Question 33

what are "Z drugs" used for?

Answer 33

for insomnia: falling asleep or staying asleep

Question 34

Z drugs relation to dependence?

Answer 34

dependence unlikely; abuse potential only at extremely high doses

Question 35

what are examples of "hypnotic" effects?

Answer 35

sleep-related activities: sleep driving (driving while in drug-induced amnestic state), making phone calls, preparing/eating food, online activity

Question 36

what is the moa of anesthetics?

Answer 36

GABA agonists at Rs

Question 37

what effects do anesthetics have?

Answer 37

keep you asleep, little analgesic or euphoric activity, onset is immediate

Question 38

what does volatile mean?

Answer 38

liquid but when hits air, it becomes a gas

Question 39

anesthetic relation to dependence?

Answer 39

inhaled anesthetics can be subject to abuse (nitrous oxide/whippets)

Question 40

what is the first choice drug for anxiety?

Answer 40

SSRI ADs

Question 41

what is the moa for buspirone (BuSpar)?

Answer 41

selective 5-HT1A agonist

Question 42

what are the side effects for buspirone (BuSpar)?

Answer 42

amnesia, mental confusion, psychomotor impairment minimal or absent

Question 43

buspirone (BuSpar) relation to dependence?

Answer 43

little addiction/abuse potential

Question 44

how quickly does buspirone (BuSpar) act?

Answer 44

slowly, gradually

Question 45

effect of buspirone (BuSpar) on sleep onset?

Answer 45

ineffective unless anxiety is cause for insomnia