F- Chapter 9: Anxiolytic and Hypnotic Drugs Flashcards
(10 cards)
Which one of the following statements is correct regarding
benzodiazepines?
A. Benzodiazepines directly open chloride
channels.
B. Benzodiazepines show analgesic actions.
C. Clinical improvement of anxiety requires 2 to 4
weeks of treatment with benzodiazepines.
D. All benzodiazepines have some sedative effects.
E. Benzodiazepines, like other CNS depressants,
readily produce general anesthesia.
D. Although all benzodiazepines can cause sedation, the drugs labeled “benzodiazepines” in Figure 9.1 are promoted for the treatment of sleep disorder.
Benzodiazepines enhance the binding of GABAAto its receptor, which increases the permeability of chloride. The benzodiazepines do not relieve pain but may reduce the anxiety associated with pain. Unlike the tricyclic antidepressants and the monoamine oxidase inhibitors, the benzodiazepines are effective within hours of administration. Benzodiazepines do not produce general anesthesia and, therefore, are relatively safe drugs with a high therapeutic index
Which one of the following is a short-acting hypnotic?
A. Phenobarbital.
B. Diazepam.
C. Chlordiazepoxide.
D. Triazolam.
E. Flurazepam
D. Triazolam is a short-acting drug. It has little daytime sedation. The other drugs listed are longer acting
Which one of the following statements is correct regarding
the anxiolytic and hypnotic agents?
A. Phenobarbital shows analgesic properties.
B. Diazepam and phenobarbital induce the cytochrome
P450 enzyme system.
C. Phenobarbital is useful in the treatment of acute
intermittent porphyria.
D. Phenobarbital induces respiratory depression, which
is enhanced by the consumption of ethanol.
E. Buspirone has actions similar to those of the
benzodiazepines
D. Barbiturates and ethanol are a potentially lethal combination. Phenobarbital is unable to alter the pain threshold. Only phenobarbital strongly induces the synthesis of the hepatic cytochrome P450 drug-metabolizing system. Phenobarbital is contraindicated in the treatment of acute intermittent porphyria. Buspirone lacks the anticonvulsant and muscle-relaxant properties of the benzodiazepines and causes only minimal sedation.
A 45-year-old man who has been injured in a car accident
is brought into the emergency room. His blood alcohol
level on admission is 275 mg/dL. Hospital records show a
prior hospitalization for alcohol-related seizures. His wife
confirms that he has been drinking heavily for 3 weeks.
What treatment should be provided to the patient if he
goes into withdrawal?
A. None.
B. Lorazepam.
C. Pentobarbital.
D. Phenytoin.
E. Buspirone.
B. It is important to treat the seizures associated with alcohol withdrawal. Benzodiazepines, such as chlordiazepoxide, diazepam, or the shorter-acting lorazepam, are effective in controlling this problem. They are less sedating than pentobarbital or phenytoin.
Which one of the following is a short-acting hypnotic
and better for sleep induction compared to sleep
maintenance?
A. Temazepam.
B. Flurazepam.
C. Zaleplon.
D. Buspirone.
E. Escitalopram.
C. Zaleplon has the shortest half-life and duration of action. Buspirone and escitalopram are not effective hypnotic agents. Temazepam and flurazepam have Longer durations of action and will reduce nighttime awakenings but will have a greater risk of daytime sedation or hangover effect compared to zaleplon.
Which of the following agents has a rapid anxiolytic effect
and would be best for the acute management of anxiety?
A. Buspirone.
B. Venlafaxine.
C. Lorazepam.
D. Escitalopram.
E. Duloxetine.
C. The benzodiazepines have same-dose, First-dose efficacy for anxiety, whereas the other agents require 2 to 8 weeks for clinically significant improvement in anxiety
Which of the following sedative–hypnotic agents utilizes
melatonin receptor agonism as the mechanism of action
to induce sleep?
A. Zolpidem.
B. Eszopiclone.
C. Estazolam.
D. Ramelteon.
E. Diphenhydramine
D. Ramelteon is the only melatonin receptor agonist to promote sleep, especially in sleep-phase disrupted sleep. Zolpidem, eszopiclone, and estazolam all utilize the benzodiazepine receptor, and diphenhydramine is a histamine receptor antagonist.
All of the following agents for the management of
insomnia are controlled substances and may have a risk
for addiction or dependence except:
A. Zaleplon.
B. Flurazepam.
C. Doxepin.
D. Zolpidem.
E. Triazolam
C. Only doxepin, a tricyclic agent with significant antihistaminergic properties, is considered to have no risk of addiction or dependence, whereas the other agents listed all have DEA schedule IV designations with some risk for addiction or dependence, especially when used for extended periods
All of the following agents may cause cognitive
impairment, including memory problems when used at
recommended doses except:
A. Diphenhydramine.
B. Zolpidem.
C. Alprazolam.
D. Phenobarbital.
E. Ramelteon.
E. All of the above listed agents, except ramelteon, have been associated with cognitive impairments, including memory impairment. Diphenhydramine
likely causes its cognitive problems from its anticholinergic and antihistaminergic effects. Zolpidem, alprazolam, and phenobarbital are well-known causes of cognitive impairment, including anterograde amnesia. Ramelteon has safety data extending to 6 months and is a noncontrolled hypnotic agent acting as a melatonin receptor agonist. It is not considered to have a risk for cognitive impairment as compared to the other agents listed
Which agent is best used in the Emergency Room
setting for patients who are believed to have received
too much of a benzodiazepine drug or taken an
overdose of benzodiazepines?
A. Diazepam.
B. Ramelteon.
C. Flumazenil.
D. Doxepin.
E. Naloxone
C. Flumazenil is only indicated to reverse the effects of benzodiazepines via antagonizing the benzodiazepine receptor. It should be used with caution due to a
risk of seizures if the patient has been a long time recipient of benzodiazepines or if the overdose attempt was with mixed drugs. Naloxone is an opioid receptor antagonist. The other agents are not efficacious in reversing effects of benzodiazepines
