hypnotics, sedatives, anxiolytics

Question 1

sedatives are used for which 2 disorders?

Answer 1

1. insomnia

2. anxiety

Question 2

overall MOA of sedatives

Answer 2

depress CNS function

Question 3

what agents are used for anxiety relief?

Answer 3

anxiolytics

Question 4

what agents are used to promote sleep?

Answer 4

hypnotics

Question 5

describe the difference in dosing between hypnotics and anxiolytics

Answer 5

SMALL doses for ANXIETY relief

LARGE doses for SLEEP induction

Question 6

what is the drug class of choice for hypnotics (promoting sleep)?

Answer 6

benzos

Question 7

what is the drug class of choice for both anxiety and insomnia?

Answer 7

benzos

Question 8

what are benzos ending in? (how can we recognize/identify them?)

Answer 8

“____zepam”

OR

“____zolam”

Question 9

MOA of benzos (3)

Answer 9

1. depress neuron fxn
2. decrease anxiety (through limbic system)
3. potentiate effects of GABA

Question 10

what is the unique aspect to GABA + benzos?

Answer 10

benzos only work on endogenous GABA; there’s a finite amount which creates a “built in” limit to CNS depression

Question 11

what is the prototype for benzos for SLEEP

Answer 11

triazolam

Question 12

what effects on sleep will you see with triazolam? (3)

Answer 12

1. decreased sleep onset
2. fewer awakenings
3. greater amt of total sleep time

Question 13

what are the prototypes (3) for benzos as anxiolytics?

Answer 13

1. lorazepam (Ativan)
2. diazepam (Valium)
3. alprazolam (Xanax)

“that LAD is very chill… he’s not anxious at all”

Question 14

what is the benzo commonly used for procedures?

Answer 14

midazolam (Versed)

“this benzo puts the MIDAs touch on things to chill people out before procedures”

Question 15

what schedule drug are benzos?

Answer 15

schedule 4

Question 16

AE (3) of benzos

just the overall category of systems they affect

Answer 16

1. CNS
2. Cardiovascular
3. Respiratory

Question 17

re: SE of benzos, what’s happening with the CNS? (6)

Answer 17

1. sedation
2. psychomotor slowing
3. confusion
4. amnesia
5. drowsiness
6. sleep driving

Question 18

out of the CNS effects r/t benzos, what 2 will improve after ~ 1 week of starting the drug?

Answer 18

sedation + psychomotor slowing

Question 19

re: SE/AE of benzos, what’s happening with the cardiovascular system?

(PO admin + IV admin)

Answer 19

oral: little to no effect

IV: profound HYPOtension + cardiac arrest

give slow + through port closest to IV

Question 20

re: SE/AE of benzos, what’s happening with the respiratory system?

(PO admin + IV admin)

Answer 20

oral: little to no effect

IV or combine w/other CNS depressants: significant respiratory depression

Question 21

can we use benzos with preggos?

Answer 21

NOOOOO

Question 22

what type of dosing with benzos will you often see withdrawal effects with? and what s+s would you see?

Answer 22

HIGH doses

panic, paranoia, delirium, HTN, muscle twitches, convulsions

think of HTN as a rebound HTN

Question 23

how should people come off benzos?

Answer 23

slowlyyyyyy wean

Question 24

what is the antidote for benzodiazepines? and what’s the unique thing about this antidote? how often should you administer it?

Answer 24

flumazenil

• only reverses SEDATION, not respiratory effects… but could have an indirect effect on respiratory*
• admin: q minute over 15 mins*

Question 25

benzodiazepine-like drugs are used for what?

Answer 25

insomnia

Question 26

benzodiazepine-like drugs ALL have a risk for what?

Answer 26

sleep-driving | rare!

Question 27

what's the prototype for benzodiazepine-like drugs (for insomnia)?

Answer 27

zolpidem (Ambien)

Question 28

what's the indication for zolpidem?

Answer 28

SHORT TERM management of insomnia

Question 29

what are the 2 most common SE of zolpidem

Answer 29

daytime drowsiness + dizziness

Question 30

what schedule drug is zolpidem?

Answer 30

schedule 4

Question 31

what is our benzo prototype for anxiolytics?

Answer 31

diazepam (valium) *val the housewife needs her anti anxiety med*

Question 32

what are our 2 non-benzo/non-barbituate prototype for anxiolytics?

Answer 32

1. busiprone | 2. hydroxyzine (scheduled QID = anxiety / prn = insomnia)

Question 33

buspirone (Buspar) is a "no" drug... what are the no's?

Answer 33

``` NOT a CNS depressant NO abuse potential NO suicide risk NO increased CNS effects with other CNS drugs NOT for PRN use NO grapefruit ```

Question 34

what's the drug-food interaction with buspirone?

Answer 34

grapefruit!!

Question 35

what drug class is hydroxyzine?

Answer 35

antihistamine (also affects serotonin)

Question 36

hydroxyzine scheduled QID would be for what?

Answer 36

anxiety

Question 37

hydroxyzine as PRN drug would be for what?

Answer 37

insomnia

Question 38

SE of hydroxyzine

Answer 38

- dry mouth - constipation - HA - dizziness - fatigue (anticholinergic SE)

Question 39

what's an AE of hydroxyzine with LONG TERM use?

Answer 39

prolonged QT intervals (watch for dysrhythmias)