Sedatives and hypnotics

Question 1

Benzo

Answer 1

-benzo and benzo-like drugs more useful
-MOA: enhance action of GABA which causes depressed effect
-good for anxiety, seizures, insomnia, muscle spasms, alcohol withdrawal, panic disorder, perioperative sedation

-complications: CNS depression, paradoxical response, N/V/anorexia, resp. depression, dependence (taper slowly over 3 weeks), acute toxicity
-caution long-term and older adults, avoid alcohol
-antidote: flumazenil

-withdrawal can be bad
-anterograde amnesia (good for pre-surgery, bad otherwise)

Question 2

Zolpidem: Non-benzo

Answer 2

-enhance GABA
-doesn’t help with anxiety, muscle relaxation, or seizures
-low risk of tolerance, user disorder, dependance
-used for insomnia

Complications: daytime sleepiness, lightheadedness, HA, sleepwalking/eating, don’t use with opioids, barbiturates, or alcohol (additive CNS depress)

Question 3

Ramelteon: Melatonin agonist

Answer 3

-MOA: activates melatonin receptors
-used for insomnia (helps fall asleep but not stay asleep)
-complications: sleepiness, dizziness, fatigue, hormonal effects
-avoid high-fat meals before med (empty stomach works better)
-take 30 mins prior to bed

Question 4

IV anesthetics

Answer 4

-expected: loss of consciousness and pain stimulation, quick onset short duration

Non-opioids:
-Barbiturates: Phenobarbital, methohexital.
-Benzos (pre-op sedation and light sedation)- Midazolam, diazepam, lorazepam.
-Propofol, ketamine
Opioids: Fentanyl

complications: resp and cardiac depression (high hypotension risk)
-Propofol: liquid heavy in fat so risk of bacteria growth if left open or sitting, give in large vein due to stinging
-Ketamine- Hallucinations, maintain low stimulus environment during recovery

-postop recovery: return to baseline VS, A and O x3, bowels return, voiding/passing gas occurs, n/v controlled