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Patho Miscellaneous > Test 2 Hypnotics and Sedatives > Flashcards

Test 2 Hypnotics and Sedatives Flashcards

1
Q

How do older sedatives/hypnotics/alcohol differ from Benzos and newer hypnotics?

A

Benzos and newer hypnotics have a higher margin of safety

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2
Q

What is the indicated use for Alprazolam?

A

Depression

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3
Q

What is the indicated use for chlordiazepoxide?

A

Alcohol withdraw syndrome

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4
Q

What is the indicated use for clonazapam?

A

Convusions, panic disorder, muscle relaxation

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5
Q

What is the indicated use for valium and lorazepam?

A

Status epilepticus

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6
Q

What is the indicated use for Triazolam?

A

Early morning insomnia

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7
Q

Which drugs are listed as anxiolytics?

A

Literally all of them except triazolam and flurazepam

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8
Q

What can make benzos dangerous?

A

When combined with other CNS depressants, but rarely fatal by themselves, even at high doses

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9
Q

What is the main mechanistical property of benzos?

A

Sedation and hypnosis, which increase as the dose increases
Decreases time to fall asleep, increases the time of Non rem sleep
Decreases the duration of Rem sleep

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10
Q

What type of amnesia can benzos cause? Differentiate if from the other type.

A

Anterograde amnesia, given pre operatively and makes them forget what’s about to happen
Retrograde is where their memory is lost of an event that already occurred

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11
Q

What are the three benzos listed as anticonvulsants?

A

Clonazepam, lorazapam, diazepam

CAD (ativan instead of L)

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12
Q

What does benzos bind to specifically? Causing what action?

A

GABA A, increases the frequency of channel opening events

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13
Q

What effect do benzos have on neuronal inhibition mediated by GABA?

A

It potentiates it!

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14
Q

What are the side effects of benzos?

A

Ataxia, discordination
Abuse/dependence
Withdrawal if using chronically then stopping
Drug to drug interactions with alcohol-increases the absorbtion of benzos

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15
Q

What effect does alcohol have on benzos?

A

Alcohol increases the absorption rate of BZDs

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16
Q

What are the half life’s of short, intermediate, and long acting benzos?

A

short- less than 6 hours
Intermediate- 6-24 hours
Long- Over 24 hours

17
Q

What category is buspirone?

A

Partial 5-HT 1A agonist at the brain and affinity with D2 receptors

18
Q

What drug class is zolpidem, zaleplon, and eszopiclone?

A

Non-benzo

19
Q

What are the non benzos MOA?

A

Selectively bind to BZ1 (a1) subtype of GABA A receptor

20
Q

What are the muscle relaxant and anticonvulsion properties of non benzos?

A

Minimal of either

21
Q

When are doe adjustments needed with non benzos?

A

Hepatic issues, elderly, patients taking cimetidine and rifampin. Inhibitor and inducer, respectively

22
Q

What is the benzo AND non benzo reversal?

A

Flumazenil

23
Q

What drug category is flumazenil?

A

Competitive BZD antagonist

24
Q

What are the downsides of barbituates, compared to benzos?

A

Barbituates are more dangerous overall, higher incidence of toxicity, abuse, and physical dependence

25
Q

What are the CNS pharmacological properties of barbituates?

A

Hypnotic- decreases REM time (just like benzos)
Hyperalgesia- INCREASED reaction to painful stimuli
Anesthesia- Thiobarbituates and short acting oxybarbituates for anesthesia induction
Anticonvulsion- Phenobarbital has a selective anticonvulsant action

26
Q

What are the other pharmacological properties of barbituates?

A

Dose related respiratory depression
Dose dependent for CV effects, if anesthesia dose, decrease CO and renal perfusion, increased TPR
Psychological- Compulsive misuse
Physical dependence

27
Q

How do barbituates work?

A

Increase the duration of GABA gated CL- channel openings
GABA mimetic at high concentrations
Inhibitory excitatory AMPA receptors

28
Q

What are the drug to drug interactions for barbituates?

A

Alcohol, antihistamines

29
Q

What are the situational contraindications to barbituates?

A

Acute intermittent porphyria-porphin biosynthesis
Pulmonary insufficiency
CV diseases

30
Q

What is the ideal treatment to barbituate poisening?

A

Gastric lavage if possible

31
Q

What are the technical usages for barbituates?

A

Sedative/hypnotic
Anesthesia-preanesthetic sedation
Anticonvulsant-phenobarbital
Hyperbilirubinemia and kernicterus

Patho Miscellaneous (6 decks)

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