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57 Cards in this Set
- Front
- Back
Most commonly prescribed class of drugs for anxiety.
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Benzodiazepines
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Name of the first benzodiazepine.
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Chlordiazepoxide (Linrium)
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_____ _____ contributes to benzo's rapid onset of action.
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Lipid solubility
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Tablets, capsules, oral solution, rectal gel, and injectable
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Benzodiazepine dose forms
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Once absorbed, benzodiazepines cross through the _____ _____ ____, the rate of which is impacted by protein binding, lipid solubility, and the ionization constant of the compound.
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blood brain barrier
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T/F: Most benzodiazepines are highly protein bound and are present in the un- ionized, lipid soluble form.
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true
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Benzo's ______ ______ the BBB and placenta barrier to produce an effect in the CNS and on the fetus (FDA category D or X), where they can accumulate with repeated doses.
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easily cross
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Potentiate the action of GABA, an amino acid and inhibitory neurotransmitter, which results in increased neuronal inhibition and CNS depression.
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benzodiazapine MOA
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________ acts in the limbic, thalmic, cortical, and hypothalamic levels of the CNS.
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GABA
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Benzodiazepines act as _________ at the benzodiazepine receptor site, thereby __________ the symptoms of anxiety.
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agonists, reducing
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Increases seizure threshold, and is used as an anti epileptic medication.
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diazepam
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CNS depression, manifested as fatigue, drowsiness, muscle weakness, and ataxia (loss of full control of body muscles).
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benzo side effects
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________ to dizziness and lethargy caused by benzodiazapines can be built over time.
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Tolerance
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T/F: The amt of benzodiazepine used to provide conscious sedation is titrated to the patients response?
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True
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The onset and duration of benzodiazapines is _________.
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variable
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Most benzos are classified as FDA pregnancy risk categories ____ and _____.
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D, X
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Patients who have a history of _____, _______, or ______, are not good candidates for benzodiazapine use due to the high prevalence of dependence.
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addiction, depression, psychosis
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Benzodiazapines have a ______ ______ which enables them to treat many forms of anxiety.
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wide therapeutic range
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Benzodiazapine antagonist, (reversal agent)
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Flumazenil (remazacon)
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Buspirone is metabolized by ______.
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CYP3A4
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Benzodiasapines reduce the effectiveness of _________, an antiparkinsonian drug.
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levadopa
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___________ have a high rate of abuse and complete cardiovascular and respiratory depression with overdose.
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Barbituates
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Barbituates do not possess _____ ______.
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analgesic effects
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Barbituate that possesses an anticonvulsant action.
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Phenobarbital
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Barbituates have an ________ ________, causing stimulation instead of sedation in the elderly.
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idiosyncratic effect
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-patients have intermittent porphyria
- postive family history of porphyria. |
barbituate contraindications
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In the primary care setting _____ often is a symptom of an underlying disorder, such as a medical or psychologic problem.
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anxiety
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Benzodiazapines act as a sedative/hypnotic by acting on the ______ _____ and _______ ______.
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limbic system, subcortical CNS
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Inhibition of the benzodiazepine receptors in the ____ _____ causes muscle relaxation.
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spinal cord
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Inhibition of benzo receptors in the _____ acts as an anticonvulsant.
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brainstem
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Inhibition of benzo receptors in the _____ causes ataxia.
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cerebellum
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Inhibition of benzo receptors in the limbic and cortical area effect ____ ____.
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emotional behavior
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Triazolam and midazolam are considered _____ acting benzos.
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short
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Alprazolam, lorazepam, oxazepam, and temazepam are considered _______ acting benzos.
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intermediate
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Diazepam, chlordiazepozide, flurazepam, and clonazepam are considered ______ acting benzos.
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long
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It is frequently necessary to combine a benzodiazapine with an antidepressant in the treatment of ______.
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generalized anxiety disorder
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CYP3A4 ______ decrease the effects of buspirone. Drugs include carbamazepine, nafcillin, nevi rapine, phenobarbital, phenytoin, and rifamycins.
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inducers
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CYP3A4 ______ increase the effects of buspirone. Drugs include itraconazole, flucanozole, clarithromycin, diclofenac, doxycycline, erythromycin, isoniazid, nefazodone, protease inhibitors, quinidine, telithromycin, and verapamil.
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inhibitors
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Pregnancy risk category B, breast feeding should be avoided
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Buspirone
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Women of child bearing age should be cautioned to use ______ _______ when taking barbituates and benzodiazepines.
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effective contraception
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Disorder of initiating and maintaining sleep.
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Insomnia
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Disorders of excessive somnolence, particularly in the daytime.
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Hypersomnia
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Disorders of the sleep-wake cycle are one of the four groups of _____ ______.
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sleep disorders
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Sleepwalking, sleep tremors, and enuresis occur with ______.
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parasomnia
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Exact mechanism of action is unknown, it is not chemically related to benzodiazepines, barbiturates, or any other anxiolytic.
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buspirone MOA
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Agents act through the potentiation of GABA on benzodiazepine receptors, especially the omega-1 subunit.
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GABA-BZ agonist MOA
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Used primarily for sedation, have some anxiolytic action.
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GABA-BZ
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Chlordiazepoxide: Children > 6 years
clorazepate: Children > 9 years Diazepam: Children > 6 months Lorazepam: Children > 12 years (used unlabeled in children <12 years. |
benzo's for children
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All insomnia medications except ______ have an increased risk for the patient engaging in activities while somnolent with no memory of having taken a pill.
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ramelteon
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Precautions should be used when using zolpidem (ambien, edluar, zolpimist) in a person with __________ due to worsening of the disease.
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depression
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In addition to medications, ______ _______ is a cardinal point of treatment in sleep disorders.
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sleep hygiene
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Only benzodiazepine indicated for muscle relaxation and is the only drug in this category with direct muscle relaxant effects.
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valium
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Acute treatment: benzodiazepines
Long-term treatment: SSRIs, SNRIs, miscellaneous drugs such as clonazepam, venlafazine, buspirone. |
GAD
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acute treatment: benzodiazepines
Long-term treatment: SSRIs, others (augment), paroxetine, sertraline, fluosxetine, alprazolam, clonazepam, lithium, beta blockers, valporate. |
panic disorder
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acute treatment: benzodiazepines
long-term treatment: beta-blockers, SSRIs |
phobic disorders
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Treatment options:
-SSRIs -TCAs |
obsessive-compulsive disorder
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Treatment is with SSRI's.
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posttraumatic stress disorder
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