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57 Cards in this Set

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