Pharm Sedative-Hypnotic Drugs

Front 1

Question: What is most likely to result from treatment with moderate high doses of diazepam?

Back 1

Agitation and possible hyperreflexia with abrupt discontinuance after chronic use.

Front 2

Question: A 56 year old, very overweight man complains of not sleeping well and tired during the day. His wife wakes him up during the night because of his loud snoring. This appears to be a breathing-related sleep disorder, what is the prescription?

Back 2

None of the above.

BZ and barbiturates are contraindicated in breathing-related sleep disorders.

Note: In obstructive sleep apnea (pickwickian syndrome), obesity is a major risk factor. Recommend PT to lose weight.

Front 3

Question: Barbiturates random information

Back 3

Dose-response curve for BZ is flatter than barbiturates (indicating, less likely to cause a drug induced coma).

Flumazenil is an antagonist of BZ, and used for respiratory depression.

Front 4

Question: Clonazepam can be used for?

Back 4

Anticonvulsant and certain anxiety stages, such as agoraphobia.

Front 5

Question: A 24 year old PT has a nervous disposition. He complains of stomach cramps. He grinds his teeth at night.

Assuming this is from generalized anxiety disorder, what is the appropriate treatment?

Regarding the properties of the drug, the physician should inform the PT to anticipate?

Back 5

Buspirone and longer-acting BZ, and anti-depressants.

The drug will take a week or so to begin working.

Front 6

Question: What is the MOA of benzodiazepines?

Back 6

Increase the FREQUENCY of opening of CL ion channels that are coupled to GABAa receptors.

Front 7

Question: A 82 year old PT has troubler sleeping. Trizaolam is prescribed for her at one half of the conventional adult dose. What is true about use of triazolam in elderly PTs?

Back 7

Triazolam is distinctive in that it does not cause rebound insomnia on abrupt discontinuance.

Hypotension is more likely than hypertension. Elderly are more prone to CNS depressants

Front 8

Question: The most likely explanation for the increased sensitivity of elderly PTs after administration of a single dose of benzodiazepine is?

Back 8

Changes in brain function that accompany the aging process.

Note: Decrease blood flow to vital organs (e.g., liver and kidney) occur during aging, which contributes to the cumulative effects of drugs.

Front 9

Question:A 28 year old woman has sporadic attacks of intense anxiety with marked physical symptoms, including hyperventilation, tachycardia, and sweating. If she is diagnosed as suffering from a panic disorder, the most appropriate drug to use is?

Back 9

Alprazolam and clonazepam.

Note: Propranolol is commonly used to attenuate excessive sympathomimetic activity in performance anxiety ("stage fright").

Front 10

Question: What drug may increase anticoagulant effects by displacement of warfarin from plasma protein binding sites and is inactive until converted in the body to an active metabolite?

Back 10

Chloral hydrate.

Front 11

Question: What drug used chronically in maintenance treatment of PTs with tonic-clonic or partial seizures states increases hepatic metabolism of warfarin and phenytoin.

Back 11

Phenobarbital

Front 12

Question: A 40 year old PT with liver dysfunction is scheduled for a surgical procedure. Lorazepam can be used for preanesthetic sedation in this PT without concern regarding excessive CNS depression because the drug is?

Back 12

Conjugated extrahepatically. However, most BZ are metabolized by the liver.

Front 13

Question: This hypnotic drug facilitates the inhibitory actions of GABA, but it lacks anticonvulsant or muscle-relaxing properties and has minimal effect on sleep architecture.

Back 13

Zaleplon, eszopiclone, and zolpidem. These drugs are not BZ.

Buspirone is not a hypnotic.

Front 14

Question: The most common type of drug interaction that occurs in PTs using benzodiazepines is?

Back 14

Additive CNS depression: alcohol, anticonvulsants, opioid analgesics, phenothiazines, antihistamines, and tricyclic antidepressants.

Front 15

What are the sedative hypnotics?

Back 15

Benzodiazepines, barbiturates

Others: Buspirone, chloral hydrate, eszopiclone, rameltoeon, zaleplon, zolpidem

Front 16

Drugs with the highest lipid solubility (e.g., thiopental) can be used for?

Back 16

Anesthesia.

Note: CNS effects are terminated by rapid redistribution to other highly perfused tissues (e.g., skeletal muscles)

Front 17

Receptors for benzodiazepines?

Back 17

Thalamus, limbic, and cerebral cortex

Front 18

MOA of benzo?

Back 18

Increases the FREQUENCY of GABA-mediated Cl ion channel opening.

Front 19

What is a competitive antagonist of BZ receptors?

Back 19

Flumazenil

Note: Flumazenil do not work on barbiturates

Front 20

MOA of barbiturates?

Back 20

Increases the DURATION of GABA-mediated CL ion channel opening.

Front 21

Barbiturates work on?

Back 21

Midbrain reticular formation.

Front 22

Zolpidem, zaleplon, and eszopiclone work on?

Back 22

GABA, with BZ receptors, BZ1 or omega1 subtypes.

Note: can be antagonized by flumazenil

Front 23

REM sleep is usually decreased with high dosage. What may occur with withdrawal from chronic drug use?

Back 23

Rebound in REM sleep.

Front 24

Anterograde amnesia is more likely with?

Back 24

BZ than other sedative-hyponotics

Front 25

High dosage of IV with what are used in status epilepticus?

Back 25

To terminate: diazepam or lorazepam.

Prolonged therapy: phenytoin

Front 26

High dosage of alcohols and barbiturates can cause?

Back 26

Depression of medullary neurons, with respiratory arrest, hypotension, and cardiovascular collapse.

Front 27

What are the withdrawal signs?

Back 27

Anxiety, tremors, hyperreflexia, and seizures, which occur more commonly with shorter-acting drugs.

Front 28

What is favored in treatment of acute anxiety states and panic attacks? What two drugs are used?

Back 28

BZ

Alprazolam and clonazepam

Front 29

What is favored in primary insomnia and other sleep disorders? What three drugs and contraindications?

Note: rapid onset with minimal effect on sleep patterns and causes less daytime cognitive impairment.

Back 29

BZ--estazolam, flurazapam, and triazolam.

Lower doses in elderly.

Not recommended for breathing-related sleep disorders.

Front 30

Used for Induction of anesthesia?

Seizure disorders?

Muscle spasticity?

Longer acting BZ used in management of withdrawal states?

Back 30

Thiopental

Clonazepam and phenobarbital

Diazepam

Chlordiazepoxide and diazepam

Front 31

SE?

Back 31

Cognitive impairment, decreased psychomotor skills, unwanted daytime sedation.

Anteriograde amnesia is the basis for "date rape"

Additive CNS depression when used with other drugs: alcohol, antihistamines, antipsychotic drugs, opioid analgesics, tricyclic antidepressants.

Front 32

OD results in? Is more likely with?

Back 32

Severe respiratory and cardiovascular depression.

Alcohol, barbiturates, and carbamates (less likely with BZ)

Front 33

How do you treat benzo OD?

Back 33

Maintenance of a patent airway and ventilatory support.

Flumazenil reverses CNS depression of BZ, esopiclone, zolpidem, and zaleplon.

Front 34

Additional SE

Barbiturates and carbamates?

Barbiturates may precipitate?

Chloral hydrate.

Back 34

Induce liver enzymes

Porphyria in susceptible PTs

Displace coumarins from plasma proteins and increase anticoagulant effects.

Front 35

MOA of buspirone, its usage

Back 35

Interacts with 5-HT(1A) as a partial agonist.

Used in GAD, but less effective in panic disorders.

Note: does not cause sedation, addiction, or tolerance. Does not interact with alcohol (unlike BZ and barbiturates. Doesn't effect driving, muscle relaxation, and has no anticonvulsant properties.

Front 36

MOA and purpose of ramelteon, and its SE?

Back 36

Activates melatonin receptors in the suprachiasmatic nuclei of the CNS and decreases latency of sleep onset with minimal rebound insomnia or withdrawal symptoms.

Decreases testosterone and increases prolactin.

Front 37

Examples of barbiturates? Its usage?

Back 37

Phenobarbital, pentobarbital, thiopental, secobarbital

Sedative for anxiety, seizures (phenobarbital), insomnia, induction of anesthesia (thiopental)

Front 38

Examples of BZ?

Back 38

Short acting: Triazolam, Oxazepam, Midazolam

TOM thumb/-azolam

Intermediate: lorazepam, temazepam, oxazepam, alprazolam, chlordiazepoxide.

Long acting: diazepam, clonazepam, flurazepam

Front 39

The usage of BZ?

Back 39

To treat anxiety, seizures, status epilepticus, muscle spasms, alcohol withdrawal, insomnia, panic disorders.

Midazolam and diazepam are used as anesthetics.