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93 Cards in this Set

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  • Back
What is hypnosis?
state of drowsiness, leading to sleep
when should anxiety be treated?
when it becomes chronic and interferes with normal functioning
What is the best treatment for transient or short term insomnia?
sedative-hyponotics
whats thes best treatment for long term insomnia?
behavioral therapy
What is the major inhibitory NT in the brain?
GABA
What GABA receptor subtype activates depression of electrical activity in the reticular formation, thalamus, cerebral cortex?
GABAa
What happens when GABA binds GABAa?
this opens chloride channels, and hyperpolarizies/depresses NT release
How do MOST sedative hypnotics and anxiolytics act?
binds to modulatory site of GABAa, prolonging GABA's action
What do barbituates bind to?
GABAa
What do barbituates do once they bind to GABAa?
they increase the DURATION of GABAa
How do barbituates affect the CNS?
they have marked depression of CNS
How do barbituates affect breathing?
they can depress respiratory drive at high doses
What schedule are barbituates?
II or III
What are the combination effects of barbituates like?
these are supra-additive
What is Thiopental (pentothal)?
this is an ultra short acting barbituate used for inducing anesthesia
What is phenobarbital (luminal)?
this is a long acting barbituate used as an anticonvulsant
How do barbituates negatively affect the CNS?
can cause drowsiness, distortion of mood, impaired judgment
How do barbituates affect REM?
they decrease REM sleep
What is the margin of safety like in barbituates?
it is very low level of safety
How do you clear barbituates from the system?
diuresis and alkalinization of the urine
How do barbituates affect heme synthesis?
these increase porphyrin synthesis, which is bad in porphyria
What happens in barbituates withdrawal?
this can be life thretening, with symptoms from restlessnesss, anxiety, weakness, orthostatic hypotension, and seizures
how does the withdrawal of barbituates vary?
this vaires with the dose and length of time they were used
What are benzodiazepines used for?
these are used as anxiolytics and sedative-hypnotics
How do benzodiazepines affect anxiety?
they reduce it, and produce drowsiness too
What is the special effect of diazepam?
this produces muscle relaxation in addition to benzodiazepine effects
What do benzodiazepines bind to?
GABAa
how do benzodiazepines effect GABA's actions?
they enhance the binding of GABA to GABAa
When can benzodiazepines act? (only)
when GABA is present
How do high benzodiazepine concentrations affect GABA release?
they inhibit GABA release @ high concentration
how safe are benzodiazepines?
these are fairly safe, as they have a ceiling effect, (due to eventual inhibition of GABA release)
how are benzodiazepines usually given?
these are given orally, but may be given IV in emergencies
once in the body, what are benzodiazepines converted to?
active metabolites, which are what actually
What do Diazepam and Chlordiazepoxide get converted into as their active metabolite?
desmethyldiazepam
how long is the half life of desmethyldiazepam
24 hours
What is special about Flurazepam?
it has a very long half life (74 hours) and will accumulate
How long will do Oxazepam and Lorazepam last? whats special about them?
these are conjugated directly to inactive metabolites- and have an intermediate half life
How long do Alprazolam and Triazolam last?
these are short, less than 6 hours
How long does Midazolam work?
very short acting, less than 2 hours
Do benzodiazepines induce liver enzymes?
no they do not
do barbituates induce liver enzymes?
yes they do!
How does Cimetidine (tagament) affect diazepam?
this decreases metabolism, and lengthens the half life
What is the standard treatment for anxiety?
benzodiazepines
What are the general dosing instructions to treat anxiety with benzodiazepines?
use the lowest does for the shortest time to provide the most benefit with the least risks
How does Cimetidine (tagament) affect diazepam?
this decreases metabolism, and lengthens the half life
What is the standard treatment for anxiety?
benzodiazepines
What are the general dosing instructions to treat anxiety with benzodiazepines?
use the lowest does for the shortest time to provide the most benefit with the least risks
What drug class is given to treat OCD?
SSRI's
What drug class is given to treat Agoraphobia/panic disorders?
SSRI's
What drug class is given to treat PTSD
antidepressants
What drugs are given to treat anxiety in children/ adolescents?
antidepressants! ha! trick question
What drugs does the ending -barital go with?
barbituates
what drugs does the ending -lam/-pam go with?
benzodiazepines
What is flurazepam commonly used to treat? and how long is its action?
this is used to treat insomnia- but it is long acting, and makes pts sluggish later.

used if pts wake up too early (long action)
What is trazolam commonly used to treat? how long is its action? problem?
this is short action, used to help fall asleep but not fall asleep.

can produce Rebound insomnia
What drug is given for prevention of absence seizures?
(brief seizures that cause a person to lose awareness, last about 20 seconds)
Clonazepam (Klonopin)
What two drugs are given IV to treat status epilepticus?
(long lasting seizures +5 min)
Diazepam (valium)

Lorazepam (Ativan)
What is Midazolam (Versed) used for? interesting side effect?
this is a very short acting benzo used for short surgical anesthesia- given IV

- causes anterograde amnesia
What benzo is used to treat acute muscle spasms?
Diazepam (valium)
What are the two long acting Benzo's used to treat alcohol/barbituate withdrawal?
chlordiazepoxide (librium)

diazepam (valium)
What happens when you mix Benzo' and booze?
there is a severe CNS depression
how do benzo's affect children negatively?
they impair memory and learning
What group of people are very sensitive to the CNS depression effect of benzos?
elderly
What three groups of people should NOT get benzo's?
Pregnant
Children
Sleep apnea pts
What happens with abrupt discontinuation of benzos?
there is a big rebound anxiety and insomnia. making the problem that was being treated far worse
How should chronic benzo use be discontinued?
tapered very slowly out
what is the common name for Flunitrazepam?
roofie
What does Flumazenil do?
this is a benzodaizepine antagonist, used to reverse the CNS depression from benzo overdose
How does Flumazenil get administered?
IV only, slow administration
What are the dangerous effects of Flumazenil administration?
can trigger withdrawal and seizures if a person is benzo dependent
How does flumazenil affect pts with barbituate and tricyclic antidepressant overdose?
this can cause seizures in these pts
What receptor for the sleeping pills like ambien, sonata, and lunesta bind to?
these are NOT benzos, so they binds the BZ1 subtype of the benzodiazepine receptor (NOT the GABAa, like benzos do)
How fast do sleeping pills act?
very strong, and very rapid sedation activity
How do sleeping pills affect the sleep stages?
preserves stages III/IV, and only minor effect on REM sleep
What sleeping pill is approved for long term insomnia treatment?
Eszopiclone (lunesta)
What is the half life of zolpidem like?
zolepidem (ambien)- has a very short half life of 2 hours
what is the half life of zaleplon like?
zaleplon (sonata)- has a very short half life of 1 hour (so only 4 hour duration of action)
What is the main side effects of sleeping pills?
GI problems
CNS- drowsiness and dizziness
Sleep walking, sleep driving, and night eating.

can produce withdrawls after long term eszopiclone (lunesta)
What does Ramelteon (Rozerem) do?
this is an agonist at melatonin MT1 and MT2 receptors- used to regulate sleepiness and maintain sleep rhythms
How does Ramelteon (Rozerem) change the sleep timing?
makes you fall asleep faster, but shortens total sleep time
Who should NOT use Ramelteon (Rozerem)
people with serve liver disease
What antihistamines can be used as sedatives for occasional insomina?
diphenhydramine (benadryl)
promethazine (phenergan)
How does Chloral Hydrate (Noctec/Somnos) act? metabolite? receptor?
this is converted in the body into trichloroethanol, which causes sedation by binding to GABAa receptor
What is the margin of safety like in chloral hydrate?
it is a very low margin of safety
What is chloral hydrate usually used for?
pediatric dental procedures, as well as in nursing homes because it is cheap- used as a sedative/hypnotic in these situations
What does buspirone do?
this relieves anxiety without producing sedation
What receptor do buspirone act on?
this is a partial agonist against 5-HT1a (in hippocampus, the anxiety area)
Does buspirone have any major side effects or interactions?
no it does not, it doesnt affect benzo or GABA receptors, and has little to no sedative effect, low addiction potential.
What is buspirone usually used to treat, and in who?
used to treat anxiety in recovering alcoholics or addicts, and the elderly.
Whats the one drug that Buspirone shoud NOT be combined with
MAOI's- this can increase BP
What is Kava?
this is an herbal OTC thing, makes you sleepy.
can cause severe liver tox
What is Valerian
this is an anxiolytic (mild)- should not be used in pregnancy- may be hepatotoxic
What drugs are given for stage fright?
beta blockers