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93 Cards in this Set
- Front
- Back
What is hypnosis?
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state of drowsiness, leading to sleep
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when should anxiety be treated?
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when it becomes chronic and interferes with normal functioning
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What is the best treatment for transient or short term insomnia?
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sedative-hyponotics
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whats thes best treatment for long term insomnia?
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behavioral therapy
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What is the major inhibitory NT in the brain?
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GABA
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What GABA receptor subtype activates depression of electrical activity in the reticular formation, thalamus, cerebral cortex?
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GABAa
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What happens when GABA binds GABAa?
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this opens chloride channels, and hyperpolarizies/depresses NT release
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How do MOST sedative hypnotics and anxiolytics act?
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binds to modulatory site of GABAa, prolonging GABA's action
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What do barbituates bind to?
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GABAa
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What do barbituates do once they bind to GABAa?
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they increase the DURATION of GABAa
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How do barbituates affect the CNS?
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they have marked depression of CNS
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How do barbituates affect breathing?
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they can depress respiratory drive at high doses
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What schedule are barbituates?
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II or III
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What are the combination effects of barbituates like?
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these are supra-additive
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What is Thiopental (pentothal)?
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this is an ultra short acting barbituate used for inducing anesthesia
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What is phenobarbital (luminal)?
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this is a long acting barbituate used as an anticonvulsant
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How do barbituates negatively affect the CNS?
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can cause drowsiness, distortion of mood, impaired judgment
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How do barbituates affect REM?
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they decrease REM sleep
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What is the margin of safety like in barbituates?
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it is very low level of safety
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How do you clear barbituates from the system?
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diuresis and alkalinization of the urine
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How do barbituates affect heme synthesis?
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these increase porphyrin synthesis, which is bad in porphyria
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What happens in barbituates withdrawal?
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this can be life thretening, with symptoms from restlessnesss, anxiety, weakness, orthostatic hypotension, and seizures
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how does the withdrawal of barbituates vary?
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this vaires with the dose and length of time they were used
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What are benzodiazepines used for?
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these are used as anxiolytics and sedative-hypnotics
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How do benzodiazepines affect anxiety?
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they reduce it, and produce drowsiness too
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What is the special effect of diazepam?
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this produces muscle relaxation in addition to benzodiazepine effects
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What do benzodiazepines bind to?
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GABAa
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how do benzodiazepines effect GABA's actions?
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they enhance the binding of GABA to GABAa
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When can benzodiazepines act? (only)
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when GABA is present
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How do high benzodiazepine concentrations affect GABA release?
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they inhibit GABA release @ high concentration
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how safe are benzodiazepines?
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these are fairly safe, as they have a ceiling effect, (due to eventual inhibition of GABA release)
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how are benzodiazepines usually given?
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these are given orally, but may be given IV in emergencies
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once in the body, what are benzodiazepines converted to?
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active metabolites, which are what actually
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What do Diazepam and Chlordiazepoxide get converted into as their active metabolite?
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desmethyldiazepam
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how long is the half life of desmethyldiazepam
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24 hours
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What is special about Flurazepam?
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it has a very long half life (74 hours) and will accumulate
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How long will do Oxazepam and Lorazepam last? whats special about them?
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these are conjugated directly to inactive metabolites- and have an intermediate half life
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How long do Alprazolam and Triazolam last?
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these are short, less than 6 hours
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How long does Midazolam work?
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very short acting, less than 2 hours
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Do benzodiazepines induce liver enzymes?
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no they do not
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do barbituates induce liver enzymes?
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yes they do!
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How does Cimetidine (tagament) affect diazepam?
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this decreases metabolism, and lengthens the half life
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What is the standard treatment for anxiety?
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benzodiazepines
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What are the general dosing instructions to treat anxiety with benzodiazepines?
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use the lowest does for the shortest time to provide the most benefit with the least risks
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How does Cimetidine (tagament) affect diazepam?
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this decreases metabolism, and lengthens the half life
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What is the standard treatment for anxiety?
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benzodiazepines
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What are the general dosing instructions to treat anxiety with benzodiazepines?
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use the lowest does for the shortest time to provide the most benefit with the least risks
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What drug class is given to treat OCD?
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SSRI's
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What drug class is given to treat Agoraphobia/panic disorders?
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SSRI's
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What drug class is given to treat PTSD
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antidepressants
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What drugs are given to treat anxiety in children/ adolescents?
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antidepressants! ha! trick question
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What drugs does the ending -barital go with?
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barbituates
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what drugs does the ending -lam/-pam go with?
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benzodiazepines
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What is flurazepam commonly used to treat? and how long is its action?
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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) |
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What is trazolam commonly used to treat? how long is its action? problem?
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this is short action, used to help fall asleep but not fall asleep.
can produce Rebound insomnia |
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What drug is given for prevention of absence seizures?
(brief seizures that cause a person to lose awareness, last about 20 seconds) |
Clonazepam (Klonopin)
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What two drugs are given IV to treat status epilepticus?
(long lasting seizures +5 min) |
Diazepam (valium)
Lorazepam (Ativan) |
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What is Midazolam (Versed) used for? interesting side effect?
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this is a very short acting benzo used for short surgical anesthesia- given IV
- causes anterograde amnesia |
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What benzo is used to treat acute muscle spasms?
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Diazepam (valium)
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What are the two long acting Benzo's used to treat alcohol/barbituate withdrawal?
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chlordiazepoxide (librium)
diazepam (valium) |
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What happens when you mix Benzo' and booze?
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there is a severe CNS depression
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how do benzo's affect children negatively?
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they impair memory and learning
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What group of people are very sensitive to the CNS depression effect of benzos?
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elderly
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What three groups of people should NOT get benzo's?
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Pregnant
Children Sleep apnea pts |
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What happens with abrupt discontinuation of benzos?
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there is a big rebound anxiety and insomnia. making the problem that was being treated far worse
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How should chronic benzo use be discontinued?
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tapered very slowly out
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what is the common name for Flunitrazepam?
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roofie
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What does Flumazenil do?
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this is a benzodaizepine antagonist, used to reverse the CNS depression from benzo overdose
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How does Flumazenil get administered?
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IV only, slow administration
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What are the dangerous effects of Flumazenil administration?
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can trigger withdrawal and seizures if a person is benzo dependent
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How does flumazenil affect pts with barbituate and tricyclic antidepressant overdose?
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this can cause seizures in these pts
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What receptor for the sleeping pills like ambien, sonata, and lunesta bind to?
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these are NOT benzos, so they binds the BZ1 subtype of the benzodiazepine receptor (NOT the GABAa, like benzos do)
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How fast do sleeping pills act?
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very strong, and very rapid sedation activity
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How do sleeping pills affect the sleep stages?
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preserves stages III/IV, and only minor effect on REM sleep
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What sleeping pill is approved for long term insomnia treatment?
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Eszopiclone (lunesta)
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What is the half life of zolpidem like?
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zolepidem (ambien)- has a very short half life of 2 hours
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what is the half life of zaleplon like?
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zaleplon (sonata)- has a very short half life of 1 hour (so only 4 hour duration of action)
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What is the main side effects of sleeping pills?
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GI problems
CNS- drowsiness and dizziness Sleep walking, sleep driving, and night eating. can produce withdrawls after long term eszopiclone (lunesta) |
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What does Ramelteon (Rozerem) do?
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this is an agonist at melatonin MT1 and MT2 receptors- used to regulate sleepiness and maintain sleep rhythms
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How does Ramelteon (Rozerem) change the sleep timing?
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makes you fall asleep faster, but shortens total sleep time
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Who should NOT use Ramelteon (Rozerem)
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people with serve liver disease
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What antihistamines can be used as sedatives for occasional insomina?
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diphenhydramine (benadryl)
promethazine (phenergan) |
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How does Chloral Hydrate (Noctec/Somnos) act? metabolite? receptor?
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this is converted in the body into trichloroethanol, which causes sedation by binding to GABAa receptor
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What is the margin of safety like in chloral hydrate?
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it is a very low margin of safety
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What is chloral hydrate usually used for?
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pediatric dental procedures, as well as in nursing homes because it is cheap- used as a sedative/hypnotic in these situations
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What does buspirone do?
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this relieves anxiety without producing sedation
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What receptor do buspirone act on?
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this is a partial agonist against 5-HT1a (in hippocampus, the anxiety area)
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Does buspirone have any major side effects or interactions?
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no it does not, it doesnt affect benzo or GABA receptors, and has little to no sedative effect, low addiction potential.
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What is buspirone usually used to treat, and in who?
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used to treat anxiety in recovering alcoholics or addicts, and the elderly.
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Whats the one drug that Buspirone shoud NOT be combined with
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MAOI's- this can increase BP
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What is Kava?
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this is an herbal OTC thing, makes you sleepy.
can cause severe liver tox |
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What is Valerian
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this is an anxiolytic (mild)- should not be used in pregnancy- may be hepatotoxic
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What drugs are given for stage fright?
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beta blockers
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