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43 Cards in this Set
- Front
- Back
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what are sedative/hypnotic effects and how do they differ from antianxiety effect?
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drugs that depress the CNS function and will actually cause respiratory depression
primarly used to treat anxeity and insomnia difference btw antianxiety and hypnotic effects of the drug is often a matter of dosing. |
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what is the drug of choice for treatment of insomnia and anxiety?
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benzodiazepines
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what are all the uses of benzodiazepines?
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insomnia/anxiety
induce general anesthesia manage seizure disorders, muscle spasm, panic disorder, and withdraw from alcohol |
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what is the most common benzodiazepine?
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diazepam
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what are the advantages of benzos?
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safer than general CNS depressants
lower potential for abuse produce less tolerance and physical dependecne fewer drug interactions |
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why are benzos safer?
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normal doses do not depress medullary function
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where is benzo metabolized?
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in liver
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what is comparason btw benzos and barbiturates?
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benzos are safer, and cause less dependence /tolerance/abuse
barbiturates cause increased liver enzymes functions(inducer) all this is based on proper use of benzos and each person will respond differently |
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what is a risk with benzos?
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they cause cardiovascular depression
so much be carefull with administration to elderly with cardiac conditinos respiratory depression is rare unless overdose |
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what are cardiac effects of benzos?
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lower BP
lower HR Lower SVR |
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what is bioavailability and distribution of benzos?
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75-90% bioavailablity
lipophilic distrubution threwout whole body can be sequestered in fat |
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what is time course fo benzos?
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duration of action 2-6 hours
therefore prescribed to be taken as needed not a constant dose med |
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what are the adverse effects of benzos?
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CNS depression-the candy drug each one you take makes you feel better and better.
anterograde amnesia sleep driving-dont take benzos during day if you going to be driving paradoxical effects-rare but can cause increased HR, sleeplessness, ects opposite of what you expect respiratory depression abuse dont use in preg especially first trimester probaly shouldnt use during lactation either |
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what are the drug interactions of the benzos?
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additive with any other CNS depressants
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what is issue with long term use of benzos?
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can lead to tolerance and dependence espeically when used for sleep aid
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what is the key way to treate acute toxicity with benzos?
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flumazenil works rapidly to block receptors that benzos target
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what are the benzodiazepine like drugs?
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drugs with similar effects but slightly different structure
zolipidem zaleplon eszoplicone |
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what is use of zolpidem
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is ambien
used as sedative-hypnotic short term managment of insomnia |
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what is use of zaleplon?
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new class of hypnotics callled the pyrazolpryrimidines
short term managment of insomnia prolonged use does not appear to cause tolerance |
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what is use of eszopiclone?
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lunesta
is the S-isomer of zopixlone used for insomnia no limitation on how long it can be used. |
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what are the melatonin agonist?
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Ramelteon
new hypnotic non benzo activation of melatonin receptros approved for chronic insomnia due to difficulty with sleep onset no real side effects and it seems to work very well. |
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what are the three classes of barbiturates?
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ultrashortacting(thiopental)
short acting(secobarbital) long acting(phenobarbital) |
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what is the MOA of barbiturates?
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binds to the GABA receptor-chloride channel complex
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what are the effects of barbiturates?
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same as benzos but more severe
CNS depression cardivascular effects induction of hepatic drug metabolizng enzymes tolerance to most CNS effects overtime but no toleracne to respiratory depression physical dependence |
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how do barbiturates stimulate P450s?
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stimulate prodcution of porphrin which leads to heme and stims cytochrome P450
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what are pharickinetics of barbiturates?
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lipid solubilty high will cross BBB, placental and into breast milk
rapid onset brief druation |
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what is barbiturates used in?
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seizure disorders
induction of anesthesia insomnia |
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adverse effects of barbiturates
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Resp. depre.
suicide abuse use in pregnancy bad excerabation of intermittent prphyria hangover paradocial excitement hyperalgesia |
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what are the symptoms of barbiturate overdose?
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resp. dep.
coma pinpoint pupils |
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how do you treat barbiturate overdose?
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removal from the body
maintain adequate O2 supply to brain |
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what are teh misc. sedative-hypnotics?
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nonselective CNS depressants
actions much like those of barbiturates acute overdose resembles poinsing with barbiturates avoid use during preg/lact chloral hydrate meprobamate paraldehyde |
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what is problem in insomnia with sleep cycles?
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sometimes its a failure to get into deep sleep. the sedatives will help pts get into stage IV.
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what is the classic drug used to treat anxiety?
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benzodiazepines specifically Busprione
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what are the good characters of buspirone?
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non-CNS depressant
does not cause sedation has no abuse potential does not inensify the effects of CNS depressants anxiolytic effects develop slowly well absorbed orally |
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what are the adverse effects of buspirone?
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dizziness
nausea heachache nervousness lightheadedness excitement most are transient |
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what are the interactions of buspirone?
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erythromycin and ketoconazole and grape fruit juice interfere with oral absorption.
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what is used in generalized anxiety disorder?
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antidepressants
-venlafaxine -paroexetine -escitalopram |
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what is given to treat panic disorder?
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propanolol to block the sympathetic response
antidepressants -SSRIs -Tricyclicls -MAOIs benzodiezepines- THIS IS FIRST LINE TREATMENT |
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what is the main drug therapy in OCD?
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SSRIs
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What are the SSRIs?
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citalopram
Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Clomiprmaine |
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what is true about clomipramine?
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used second line drug bc its less tolerated than the SSRIs
it is a trycyclic antidepressant |
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what is key for treatment of OCD with SSRIs?
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must maintain drug and dose for 1-2 months to check for efficacy before switching takes a long time for these meds to work
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treatment for PTSD and social phobia?
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SSRI
benzos other antidepressants same stuff as with the other anxiety disorders |
