Anxiolytic & Insomnia questions

Benzodiazepine indications?

Sedation with retrograde amnesia

What are benzodiazepines MOA

Bind to GABA receptors in CNS and enhance the inhibitory action of GABA = CNS depression

What are the effects of benzodiazepine

sedative, anxiolytic, anterograde amnesia, muscle relaxation, no analgesic effects

What is the reversal/ antidote of benzodiazepine

Flumazenil

What is the MOA of Flumazenil (benzodiazepine antidote)

Competitive GABA receptor antagonist

What drug class is Diazepam

Benzodiazepine

What is Diazepams onset?

30 mins

What benzodiazepine has the longest duration?

Diazepam

What drug class is Lorazepam?

Benzodiazepine

Lorazepam onset

30 mins

Does Lorazepam have a longer or shorter duration than diazepam?

shorter

What drug class is Triazolam

Benzodiazepine

What is triazolam onset

30 mins, same as diazepam and lorazepam

What is triazolam duration

shorter than lorazepam and diazepam

What benzodiazepine might a be prescribed if the patient asks for a second dose to take the night before appointment to help sleep?

Triazolam

What drug class is Midazolam?

Benzodiazepine

What benzodiazepine has the shortest duration?

Midazolam

What benzodiazepine has the fastest onset?

Midazolam

Antihistamines MOA

H1 receptor antagonist

Antihistamines indication

Sedation without amnesia

What may be combined with antihistamines to create synergy effects?

other anxiolytics, narcotics, local anesthetics

Hydroxyzine drug class?

Antihistamine

Hydroxyzine onset?

15 mins

What does hydroxyzine get metabolized to ?

cetirizine

Cetirizine drug class

non-sedating antihistamine

Promethazine drug class?

Antihistamine

Hydroxyzine indications?

moderate levels of sedation without amnesia

Promethazine indications?

Sedative w/o amnesia

Antihistamine that is also an antiemetic (relieve nausea and vomiting)

Promethazine

ADRS and precautions with antihistmaines?

Dry mouth and urinary retention

Non-BZD anxiolytic MOA

Bind to BZD site on GABA

Non-BZD anxiolytic antidote?

flumazenil

Non-BZD anxiolytic effects?

sedative and amnesia

Zaleplon drug class?

Non-BZD anxiolytic

Zolpidem (Ambien) drug class?

Non-BZD anxiolytic

Non-BZD anxiolytic onset?

30 mins

Nitrous Oxide MOA

CNS depression

• stabilizing axonal membrane

Nitrous Oxide effects

Sedative and amnesia. May also act on opioid receptor to create analgesic effects

Nitrous Oxide onset?

Within 3 mins

Nitrous Oxide reversed by?

Oxygen 100%

Insomnia medication contraindications

• pts with respiratory disorders and history of substances use disorder

• caution with pts on other CNS depressing agents, like opiods

Phenobarbital drug class?

Barbiturates for insomnia

What classes of drugs can be used to treat insomnia?

• Barbiturates: Phenobarbital

• BZD: Triazolam

• Non-BZD: Zolpidem

• Melatonin receptor agonists: Ramelteon

• Orexin receptor antagonists: Suvorexant

• H1RBS, 1st gen: Diphenhydramine, Doxylamine

• Antidepressants: Doxipine, Paroxetine, Mirtazapine, Trazodone

Ramelteon drug class?

Melatonin receptor agonist for insomnia

Suvorexant drug class?

Orexin receptor antagonist for insomnia

Insomnia drug class that is safe, effective and well tolerated and used for pts who can not initiate or maintain their sleep?

BZDs

BZDs ADR?

• Tolerance may develop

• Residual daytime sedation

• Rebound insomnia

• withdrawal symptoms/ physical dependence

  • worsening insomnia, anxiety, muscle twitches, photophobia, tinnitus, auditory and visual hypersensitivity, seizures

What insomnia drug class might a pt develop tolerance to and experience residual daytime sedation?

BZDs

BZDs for insomnia contraindications?

• Elderly pts: impaired memory, risk of falls

• Pts with hepatic/renal insufficiencies

BZDs withdrawal symptoms

• Worsening insomnia

• anxiety

• muscle twitches

• photophobia

• tinnitus

• auditory and visual hypersensitivity

• seizures

Non-BZDs meds used for insomnia

Zaleplon, Eszopiclone, Zolpidem

Zaleplon drug class

Non-BZD GABA agonists

Zaleplon indications

sleep initiation not for maintenance

Non-BZD GABA agonist drug that has fewer day time issues

Zaleplon

Non-BZD GABA Agonist with the shorter t1/2

Zaleplon

Eszopiclone drug class?

Non-BZD GABA Agonist

Non-BZD GABA Agonists with longer t 1/2

Eszopiclone, Zolpidem

How do Non-BZD GABA Agonists compare to BZDs?

Non-BZD:

• lack muscle relaxant properties

• much lower respiratory depression

• lower risk of developing tolerance

Both BZDs and Non-BZDs:

• cause anterograde amnesia

Insomnia medication that does not cause dependence or tolerance, does not cause respiratory depression, and does not cause anterograde amnesia?

Ramelteon, a melatonin agonist

OTC insomnia medication?

Melatonin

Antidepressants used for insomnia?

• Doxepin

• Paroxetine

• Mirtazapine

• Trazodone

Tricyclic antidepressant (TCA) used to treat insomnia

Doxepin

Selective serotonin reuptake inhibitors (SSRI) antidepressant used to treat insomnia?

Paroxetine