Pharmacology - Sedative Hypnotics / Mood Affective Disorders

sedative hypnotic agents can treat

• epilepsy

• muscle relaxation

• reduce anxiety

• decreased alertness

• insomnia

pharmacokinetic properties of an ideal hypnotic

• rapid absorption

• no active metabolites

• optimal half-life

pharmacokinetic effect of an ideal hypnotic

• rapid sleep induction

• physiologic sleep pattern

• mechanism other than general CNS depression

• sleep maintenance

• improved daytime function

side effects of an ideal hypnotic

• no residual sedation

• no respiratory depression

• no ethanol interaction (alcohol)

• no tolerance

• no physical dependence

• no rebound insomnia

• no effect on memory

benzodiazepines

GABA agonists

• diazepam (valium)

• alprazolam (xanax)

• clonazepam (klonopin)

suffix -PAM

sedative drug

rohypnol

date-rape drug

7-10 times stronger than valium

effective in 20-30 minutes

side effects of alprazolam

• memory problems, confusion, hallucination

• severe skin rash (!)

• seizures, weakness, coordniation impairment

• yellowing of skin or eyes

REFER

elderly patients have a

reduced ability to metabolize

lower tolerance to dosage

drugs stay in their system longer

want to use short-acting benzos in older population

sx of benzodiazepine withdrawl

• muscle spasms

• seizures

• anxiety/panic attacks

• aches/pains

a bartender is just a

pharmacist with a limited inventory

Barbituates

AMPA receptors

suffix - BARBITAL

barbituates

benzodiazepines effect of CNS

• sedation —> hypnosis —> stupor

• do not cause general anesthesia

• anti-anxiety / sedative hypnotic properties

• some are muscle relaxants (klonopin)

barbituates effect on CNS

• depress respiratory drive

• higher dose—> pharmacological hypnosis, neurogenic abolished, hypoxic respiratory drive reduced, chemoreceptor drive is attenuated

• higher dose, hypoxic drive is abolished

ambien

• no memory

• increased risk of falls

types of affective disorders

• bipolar affective disorder

• cyclothymia

• depressive disorder

depression is a result of deficiency in cortical and limbic

serotonin, norepinephrine, and dopamine

MAOI

inhibits breakdown of a hormone

tricyclic hormones

block other hormones from binding to next synapse

Tricyclics common side effects

• tremors

• indigestion

• HA

• dry mouth

• drowsiness

• elevated HR!

SSRIs common side effects

• sweating

• indigestion / nausea

• HA

• dry mouth

• drowsiness

• sexual side effects

SNRIs common side effects

• tremors

• nausea

• HA

• dry mouth

• blurred vision

• increased BP

• sexual side effects

• nervousness

• dizziness

MAOIs common side effects

• insomnia

• muscle aches

• low BP

• dry mouth

• sexual side effects

• nervousness

• dizziness

• need to avoid discongestants and certain foods (fish, chocolate, fermented foods)

adverse effects of SSRIs (SSS)

stomach upset

sexual dysfunction

serotonin syndrome

serotonin syndrome sx

• change in mental state

• dry mouth

• sweating or fever

• hypothermia/shock

• nausea/diarrhea

• tremors / reflex changes

• muscle rigidity

SSRI discontinuation syndrome

• dizziness

• nausea

• HA

• irritability

• insomnia

SSRI and risk of fx in premenopausal women

decrease in hormones (estrogen)

artificial increase of other hormones (seratonin)

increased fx risk