anxiolytics hypnotics stimulants facts

Benzodiazepines (6)

clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), chlordiazepoxide (Librium), midazolam (Versed)

Z-drugs (3)

eszopiclone (Lunesta), zolpidem (Ambien), zaleplon (Sonata)

Stimulants (4)

amphetamine/dextroamphetamine (Adderall), dexmethylphenidate (Focalin), methylphenidate (Ritalin), lisdexamfetamine (Vyvanse)

Non-stimulant ADHD drug (1)

atomoxetine (Strattera)

Non-benzo anxiety drug (1)

buspirone (Buspar)

C-II drugs in this module (4)

amphetamine/dextroamphetamine (Adderall), dexmethylphenidate (Focalin), methylphenidate (Ritalin), lisdexamfetamine (Vyvanse)

C-IV drugs in this module (9)

All 6 benzos + all 3 Z-drugs

NOT controlled in this module (2)

buspirone (Buspar), atomoxetine (Strattera)

What schedule are benzodiazepines?

C-IV

What schedule are Z-drugs?

C-IV

What schedule are ADHD stimulants?

C-II

ADHD drugs (5)

amphetamine/dextroamphetamine (Adderall), dexmethylphenidate (Focalin), methylphenidate (Ritalin), lisdexamfetamine (Vyvanse), atomoxetine (Strattera)

Insomnia drugs (3)

eszopiclone (Lunesta), zolpidem (Ambien), zaleplon (Sonata)

Benzo also for seizures (1)

diazepam (Valium)

Benzo for status epilepticus (1)

lorazepam (Ativan)

Benzo for alcohol withdrawal (1)

chlordiazepoxide (Librium)

Benzo for procedural sedation (1)

midazolam (Versed)

Benzos used mainly for anxiety (2)

clonazepam (Klonopin), alprazolam (Xanax)

Anxiety drug with no sedation and no abuse risk (1)

buspirone (Buspar)

ADHD stimulant that is a prodrug (1)

lisdexamfetamine (Vyvanse)

ADHD drug that comes as a patch (1)

methylphenidate (Daytrana)

Extended-release methylphenidate brand

Concerta

Three brands of methylphenidate

Ritalin, Concerta, Daytrana

Dexmethylphenidate is related to which drug?

methylphenidate (it's the active half of the molecule)

Suffix -pam / -lam means

Benzodiazepine

Z-drugs mnemonic

Start with Z (zolpidem, zaleplon) and make you zonk out

Benzo mechanism

Enhances GABA, which causes CNS depression

Benzo effects (3)

Anxiety relief, sedation, anticonvulsant

Buspirone mechanism

Partial serotonin agonist

Stimulant mechanism

Block norepinephrine and dopamine reuptake and promote their release

Atomoxetine mechanism

Selective norepinephrine reuptake inhibitor (NRI)

Why buspirone isn't for panic attacks

Takes weeks to work, not an as-needed drug

Common benzo and Z-drug side effects (2)

Drowsiness, cognitive slowing

Common stimulant side effects (3)

Insomnia, decreased appetite, weight loss

Common buspirone side effects (2)

Dizziness, headache

Serious benzo risks (3)

Respiratory depression, dependence, withdrawal

Why benzos must be tapered

Abrupt stop can cause seizures

Z-drug boxed warning

Complex sleep behaviors (sleep-driving, sleepwalking), injury or death

Stimulant boxed and serious risks (3)

Abuse/misuse, sudden cardiac death, high blood pressure

Atomoxetine boxed warning

Suicidal thoughts in children and teens

Benzos or Z-drugs + opioids, alcohol, or CNS depressants

More respiratory and CNS depression

MAOI + buspirone, stimulants, or atomoxetine

Serotonin or hypertensive crisis (14-day gap)

Avoid stimulants and atomoxetine in (2)

Severe heart disease, moderate to severe high blood pressure

Zolpidem dose difference by sex

Women get a lower starting dose (slower clearance)

Take Z-drugs when?

Right before bed, with 7 to 8 hours available to sleep

Benzo overdose reversal agent

flumazenil

C-II refill rule

No refills. New prescription each time

C-IV refill rule

Up to 5 refills within 6 months

Look-alike: Xanax vs Zantac

Xanax = alprazolam (benzo). Zantac = ranitidine (old H2 blocker, now famotidine)

Look-alike: Klonopin vs clonidine

Klonopin = clonazepam (benzo). Clonidine = blood pressure drug

Look-alike: Adderall vs Inderal

Adderall = stimulant. Inderal = propranolol (beta-blocker)

Look-alike: Lunesta vs Neulasta

Lunesta = eszopiclone (sleep). Neulasta = pegfilgrastim (white cell booster)