Anxiolytic, Antiseizure, and Muscle Relaxant Agents

Practice flashcards reviewing anxiolytic, hypnotic, antiseizure, and skeletal muscle relaxant medications, mechanisms, indications, side effects, and lifespan considerations based on the lecture material.

How does the text define anxiety?

Anxiety is defined as a feeling of tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus.

What is the definition of sedation according to the lecture notes?

Sedation is defined as the loss of awareness and reaction to environmental stimuli.

How is hypnosis defined in the context of anxiolytic and hypnotic agents?

Hypnosis is defined as extreme sedation resulting in further CNS depression and sleep.

What structures are labeled in this diagram of a nerve synapse?

The labeled structures are vesicles, synaptic cleft, reuptake pump, neurotransmitter, and receptor.

What common naming suffixes identify benzodiazepines?

The suffixes $-lam$ (such as Alprazolam and Midazolam) and $-pam$ (such as Temazepam and Clonazepam).

What are the main contraindications for benzodiazepine therapy?

Drug allergy, narrow-angle glaucoma, and pregnancy.

What clinical characteristics and administration guidelines apply to Midazolam (Versed)?

Midazolam is used preoperatively and for moderate sedation, causing amnesia, anxiolysis, and sedation. It is a high-alert medication given by injection in adults and available in liquid oral dosage form for children.

What agent is used to reverse benzodiazepine overdose, and what key adverse effect can it cause?

Flumazenil (Romazicon) is used for reversal via intravenous infusion; it may cause seizures.

What initial dose of Zolpidem (Ambien) is recommended for females and elderly patients?

A starting dose of $5\,mg$, and rarely $10\,mg$.

What is the definition of epilepsy in the lecture notes?

Epilepsy is a chronic disorder characterized by seizures, involving a sudden abnormal discharge of excessive electrical energy from nerve cells in the brain.

Which antiepileptic drug administration is preferred for newborns between $1\text{ to }10\text{ days}$ of age?

Intramuscular phenobarbital.

What is the therapeutic goal of antiepileptic drug (AED) therapy?

To control or prevent seizures while maintaining a reasonable quality of life.

What is the target therapeutic serum drug level range for Phenytoin (Dilantin)?

$10\text{ to }20\,\text{mcg/mL}$.

What administration precautions are required for intravenous (IV) Phenytoin (Dilantin)?

It is very irritating to veins, must be diluted in normal saline (NS), requires the use of a filter, and has numerous IV incompatibilities.

What are the adverse effects listed for Valproic Acid?

Drowsiness, GI disturbances, tremors, weight gain, hair loss, hepatotoxicity, and pancreatitis.

What are the indications for Carbamazepine (Tegretol)?

Partial seizures, tonic-clonic seizures, and trigeminal neuropathy.

What is the mechanism of action and Black Box warning for Gabapentin?

It is a chemical analogue of GABA that increases GABA synthesis and synaptic accumulation; its Black Box warning is for respiratory depression.

What is the maximum daily dose of Levetiracetam (Keppra) for adult patients?

$3000\,mg/\text{day}$.

Which benzodiazepines are specifically mentioned as being used as antiepileptic agents?

Clobazam (Onfi, Sympazan), Clonazepam (Klonopin), and Diazepam (Valium).

What is the primary physiological difference between muscle spasms and muscle spasticity?

Muscle spasms usually result from musculoskeletal injury causing sensory impulses to the spinal cord, whereas muscle spasticity results from neuron damage within the CNS that alters excitatory or inhibitory influences.

Which muscle relaxant is indicated to relieve spasticity in children with cerebral palsy?

Baclofen.

What is the drug of choice when a child requires treatment for tetanus?

Methocarbamol.

Which patient populations have an increased risk for dantrolene-associated hepatotoxicity?

Female patients and patients over $35\text{ years}$ of age.

Which centrally acting skeletal muscle relaxant is preferred for older adults and patients with hepatic or renal impairment?

Carisoprodol.

What supportive interventions are required if centrally acting muscle relaxants are taken in combination with CNS depressants?

Maintaining an adequate airway, EKG monitoring, and administering fluids to avoid crystalluria.