Psych: Sleep and Anxiety Disorders Flashcards Preview

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Flashcards in Psych: Sleep and Anxiety Disorders Deck (24)
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1
Q

Barbiturate Drugs?

A
  • Phenobarbital
  • Thiopental
2
Q

Phenobarbital (Luminal)

A
  • Barbituate – long half life
  • Binds directly to the GABAA receptor
  • Increases the efficacy of endogenous GABA signaling
  • Increases Cl- channel openings –> membrane Hyperpolarization and decreased Excitability
  • Suppresses Reticular activating system –> suppresses Seizures at low levels that do not induce Hypnosis
  • Tx: Tonic-clonic and Partial seizures (preferred Pregnant women)
  • SEx: Sedation, Inducer of CYP450 system
3
Q

Thiopental (Pentothal)

A
  • GABAergic – short half life
  • Binds directly to the GABAA receptor
  • Increases the efficacy of endogenous GABA signaling
  • Increases Cl- channel openings –> membrane Hyperpolarization and decreased Excitability
  • Suppresses Brainstem Reticular activating system; Sedation, Amnesia, LOC, Reflex suppression
  • Tx: Pre-anesthetic sedative, Adjunct to Local anesthesia, Sedative-hypnotic
  • Hepatic metabolism by CYP450 sys. and Potent CYP450 inducer
4
Q

Benzodiazepines

A
  • Binds directly to GABAA receptor and increases potency of endogenous GABA signaling
  • Increases Cl- channel openings –> membrane Hyperpolarization and decreased Excitability
  • Suppresses Brainstem Reticular activating system; Sedation, Amnesia, LOC, Reflex suppression
  • Inhibitory neurotransmission –> Anticonvulsant and Muscle relaxant
  • Indirectly activate GABA –> Larger therapeutic index than Barbituates
  • Tx: Sedative-hypnotic, Anxiolytic: short-term management, Status Epilepticus, Prophylaxis against Ethanol withdrawal, Muscle relaxant, Anesthesia induction
  • SEx: Drowsiness, Impaired judgement, Decreased Motor skills
  • Tolerance and High potential for Dependence
  • Concomitmant –> Fatal CNS depression
5
Q

Short half-life Benzodiazepines? ( < 8 hours)

(M O T)

A
  • Midazolam
  • Oxazepam
  • Triazolam
6
Q

Medium half-life Benzodiazepines? (8 – 16 hours)

(A E L T)

A
  • Alprazolam
  • Estazolam
  • Lorazepam
  • Temazepam
7
Q

Long half-life Benzodiazepines? ( > 16 hours)

(CCC D F Q)

A
  • Chlordiazepoxide
  • Clonazepam
  • Clorazepate
  • Diazepam
  • Flurazepam
  • Quazepam
8
Q

Benzodiazepine Drugs?

(M O T – A E L T – CCC D F Q)

A
  • Midazolam
  • Oxazepam
  • Triazolam
  • Alprazolam
  • Estazolam
  • Lorazepam
  • Temazapam
  • Chlordiazepoxide
  • Clonazepam (also Spasmolytic)
  • Clorazepate
  • Diazepam (also Spasmolytic)
  • Flurazepam
  • Quazepam
9
Q

Non-benzodiazepines?

(E - ZZ)

A
  • Eszopiclone (Lunesta)
  • Zolpidem (Ambien)
  • Zoleplon (Sonata)
10
Q

Eszopiclone (Lunesta)

Zolpidem (Ambien)

Zoleplon (Sonata)

A
  • GABAergic
  • Nonbenzodiazepine Sedative-hypnotic
  • Selectively stimulates the w1 subtype of GABAA receptor
  • Produces Sedation and Anxiolysis – very little Muscle relaxant or Anticonvulsant activity
  • Tx: Insomnia, Restless leg syndrome
  • SEx: Drowsiness, Dizziness, and Fatigue
  • Additive w/ other CNS depressors
11
Q

Benzodiazapine Antagonist?

A
  • Flumazenil
12
Q

Flumazenil (Romazicon)

A
  • Benzodiazepine Analog Antagonist
  • Competitively inhibits the actions of Benzodiazepine
  • Rapidly-reverse Benzodiazepine overdose but MAY precipitate withdrawal Seizures, espcially in Alcoholics or Chronic Benzodiazepine users
13
Q

Ramelteon (Rozerem)

A
  • Weak Non-benzodiazepine Sedative-hypnotic
  • Selectively Stimulates Melatonin Type 1 and Melatonin Type 2 receptors
  • Melanonin is a hormone secreted by the Pineal gland that regulates the Sleep-wake cycle
14
Q

Buspirone (BuSpar)

A
  • Selective Partial Agonist of 5-HT1A serotonin receptors
  • Tx: Anxiolytic w/out sedation
  • Cannot be used to treat Benzodiazepine withdrawal
  • SEx: Tachycardia, palpatations, GI distress, Less abuse potential than Benzodiazepines, No rebound anxiety or withdrawal symptoms with Discontinuation
  • Contraindicated w/ Hepatic or Renal impairment
  • Hepatic oxidation to active metabolite
  • Use w/ MAOIs may lead to Hypertensive crisis
  • Cocomitant consumption of Grapefruit joice can lead to markedly increased levels of Buspirone because of inhibition of CYP3A4
15
Q

TCA Sedatives Drugs?

A
  • Amitryptaline
  • Doxepin
16
Q

Amitryptyline (Elavil)

Doxepin (Sinequan)

A
  • TCA that Inhibits reuptake of Norepinephrine (++) and Serotonin (+++)
  • Clinical effects not seen for several weeks
  • Also blocks; Anti-H1 (+++), Anti-M1 (++),
  • *Anti-a1-adrenoceptors (++), and Anti-a2-adrenoceptors** receptors –> accounting for Numerous side effects
  • Tx: Clinical Depression, Neuropathic and Chronic Pain, Enuresis, Migraine prophylaxis, ADHD in children
  • SEx: Anti-histamine, Sedation, Weight gain, Secondary amines cause less sedation than Tertiary amines
  • Anticholinergic: Blurred vision, Dry mouth, Urinary retention, Constipation, Agitation, Tachy, Sweating
  • a1-adrenoceptors: Postural HTN, Tachycardia
  • 1A antiarrhythmic properties from Na+ channel blockade
  • Overdose: Coma, Metabolic acidosis, Hyperpyrexia, Cardio Arrhythmias
17
Q

Trazodone (Desyrel)

A
  • Atypical Antidepressent 5-HT2 Antagonist
  • SEx: Anti-H1 (+++ - sedation), Anti-a1 (+ - Hypotension)
  • Tx: Clinical depression
  • SEx: Sedation (because H1 blockade), rare Hepatic failure
  • CYP3A4 inhibitor
  • More sedating than Nefazodone
  • Priapism
18
Q

Mirtazepine (Remeron)

A
  • Similar to Trazadone
  • 5-HT2 and 5-HT3 Antagonis and a2 adrenorecptor Antagonist on noradrenergic and serotonergic neurons, increases NE and 5-HT release
  • Powerful H1 blocker –> Very Sedating, Appetitie, Weight gain
  • SEx: Anti-H1 (+++ - sedation), Anti-a1 (0/+ - Hypotension)
  • Minimal effects on Amine reuptake
  • Can also be used in Bullimia Nervosa pts.
19
Q

Gaba-hydroxybutyrate (GHB) (Sodium Oxybate)

A
20
Q

Valerian

A
21
Q

Alcohol

A
22
Q

Melatonin

A
23
Q

Doxylamine – antihistamines

A
24
Q

Spasmolytic Drugs?

A
  • Diazepam
  • Clonazepam
  • Baclofen
  • Tizanidine
  • Dantrolene