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clinical neuro 3

therapeutic window for barbituates very narrow
therapeutic window difference between effective dose and deadly dose
onset of phenobarbital slow
GABA opens.. Cl- channels
MOA of barbituates GABA agonists
clinical uses of secobarbital short term insomnia, acute psychosis
clinical uses of phenobarbital preoperative sedation
often produces hyperactivity in children phenobarbital
MOA of BZs allosterically bind to GABAa and increases GABA's effect
DOC for panic disorders/anxiety, esp in elderly alprazolam
DOC for generalized anxiety disorder lorazepam
DOC for short-term anxiety meprobamate
short term sedative-hypnotic meprobamate
DOCs for alcohol withdrawl chlorazepate, chlordiazepoxide
used to shorten sedation for surgery flumazenil
toxic effects of BZs are related to sedative actions
BZs have some teratogenicity during first trimester
Chance of physical dependence is high with BZs
symptoms of BZ withdrawl restlessness, anxiety, weakness, generalized seizures
dosing to avoid withdrawl sx with BZ taper 25% per week to 50% of dose, then 1/8th dose every 4-7 days
contraindication for alprazolam pulmonarly compromised pts
monitor use in depressive pts w/suicidal ideation chlordiazepoxide
high doses reduce REM meprobamate
associated w/congenital malformations meprobamate
non-BZ used as sedative-hypnotic zolpidem & zaleplon
act at GABAa type 1 only zolpidem & zaleplon
non-BZ w/some anxiolytic action zaleplon
stimulates GABA release propofol
DOC for ambulatory surgery propofol
metabolism of propofol rapid metabolism, 99% changed before exceretion
pain may occur @ injection site propofol
contraindicated in children due to acidosis propofol
DOC for pts w/limited CV reserve (does not lower BP) etomidate
recovery w/etomidate slower than propofol
analgesic action of etomidate none
adverse effects of etomidate pain @ injection site, myoclonus, post-op nausea & vomitting
3 sedation settings monitored anesthesia care, conscious sedation, deep sedation
monitored anesthesia care pre-midazolam IV, then propofol/ketamine/opioids
conscious sedations IV diazepam, midazolam, propofol
deep sedation IV thiopental, midazolam, propofol,opiods, and ketamine
MOA of buspirone 5HT1A agonist, inhibits dorsal raphe and stim locus cereleus
buspirones & BZs not cross-tolerant
clinical use of buspirone long-term anxiety
effect of buspirone on NTs dec 5HT, inc NE, inc DA
no potential for abuse, dependence, or withdrawal buspirone
pts maintain cognitive & psychomotor skills buspirone
can be used w/alcohol buspirone
less effective in recent BZ users buspirone
reduces visceral activity propranolol
treats performance anxiety propranolol
GAD, panic disorders, PTSD, social phobias, and other phobias can be treated with SSRIs
anxiety + depression mirtazapine
may produce slightly less locomotor disruption bretazenil
non-BZ that has a similar MOA zopiclone
melatonin agonist, MT1 and MT2 ramelteon
shortens latency to sleep w/no rebound insomnia or withdrawl ramelteon
Busiprone is aka Buspar
Created by: drhermy