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Pharm 4

Chap 19

Benzodiazepines indications anxiety, insomnia, muscle spasm, seizure, spasticity, alcohol withdrawal - short term use
Benzodiazepines s/e motor incoordination, dizziness, excessive drowsiness; impair cognitive processing and affect concentration, judgment and planning; interfere driving, and psychomotor skills
Long-term use of benzo effects physical dependence
abrubtly discontinued benzo withdrawal syndrome: rebound anxiety, insomnia, headach, irritability, muscle twitches
abrupt withdrawal from alprazolam seizures
benzo and barbituates reinforcing effects of benzo is less than the reinforcing effects of barbiturates, but greater than reinforcing effects of sedating antihistamins; massive overdose less likely to cause fatal than Barbi
Benzodiazepine and pregnancy category D, can't use long term for pregnancy
Diazepam indications also for acute seizures, severe muscle spasm, spasticity
Lorazepam indications anxiety and seizures
Temazepam, Flurazepam, triazolam indications insomnia
Lorezepam and temazepam preferred for elderly
Triazolam s/e amnesia, confusion, delirium esp in elderly
Alprazolam, indications anxiey, panic disorder
clonazepam indications anxiey, panic disorder, Seizures
midazolam IV for anesthetic for pt going to surgery
Barbiturates indications anxiety disorders, insomnia, seizures, anesthesia
Benzo vs Barbiturates uses Barbiturates do not produce significant muscle relaxation and are not used in treating muscle spasm or spasticity disorders, massive use of Barbi can be more fatal
phenobarbital indications seizures
Antihistamines (dyphenhydramine) treat mild insomnia, anxiety, sleep preparations, sedative before surgery
Antihistamines characteristics sedation, blood-brain barrier, block acetylcholine release induce drowsiness and sleep
Zolpidem, zaleplon, eszopiclone newer agents for insomnia
Different between this new group and old benzo (short vs long acting) - less adverse effects - weaker daytime sedation and hangover effect due to shorter elimination halflife. Old benzo are less selective in choosing receptor and bind to a more widespread distribution of receptors
Melatonin indications treatment of jet lag, insomnia in shift-changed workers and elderly, delayed sleep-phase syndrome and non-24 hour sleep-wake disorder
Ramelteon indications sleep-onset insomnia
Non-benzo anxyolitics propanolol and buspirone
Buspirone treatment of chronic anxiety by anxiolytic effect
Buspirone special anxiolytic effects without causing marked sedation, amnesia, tolerance, dependence
Buspirone s/e headache, dizziness, nervousness
Propanolol prevent tachycardia and other signs of stage fright/ acute situational or perfomance anxiety. - take 1 hour before anxiety-provoking
Created by: prinluu