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sedatives/anxiolytic
clinical neuro 3
| Question | Answer |
|---|---|
| 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
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