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pharm quiz 4.2
Insomnia & Anxiety
| Question | Answer |
|---|---|
| What medications could cause insomnia? -5 | caffeine, Parkinson’s drugs, theophylline, nicotine, corticosteroids, SSRIs, and others |
| What is the preferred treatment of insomnia? | Non-drug treatment; sleep hygiene/sleep fitness |
| How often should hypnotics be used? | Should only be used when non-drug treatment has failed, should be limited to use only 2-3 days a week |
| What are aspects of sleep hygiene/ sleep fitness? -7 | Routine sleep schedule, avoid medications that will effect sleep, increase physical activity (<7 pm), increase daytime sunlight, bedroom comfortable, quiet, dark, & reserve for sleeping, unwind before bedtime, get up if you don't fall asleep in 20 min |
| Insomnia medications *examples* -5 categories, 8 to remember | Zolpidem (Ambien, Ambien CR), Zaleplon (Sonata), Eszopiclone (Lunesta); Doxylamine & Diphenhydramine (Benadryl, Unisom, Tylenol PM, Advil PM®); Ramelteon (Rozerem); Benzodizepines (-p/lam); Barbiturate sedatives (-barbital) |
| Zolpidem (Ambien, Ambien CR), Zaleplon (Sonata), Eszopiclone (Lunesta) Information? | Similar M of A to benzodizepines, use only as hypnotics, quick half-life & onset, take right before bed, similar adverse effects to benzodiazepines |
| What is an important adverse side effect caused by Zolpidem that puts the patient at risk? | Causes "sleep walking" & "sleep driving" without memory of the events |
| Doxylamine & Diphenhydramine (Benadryl, Unisom, Tylenol PM, Advil PM®) Information? | M of A: sedating antihistamines; available OTC; tolerance can develop with continued use; strong anticholinergic side effects |
| Ramelteon (Rozerem) Information? | M of A: Melatonin receptor agonist; prescription only, but is not controlled like the benzodiazepines and Zolpidem-like hypnotics |
| Benzodiazepine sedatives | End in -pam or -lam, except chlordiazepoxide |
| Mechanism of Action for Benzodiazepine sedatives? | enhances action & binding of gamma aminobutric acid (GABA)to its CNS receptors, inhibitory CNS neurotransmitter inhibiting neuronal activity |
| Therapeutic uses of Benzodiazepines? | Anxiolitic (reduce anxiety); Insomnia- don't use long half-lives with elderly; Status epilepticus - quick onset; Alcohol withdrawal symptoms; Muscle spasm |
| Benzodiazepines used for Anxiety? | SL doses of lorazepam and alprazolam |
| Benzodiazepines used for Status Epilepticus? | Diazepam & lorazepam; quick onset |
| Benzodiazepines used for alcohol withdrawal symptoms? | Oxazepam & chlordiazepoxide |
| Benzodiazepines used for muscle spasms? | diazepam & clonazepam; relax by effecting spinal cord |
| Adverse effects of Benzodiazepines? -7 | CNS depression (drowsiness, confusion); Respiratory depression; Anterograde amnesia (forgetfulness); Sleep walking; Abuse- addiction; Physical dependence/Withdrawal symptoms (anxiety, insomnia, panic, tremors, HTN); Overdose (hypoTN, shock, coma/death) |
| Drug interactions with Benzodiazepines? -3 | Additive effects with other CNS depressants; Additive effects with other respiratory depressants; Some have cytochrome p450 interactions |
| Barbiturate sedatives *examples* -3 | End in -barbital; phenobarbital pentobarbital (Nembutal) secobarbital (Seconal) |
| Mechanism of Action for Barbiturates? | Potentiates the effects of GABA on CNS, GABA agonists |
| Therapeutic uses of Barbiturates? | No longer used for anxiety and rarely used as hypnotics!; Preventative treatment of seizure in children; Hypnotic |
| Which Barbiturate is used as a preventative treatment of seizure in children? | Phenobarbital |
| Which Barbiturate is used as a hypnotic? | Secobarbital |
| Adverse Effects/ drug interactions with Barbiturates? | Similar to benzodiazepines except more pronounced; p450 interactions; ADHD |
| Types of Anxiety Disorders? -5 | Post-traumatic Stress Disorder; Generalized Anxiety Disorders; Panic Disorders; Obsessive-Compulsive Disorders (OCD); Phobic Disorders |
| What is the general treatment of Anxiety Disorders? | Scheduled daily doses of antidepressants or Buspirone (Buspar); avoid daily doses of benzodiazepines except for when immediate relief of acute anxiety is needed |
| Buspirone (Buspar) Information | Mechanism of action unknown, but has some effect on serotonin; Slow onset of action, affects serotonin like SSRIs, but is not an antidepressant; Used to treat anxiety only; is not a Benzodiazepine; not sedating |
Created by:
hcress08
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