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 |