Pharmacological therapy and ECT - anxiolytic and hypnotic drugs

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Author:
trincam2008
ID:
275540
Filename:
Pharmacological therapy and ECT - anxiolytic and hypnotic drugs
Updated:
2014-06-25 10:49:12
Tags:
psy pharm
Folders:
psychiatry
Description:
intro, classification, MoA, Indications, SE
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  1. Intro, what is? hypnotic drug? anxiolytic drug?
    Probs particular? important drugs in this group
    • A hypnotic drug is one that induces sleep.
    • An anxiolytic or sedative drug is one that reduces anxiety.

    • - can result in tolerance, dependence and
    • withdrawal symptoms.

    - additive effects in combination or with alcohol, are additive.

    • - most important drugs in
    • this group are the benzo-diazepines and ‘Z drugs” (zopiclone, zolpidem
    • andzaleplon), which have very similar actions andindications


    This differentiation is not particularly helpful as anxiolytic drugs can induce sleep when given in higher doses and hypnotics can have a calming effect when given in lower doses, e.g. the benzodiazepines, which are anxiolyticin low doses and hypnotic in high doses.
  2. Classification of benzodiazepines
    • - Short acting:
    • oxazepam, temazepam, lorazepam (OTL-on time lora)

    • - Long acting:
    • diazepam, chlordiazepoxide (DC - điện)

    (according to strength, length of action, routes of admin)
  3. Classification of Z drugs
    • - very short: zaleplon
    • - short: zolpidem, zopiclone

    (according to strength, length of action, routes of admin)
  4. MoA
    Potentiating chloride entry, so hyperpolarizing the post - synaptic membrane and reduces neuronal excitability

    Bind to benzodiazepine receptors on GABA A receptor complex
  5. Indications of benzodiazepines
    • - insomnia, especially short-acting benzodiazepines(short-term use)
    • - Anxiety disorders
    • - Alcohol withdrawal, especially chlordiazepoxide
    • - Akathisia
    • - Acute mania or psychosis (sedation)

    - Other: epilepsy prophylaxis, seizures, muscle spasm(diazepam), anaesthetic premedication.
  6. Indications of Z drugs
    Insomia (short term use)
  7. SE of benzo and Z drugs
    • - risk of developing dependance, esp with prolonged use and shorter acting drugs
    • - dangers of driving or operating machinery due to drowsiness, ataxia and reduced motor coordination
    • - great caution in older adults where drowsiness, confusion and ataxia can precipitate falls or delirium
    • - Use with caution in patients with chronic respiratory disease (e.g. COPD, sleep apnoea) as they may depress respiration
  8. Other hypnotic and anxiolytic agents
    • - Buspirone
    • +5-HT1A receptor agonist that is used to treat generalized anxiety disorder. It is unrelated to the benzodiazepines, does not have hypnotic, anticonvulsant or muscle relaxant properties, and is not associated with dependence or abuse.
    • + Response to treatment may take up to 2 weeks, unlike the benzodiazepines which have an immediate anxiolyticeffect.

    - Sedating antihistamines (e.g. diphenhydramine(Nytol®)) are available for insomnia without a prescription. Unfortunately, their long duration of ac-tion may lead to drowsiness the following day.

    -
  9. OTHER DRUGS USED IN PSYCHIATRY
    - Alcohol dependence: acamprosate, disulfiram

    - Opiate dependence: methadone, buprenorphine, lofexidine, naltrexone

    - Dementia: cholinesterase inhibitors (donepezil, rivas-tigmine, galantamine), memantine

    - Psychostimulants: methylphenidate, dexamfetamine

    - Generalized anxiety disorder:pregabalin

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