Anxiety-Sedation-Epilepsy
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- What is the dose-dependent progression of effects that anxiety drugs have?
- Relax (decrease anxiety)-sedation-anesthesia-coma
- What type of drug is Buspar?
- Antianxiety drug
- How does Buspar work?
- Stimulates CNS serotonin receptors, partial agonist.
- What effects does Buspar lack that BZD has?
- Lacks muscle relaxant, amnesiac, anticonvulsant and hypnotic effects.
- What are the most common adverse rxns of Buspar?
- Nausea, headache, dizziness, insomnia.
- What is an important distinguishing feature between Buspar and BZD when considering SE?
-
Buspar does NOT cause dependence or withdrawal effects. It is not addictive. Doesn't interact with alcohol.
BZD is addictive. - What is the indicated use for Buspar?
- Generalized anxiety disorder.
- How do barbiturates work? Why are they dangerous?
- Depress CNS. Narrow therapeutic index, highly addictive.
- What are some therapeutic uses of Barbiturates?
- Effective for sedation, insomnia and in emergency cases, can be used for seizures.
- What is the most frequently used class of drugs to treat anxiety?
- Benzodiazepines (BZD)
- Name three drugs under the BZD class.
- Valium, Xanax and Ativan
- How do these drugs differ?
- The main difference is the duration of action related to their lipid solubility.
- What is the prototype for BZD and how do they work?
-
Valium.
Increases the inhibitory effects of GABA in CNS. GABA facilitators. - What are the pharmacological actions of BZDs? (4)
-
-Reduction of anxiety
-Sedation, hypnotic actions
-Anticonvulsant
-Muscle relaxor - What are some SE of BZDs? (4)
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-Psychological and physical dependence w/ chronic administration.
-Withdrawal including anxiety, confusion, aggitation, restlesness, insomnia.
-CNS depression, drowsiness, ataxia, memory impairment.
-Paradoxial excitement. - Name 4 barbiturate drugs.
-
1. phenobarbital
2. pentobarbital
3. butabarbital
4. secobarbital - What is the prototype for barbiturates? MOA?
-
Phenobarbital.
MOA: Interfere w/ sodium and potassium transport across cell membrane. Causes an inhibitory effect on reticular activating system. Inhibits polysynaptic transmission in all areas of CNS. - How does phenobarbital get into CNS?
- It readily penetrates CNS due to high lipid solubility. Becomes widely distributed throughout body.
- What is the duration of action of phenobarbital?
- Long-acting, 1-2 days.
-
What are some SE of Phenobarbital?
CNS/CP -
-Physical and psychologically addicting w/ prolonged use.
-Abrupt w/drawal may be fatal
-Drowsiness and decreased motor performance day after administration.
-Mood, judgement, fine motor skills may be distorted.
-CVS: bradycardia/hypotension
-CP: hypoventilation - Which sedative-hypnotics/anti-anxiety drugs are addicting?
- All but Buspar.
- Are barbiturates useful for treating anxiety?
- NO
- How does Dilantin work?
-
Decreases the influx of NA ions, stabilizing neuronal membranes to depolarization.
Does not cause CNS depression like barbiturates, but it will cause drowsiness, but not hypnosis. -
What are the SE of Dilatin?
-CNS
-GI
-Mouth -
CNS: Nystagmus and ataxia due to depression of cerebellum/vestibular system.
GI: Nausea and vomitting
Mouth: Gingival hyperplasia, esp. in children. Must brush gums frequently and vigorously. - If serious SE occur, what is the protocal for stopping Dilatin treatment?
- Cannot stop abruptly. Could have a rebound seizure that is very profound. Have to ween off.
- How does Carbamazepine work?
- Reduces the propagation of abnormal impulses in the brain by BLOCKING sodium channels.
- What are the SE of Carbamazepine? (ABCD)
-
Ataxia
Aplastic anemia (alteration of RBC)
Blurred vision
Cardiac Arrhythmias
Dizziness
Drowsiness - How does Valproate work?
- Reduces the propagation of abnormal electrical discharge in the brain. It may also ENHANCE the effect of inhibitory GABA.
-
What are some SE of Valproate?
AGLIST -
-GI distress
-Temporary hair loss
-Sedation
-Ataxia
-Impaired platelet function
-Liver toxicity - What kind of seizures is Dilantin used for?
- All kinds
- What kind of seizures is Carbamazepine used for?
- All partial and generalized tonic-clonic seizures.
- What kind of seizures is Valproate used for?
- Absence seizures and complex partial seizures.