Sedative-hypnotics

Question 1

What are the 5 classes of sedative-hypnotics?

Answer 1

1. Benzodiazepines - Diazepam, Midazolam
2. Barbituates - Phenobarbital
3. Sleep aids - Zolpidem (non-benzodiazepine)
4. Anxiolytics - Buspirone
5. Ethanol

Question 2

GABAa receptors are activated by what?

Answer 2

GABA

Question 3

How do sedative-Hypnotics potentiate inhibition at all levels of CNS via GABAa receptors?

Answer 3

• Increased flow through channel
• Increased channel opening time

Question 4

Sedation vs hypnosis

Answer 4

Sedation - calming, anxiolytic
Hypnosis - encourages sleep

Question 5

Differentiate between desirable and less desirable effects of hypnotics on sleep?

Answer 5

Desirable:
- Decreased time to fall asleep
- Increased stage 2 NREM (non-rapid eye movement) sleep
Less Desirable:
- Decreased REM (rapid eye movement) sleep
- Decreased stage 4 NREM slow-wave sleep

Question 6

Which sedative-hypnotics are useful anesthesia adjuncts?

Answer 6

Barbituates – thiopental and methohexital
Benzodiazepines - diazepam, lorazepam, and midazolam

Question 7

What is the reversible agent for Benzodiazepines?

Answer 7

flumazenil

Question 8

What class of sedative-hypnotics can contribute to a persistent postanesthetic respiratory depression?

Answer 8

Benzodiazepines

Question 9

Where is alcohol metabolized?

Answer 9

Liver: 90% (remainder in lungs and stomach)
- zero-order kinetics

Question 10

What are the standard alcoholic drink sizes?

Answer 10

Beer - 10oz
Wine - 3.5oz
Liquor - 1oz

Question 11

Adults can metabolize how many alcoholic drinks per hour?

Answer 11

1

Question 12

What are the 2 major pathways of metabolism to acetaldehyde?

Answer 12

Alcohol dehydrogenase pathway
Microsomal ethanol-oxidizing system (MEOS)

Question 13

Differentiate between tolerance, dependence, and addiction

Answer 13

Tolerance – More of the drug is needed to get the same initial effect
Dependence – Body is now reliant on drug
Addiction – Behavior – will seek out drug regardless of negative consequences

Question 14

What is the most common neurologic abnormality
from ethanol consumption?

Answer 14

Generalized symmetric peripheral nerve injury
- Distal paraesthesias of hands and feet

Question 15

What are the other neurological disorders that can be induced by alcohol consumption?

Answer 15

• Gait disturbances, ataxia
• Optic nerve degeneration
• Dementia, demyelinating disease

Question 16

Wernicke-Korsakoff Syndrome is characterized by what deficiency?

Answer 16

Thiamine

Question 17

What are the symptoms of Wernicke-Korsakoff Syndrome?

Answer 17

Paralysis of the external eye muscles, ataxia, confusion, psychosis, coma, death

Question 18

Differentiate between mild, severe, and extreme alcohol withdrawal syndrome

Answer 18

Mild (6-8 hours after consumption stops, lasts 1-2 days)
- Tachycardia, hypertension, tremor, anxiety, insomnia

Severe (lasts 1-5 days)
Withdrawal seizures – most common cause of seizures in adults
- Alcoholic hallucinations

Delirium Tremens - extreme
Delirium, agitation, autonomic system instability, low grade fever, diaphoresis

Question 19

What is the most common cause of seizure in adults?

Answer 19

Alcohol withdrawal seizures

Question 20

What are the 3 drugs used to treat alcohol withdrawl?

Answer 20

1. Naltrexone
2. Acamprosate – Adjunctive
3. Disulfiram

Question 21

What are the 3 non-pharmacologic treatments for sleep problems?

Answer 21

Proper diet and exercise
Stimulant (caffeine) avoidance
Comfortable sleep environment, routine

Question 22

What are the pharmacologic treatments for sleep problems?

Answer 22

• Benzodiazepines, barbiturates – less effective sleep
• Zolpidem (Ambien) and Eszopiclone (Lunesta) – abuse potential
• OTC – Most are antihistamines

Question 23

What are the effects of alcohol on GABA and glutamate?

Answer 23

• Ethanol enhances the action of GABA at GABA-A receptors
• Ethanol inhibits the ability of glutamate to open the cation channel

Question 24

What is the progression of liver disease from chronic alcohol use?

Answer 24

• Alcoholic fatty liver
  
  • Alcoholic hepatitis
  • Cirrhosis
  • Liver failure

Question 25

What are the common electrolyte imbalances from alcohol intoxication?

Answer 25

Hypoglycemia, hypokalemia

Question 26

What are the effects of alcohol on sleep?

Answer 26

- Induces sleepiness (GABAa potentiation) - Suppresses REM in early sleep (deep sleep, difficult to wake) - Increased wakefulness in later sleep - Prolonged REM in second half - Bizarre and intense dreams

Question 27

What class of drugs are used as “Date-Rape” drugs?

Answer 27

benzodiazepines

Question 28

Most complex focal seizures arise in the ______ lobe

Answer 28

Temporal