PHARMA - SEDATIVES AND HYPNOTICS

#LAST

1. Sedatives should induce drowsiness and encourage

the onset the maintenance of sleep, while hypnotics
reduce anxiety and has a calming effect
2. Hypnotic effects involve a more pronounced
depression of the CNS than sedation. (T/F)
3. How can hypnotic effects be achieved?
4. What drug class are the most widely used anxiolytics?
5. What is the prototype of barbiturates?
6. What is a prodrug that is first converted to its active
form desmethyldiazepam in the stomach?
7. Which enzyme metabolizes most of the
sedatives/hypnotics?
8. Which 2 drugs have metabolites that have shorter half
life, which are considered more as hypnotics than
anxiolytics?
9. What is the only barbiturate that has a significant
portion not metabolized?
10. What is the elimination half life of phenobarbital?
11. Patients with renal insufficiency should never be given
phenobarbital (T/F)
12. Most S/H are given with caution in patients with
hepatic problems, which phenobarbital as the
exception (T/F)
13. Newer hypnotics have phase 1 and phase 2
metabolism (T/F)
14. If patient is given rifampicin along with zolpidem,
bioavailability increases. (T/F)
15. What is a strategy to lower serum phenobarbital
levels during toxicity? What is the rationale behind it?
16. Sedative hypnotics have affinity to both GABAa and
GABAb receptors (T/F)
17. What happens when bdz’s bind to GABAa receptors?
18. Benzodiazepines increase FREQUENCY of channel
opening, while barbiturates prolong DURATION of
opening (T/F)
19. Barbiturates, although binds to GABA receptors
mainly, can also bind glutaminergic receptors. (T/F)
20. What is the reason for the greater CNS/anesthetic
effects of barbiturates?
21. Benzodiazepines, at low doses, have an anxiolytic
effect (T/F)
22. Why are benzodiazepines addictive?
23. At high doses, barbs and bzd’s become hypnotic
agents (T/F)
24. Describe all stages of the sleep cycle (tangina)
25. At what stage of the sleep cycle does the body first
go into deep sleep?
26. At what stage of the sleep cycle does the body make
repairs?
27. At what stage of the sleep cycle does the brain
become more active, and where a person dreams?
28. Sleep progresses in a sequential manner (T/F)
29. Benzos and older drugs reduce sleep onset latency,
increase stage 2 NREM sleep, and increases duration
of REM sleep (T/F)
30. What is the effect of newer agents when it comes to
sleep?
31. Which newer agent decreases REM, and has minimal
effect on slow wave sleep?
32. Which newer agent decreases sleep onset latency,
but has minimum effect on total sleep time?
33. Which newer agent increases total sleep time,
especially stage 2?
34. What is the REM-rebound?
35. Eszopiclone, at high doses, is associated with
rebound insomnia (T/F)
36. Anesthetic agents should preferably be long acting
rather than short acting (T/F)
37. What drug do you give to reverse the respiratory
depression brought about by anesthesia use?
38. What drugs are used to relieve muscle spasm?
39. The newer agents lack anticonvulsant action (T/F)
40. As long as someone is healthy and have no
problems with CV function, sedative hypnotics do not
cause any detrimental effects (T/F)
41. What is the phenomenon of reduced drug response
due to repeated exposure to sedative hypnotics?
42. Tolerance is not observed with newer agents (T/F)
43. The mechanism of tolerance may be due to increase
in what?
44. Tolerance also can be explained by the upregulation
of receptors (T/F)
45. What is the only benzodiazepine antagonist
available in the market?
46. Flumazenil works as an allosteric inhibitor of
benzodiazepine receptors (T/F)
47. If a patient is taking both a benzo and a tca, once
you give flumazenil, it can cause arrhythmias or
convulsions (T/F)
48. Flumazenil can be used for the treatment of
benzodiazepine addiction (T/F)
49. Melatonin agonist drugs (anything with -mel) are
present in which part of the brain?
50. Melatonin agonists have a direct effect on
GABAergic transmission (T/F)
51. Melatonin agonists have withdrawal symptoms when
discontinued (T/F)
52. Which enzymes converts melatonin agonists to
active metabolites?
53. Benzodiazepines and barbiturates can be used for
long term management (T/F) explain the rationale
behind the correct answer
54. For immediate relief of anxiety, what class of drugs
do you give?
55. Anxiety attacks are managed with benzodiazepines
for how many weeks?
56. If you are tapering benzodiazepines, what do you
overlap it with?
57. Which is safer, benzodiazepines or barbiturates?
58. Benzos have amnestic effects (T/F)
59. In the context of sedatives and hypnotics, the
largest dosing should be during the day, and the
minority should be at night. (T/F)
60. Hypnotics can be used for long term treatment (T/F)
61. Abrupt discontinuation of hypnotics have no effects
of rebound insomnia (T/F)
62. At hypnotic doses, there is anterograde amnestic
effects (T/F)