Sedative Hypnotic

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Sedative Hypnotic

  1. 1. Sedative Hypnotics Anti-Anxiety Agents PharmacologyClinical Management of Anxiety & Sleep Disorders
  2. 2. Anxiety & Panic Disorders • Uneasiness, worry, apprehension • Fearful feelings • Interferes w/life • Inappropriate response • Self-tx w/ Etoh
  3. 3. Sleep Disorders• Transient – Results from stress or change (days)• Short Term – Persistent major life stress(3 weeks)• Chronic – Medical/psych illness
  4. 4. Stages of Sleep Stage2 Stage 1 Non REM 2-5% 67-75% Stage 3 & 4 REM sleep Deep sleep 25-33% 15-25%
  5. 5. Sleep Hygiene• Arise same time • Alternative medicines• Avoid daytime naps • Antihistamines• Avoid Etoh, large • OTC meals, nicotine, • Sedating caffeine antidepressants• Good sleep area • benzodiazepines• Increase exercise• Got Milk?
  6. 6. Etiology• Situational • Organic Disease – Acute – GIT – Unpleasantness • Ulcer – Procedure (MRI) – Cardiovascular • MI• Chronic • Angina – Excessive, unreasonable worry/panic about life
  7. 7. CNS Pathway (Dose Dependant)• Sedation• Hypnosis• Anesthesia• Coma
  8. 8. Treatment Options for anxiety & insomnia• Non Pharmacologic • Pharmacologic – Good sleep hygiene Overview – Sleep restriction – Alternative medicines – Relaxation training – Antihistamines – Cognitive behavior – Barbiturates therapy • Phenobarbitol – Benzodiazepines – Non-Benzodiazepines • OTC sleep aids • Sedating Anti- depressants
  9. 9. Bens & Barbs (no, it’s not Barbie’s newboyfriend)• Benzodiazepines • Tolerance• Organ Effects – Psychological – Sedation – Physiological – Hypnosis • Selected Agents – Anesthesia – Diazepam – Muscle Relaxation – Flurazepam – Respiratory – Prazepam – Cardiovascular – Clorazepate – Alprazolam
  10. 10. Miscellaneous Agents• Buspirone (Buspar) – Non-controlled, non-addicting• Zaleplon (Sonata)• Zolidem (Ambien)• Meprobamate (Miltown)• Hydroxyzine (Atarax) – Antihistamine
  11. 11. Sedative Drug Interactions• Other CNS depressants & Etoh• Herbals (Kava, valerian root)• Barbs & warfarin – increase metabolism of warfarin reduce effect• Barbs & BCP – Increase metabolism of BCP reduce effect
  12. 12. Clinical Management• Long term use of sedative hypnotics is irrational & dangerous medical practice.• Stepped Care• Risk versus Benefit – Taper • Go low, go slow

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