Term
| Which 5 benzodiazepines have the fastest onset of action? |
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Definition
Diazepam (Valium)
Lorazepam (Ativan)
Alprazolam (Xanax)
Triazolam (Halicon)
Estazolam (ProSom) |
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Term
| What are the 8 long-acting benzodiazepines? |
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Definition
Diazepam
Chlordiazepoxide
Clonazepam
Clorazepate
Flurazepam
Prazepam
Quazepam
Halazepam
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Term
| Which benzodiazepine given orally has the shortest half-life? |
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Definition
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Term
| Which 4 benzodiazepines have a half-life of 8-30 hours? |
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Definition
| lorazepam, oxazepam, temazepam, estazolam |
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Term
| What is the half-life of alprazolam? |
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Definition
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Term
| What are the three "Z drugs"? What is their mechanism of action? |
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Definition
Zaleplon, zolpidem, eszopiclone
They have selectivity for certain subunits of the GABA receptor |
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Term
| What is the mechanism of action of benzodiazepines? |
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Definition
| Activate the three specific GABA-benzodiazepine (GABA-BZ) binding sites on the GABAA receptor, opening Cl- channels and reducing the rate of neuron and muscle firing |
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Term
| What is the advantage of z-drugs compared with benzodiazepines in the treatment of insomnia? |
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Definition
| Less of a rebound effect upon discontinuation |
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Term
| How is flumazenil administered? |
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Definition
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Term
| What is the serious side effect of flumazenil? Which 3 groups are most vulnerable to it? |
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Definition
| Seizures, especially in persons with seizure disorders, those physically dependent on BZDs, or those who've ingested large quantities of BZDs. |
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Term
| What danger is present in mixed-drug overdoses when flumazenil is given? |
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Definition
| The toxic effects of other drugs, which so far had been treated by the BZDs, may now become apparent. |
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Term
| If a person has not responded 5 mins after a total of 5 mg of flumazenil, what should be done next? |
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Definition
| The major cause of sedation is probably not BZDs - search for a different cause. |
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Term
What percentage of patients using benzodiazepines experience:
1. Drowsiness?
2. Ataxia?
3. Dizziness? |
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Definition
1. Drowsiness - 10%
2. Ataxia - 2%
3. Dizziness - 1% |
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Term
| Which benzodiazepines may cause anterograde amnesia? |
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Definition
| High-potency benzodiazepines, especially triazolam, and zolpidem. |
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Term
| What unique side effect has been described with triazolam? |
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Definition
Serious aggressive behavioral manifestations.
Unclear if this is true. |
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Term
| What are the 7 conditions that are relative CIs to benzodiazepine treatment? |
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Definition
History of substance abuse
Cognitive disorders
Renal disease
Hepatic disease (may cause coma)
Porphyria
CNS depression
Myasthenia gravis |
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Term
| Which two groups require dosage adjustment of zolpidem and zaleplon? |
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Definition
Elderly
Hepatic impairment |
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Term
| What rare side effect has been associated with zolpidem? Which group of patients is especially susceptible? |
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Definition
| Hallucinations. Patients treated with zolpidem and SSRIs take longer to recover from the hallucinations. |
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Term
| Benzodiazepine withdrawal syndrome appears in how many patients treated for >2 weeks? |
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Definition
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Term
| Which benzodiazepine is particularly associated with an immediate and severe withdrawal syndrome? |
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Definition
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Term
| Which drug can be used to ease withdrawal from a benzodiazepine, resulting in a more rapid and better-tolerated withdrawal? |
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Definition
| Carbamazepind 400-500 mg/d |
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Term
| Two specific benzodiazepines may rise to toxic plasma levels when combined with two specific other drugs. Which are they? |
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Definition
| The plasma concentration of triazolam and alprazolam are increased to potentially toxic levels by nefazodone and fluvoxamine. |
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Term
| The combination of benzodiazepines with which antipsychotic should be avoided? |
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Definition
| Clozapine - may cause delirium |
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Term
| What is ramelteon (Rozerem)? |
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Definition
| A hypnotic. Targets melatonin MT1 and MT2 receptors in the brain's suprachiasmatic nucleus. |
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