Case Study – Sedative Hypnotics

by Pravin Shukle, MD

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    00:01 Alright, here is a question that I'd like to call physician heal thyself and then get back to work. So here is a 45 year old emergency physician is complaining of anxiety, difficulty sleeping and an inability to deal with the stresses of work.

    00:15 Buspirone is prescribed. The following are true about this medication. A, the patient may not notice improvement for 10 days.

    00:24 B, buspirone has a high addictive potential and should not be given to a person with ready access to medications.

    00:31 Is it C, buspirone acts through antagonizing orexin receptors in the brain? Or D, it may cause sedation and motor coordination problems and it should not be used in this patient? Which one is correct? Right, A. This is the downside of this particular agent but otherwise it has a lot of advantages. In a person who requires on their motor skills you really want to give this drug.

    01:00 It does not really have a high addictive potential which is another advantage. And in terms of how it acts, it does not act through the orexin receptors, so C is incorrect. Let's take a look at a 21 year old grocery clerk who complains of occasional rapid heart rate, sweating, anxiety and nausea. Now what brings this symptoms on. It's brought about when her supervisor is present. She doesn't complain of any symptoms when she is on holidays or away from work. The best medication to use in this situation is propranolol, eszopiclone, zopiclone, tasimelteon or alprazolam? Okay so let's take a look at our choices here. The correct answer is alprazolam. Let's see why the other ones are not correct. A, propranolol. Propranolol is a beta blocker, a very old drug and it was one of the first drugs used in anxiety treatment. Propranolol blocks the adrenaline response of anxiety and so it masks some of the symptoms. Propranolol is used in very rare situations like stage fright where people still need to be highly alert on their game, but the symptoms only occurs when they are speaking. So propranolol can be a choice but it's not the best choice. Eszopiclone and zopiclone are great agents for generalized anxiety disorder and they are great agents for insomnia but they are not particularly good agents for acute anxiety states brought about by situations or what we call panic attacks. Tasimelteon is a fantastic drug for managing sleep disorder and it's a great drug for insomnia, not so much for generalized or acute anxiety. The correct answer is alprazolam, a short acting benzodiazepine. It works well, it calms the limbic system and it would be the drug of choice in this situation.

    03:06 Well there you have it. If you have any concerns or questions, just email us. And good luck on your exams.

    About the Lecture

    The lecture Case Study – Sedative Hypnotics by Pravin Shukle, MD is from the course CNS - Pharmacology.

    Author of lecture Case Study – Sedative Hypnotics

     Pravin Shukle, MD

    Pravin Shukle, MD

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