Sedatives and Hypnotics

• Lorazepam is a benzodiazepine used for anxiety, insomnia, and seizures
• Drugs given to treat anxiety are sedatives
• Drugs given to treat insomnia are hypnotics
• Lorazepam is contraindicated for patients who are pregnant or who have sleep apnea
• Lorazepam works by binding to the benzodiazepine receptor on GABA receptors and enhancing the inhibitory effects of GABA; GABA must be present for effects to happen
• Adverse effects of Lorazepam include CNS depression (drowsiness/dizziness), amnesia, sleep driving, opposite effects (anxiety, euphoria, excitation, insomnia), and respiratory depression
• Lorazepam has the potential for drug abuse and dependence
• Lorazepam cannot be abruptly discontinued (causes withdrawal)
• Prolonged use of Lorazepam can lead to tolerance to anti-anxiety or hypnotic effects
• Benzodiazepine overdose can be reversed with the antagonist Flumazenil; respiratory depression may not respond to treatment; other treatments include gastric lavage, activate charcoal, saline cathartic, and dialysis
• Lorazepam works best for short-term anxiety management (panic attacks)
• Buspirone is a serotonin agonist that is used for long-term anxiety management; it takes a few weeks for effects to develop; grapefruit will inhibit metabolism of it