Atypical Sedative Drugs – Pharmacology | Lecturio

Atypical Sedative Drugs – Pharmacology | Lecturio


[Music] let’s take a look at some of the atypical drugs there are atypical drugs that will act through the benzodiazepine receptor there are drugs that will act through the melatonin receptor there are also drugs that will act through the serotonin receptor and there are drugs that will act through the newly discovered or xyn receptor the atypical drugs that act through the benzodiazepine receptor include drugs like Zola PEM it causes increased flow through the chloride channel once again it helps gaba by inhibiting the gamma subunit and it binds between the alpha and gamma subunits you can see that it’s a slightly different binding site than both benzodiazepine and flumazenil it acts through only one type of receptor and that receptor which contains the alpha one type of subunit more specific actions with this drug so you get insomnia control without some of the other side effects because you’re now acting on a more specific level of the brain this is why these new drugs seem to be a little bit better for treating insomnia flumazenil or annex 8 is an antagonist to these types of drugs and that’s because flumazenil binding point is actually very closed to drugs like Zola PEM’s binding point it is used as a reversal agent in overdoses from these medications and as I said before it binds at a similar site to both the benzodiazepines and Zola Pam let’s talk about the atypical drugs that act through the melatonin receptor so remelting is melatonin agonist it is active in the suprachiasmatic nuclei so it’s very very useful in insomnia treatment the thing that I like about this class of drugs is that they have a low risk for abuse they are less addictive than the other medically made medications including benzodiazepines now one of the downsides is that it is metabolized through an – an active metabolite by cytochrome systems so in in this regard it will interact with drugs like fluvoxamine and the azole antifungals so be aware that you can get drug interactions with this medication tazer Melton or Helio ta’s is a very commonly prescribed medication once again it also is a melatonin agonist once again it also works in the suprachiasmatic nuclei and it is for this strange disorder called the non 24-hour sleep wake disorder in blind people so let me just explain this really quickly blind people can’t see the Sun for obvious reasons and melatonin is an agent in that is naturally made in the brain in response to light so it helps us with our sleep/wake cycles blind people don’t have that cue so they sometimes have altered melatonin levels this drug is used to help blind people sleep at night and wake during the day it is the only drug I believe that is currently licensed for use in this particular disorder and that’s why I do want you to remember this particular melatonin antagonist because it’s probably the only one that we’ll see in a long time indicated for this sleep disorder let’s move on to the atypical drugs that act through the newly discovered orexin receptor suva reka scent is an erection receptor antagonist it does have very good hypnotic prophy profiles let’s take a look at its profile issues though with respect to safety the safety in addictive risk persons is unknown so we don’t know if it’s going to be a highly addictive medication or not the safety in pregnancy is currently unknown and the safety and breastfeeding is currently unknown so we don’t know a lot of things about this new class of drugs as time goes on we’ll know more and more now you should be aware that this drug class does interact currently with all cytochromes system drugs so it’s an important consideration when you have people on multiple medications as to whether or not you’re going to use these medications atypical drugs that act through the serotonin receptor include buzzer prone or busbar this is a very very commonly used medication it is a selective angio lytic it has minimal sedative effects and motor effects or rebound it acts on the 1a serotonin receptor now serotonin receptors are sometimes called serotonin receptors sometimes they’re called 5-ht receptors so just to be clear 5ht and serotonin are the same thing this drug has a very slow onset of action and it’s used in generalized anxiety disorders but not in panic disorders general as generalized anxiety disorders require long-term treatment panic disorders are relatively rapid on rapid off kinds of problems so long-term drugs don’t work as well in these types of situations we’re going to see the psychiatry lectures later on for more information so we won’t talk about it too much today side effects with these medications the thing i want you to remember is once again these drugs do have interactions through the cytochrome system they can cause tachycardia they can cause meiosis and GI distress as well the thing that you want to remember about this drug and the thing that is important for your exam as well as in practice is that this is one of the few drugs that’s actually safe in pregnancy so this is where it comes into play so let’s summarize some of the sleep disorder drugs that we use in modern medicine we used to use a lot of benzodiazepines like Florida Pam but not so much now because they’ve been replaced by these newer drugs they start with the letter Z so sometimes it’s easy to remember them Zappa Klem Zell upon zopiclone EES Apple clone they all have Z or Z in their in their nomenclature so it’s sometimes easier for us to pick them out they have alpha specific atypical agents acting through the benzodiazepine receptor and these are very effective agents in sleep and insomnia as well and the newer melatonin specific agents are rapidly increasing in popularity there is also a product out in the hirable product world called melatonin a lot of people like to buy melatonin over-the-counter and as a horrible product unfortunately we don’t really know what’s in these bottles some of the bottles that are being sold in herbal product stores have no melatonin specific agents and some of them have too much so it’s very hard to predict whether or not these agents are useful or not there is biological plausibility for them but I say buyer beware and you’re better off just getting something that actually has a USP number there’s going to be a specific subset of patients who are unique and these are people who rely heavily on motor skills so I want you to think of the plastic surgeons and the neurosurgeons in your in in your world and think about if they have anxiety what are we going to treat them with well buzzer prone or busbar has little psychomotor side effects so if you have a person who is heavily dependent on motor skills whether they’re an artist or a surgeon this is a great choice the other reason why this is a good choice is because it’s safe in pregnancy a nice thing about these drugs this particular class of drug is that has a low risk of addiction [Music]

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