Case Study – Sedative Hypnotics

00:01 Let's do another case study.

00:02 A 45-year old emergency room physician is complaining of anxiety, difficulty sleeping, and an inability to cope with the stresses of his daily job.

00:14 He gets buspirone prescribed to him.

00:16 The following are true about this particular medication.

00:21 A. The patient may not notice improvement for up to 10 days.

00:28 B. Buspirone has a high addictive potential and it should not be given to a person with ready access to multiple medications.

00:37 C. Buspirone acts through antagonizing orexin receptors in the brain.

00:43 Or D. Buspirone will cause sedation and motor coordination issues.

00:49 It should not be used in a person like an ER doctor.

00:53 Which one's true? Right. A is true.

00:58 In fact, this is a very good illustration of where buspirone is, is actually an advantages drug, because it doesn't cause a lot of psychomotor retardation or coordination issues.

01:08 It doesn't cause a lot of addictive issues.

01:11 And obviously, it does not act through the orexin receptor.

01:16 Let's go on to a second case study.

01:18 A 21-year old grocery store clerk complains of occasional rapid heart rate, complaints with sweating, some anxiety, and nausea.

01:28 Episodes are brought about when her supervisors present.

01:32 She doesn't complain of any of these symptoms when she's on holidays, or when she's in social circumstances not related to work.

01:40 The best medication to use in this situation is one of the following.

01:44 A. Propranolol, B. Eszopiclone, C. Zopiclone, D. Tasimelton, or E. Alprazolam.

01:56 So we have several good choices here.

01:58 But I think the best answer for this question is E. Alprazolam.

02:02 Alprazolam is an excellent anti-anxiety medication and it's good for situational anxiety.

02:07 One could suggest A.

02:09 But A, is a little bit different in the sense that it's purely a beta blocker.

02:13 If patients come to you complaining of, you know, pounding chest and pounding tachycardia prior to say doing a speech in front of a large audience, you might want to consider propranolol in that situation.

02:25 But I think in this particular answer, where she has multiple symptoms associated with anxiety, including the sweating and nausea, I think it's reasonable to go to alprazolam.

02:37 Okay, that's it.

02:38 You did really well.

02:39 Good luck on your exams.