Chap 22: Sedative/Hypnotics

INTRODUCTION
- sedative = anxiolytics = reduce anxiety + exert calming efx - CNS depressive efx minimal
- hypnotics = CNS depression = produce drowsiness + induce sleep state
- many sedatives - increase dose = hypnotics- drug A = alcohol, barbiturates --> can cause anaesthesia + death
- drug B = BZD, newer hypnotics --> needs higher dose to cause anaesthesia

Chemical classifications of sedative/hypnotics
- BZD

• most BZD contain carboxamide group

- barbiturates

• glutethimide + meprobamate - different structures than barbiturates but similar efx
• ethanol, chloral hydrate
  

- zolpidem (imidazopyridine), zaleplon (pyrazolopyrimidine), eszopiclone (cyclopyrrolone), ramelteon (melatonin receptor agonist), buspirone (slow-onset anxiolytic agent)

• all structurally unrelated to BZD but similar MOA

- antipsychotics, antidepressants, antihistamine

PHARMACOKINETICS
Absorption + distribution
- depends on fat solubility
- all cross placental barrier + CNS system, detectable in breast milk --> CNS depressant efx

Metabolism (Biotransformation)
- BDZ

• liver clears all BZD
• phase I (oxidization) and II (conjugation)
• individual drugs has different biotransformation --> some after phase I are metabolically active hence longer T1/2

- barbiturates

• hepatic oxidation to form alcohols, acids + ketones
• usually slow in metabolism hence barbiturates have long T1/2 eg phenobarbital 4-5 days
• beware of multiple dosing
  

- newer hypnotics

• zolpidem reaches peak in 1.6 hrs --> elimination T1/2 1.5-3.5 hrs
  

Excretion
- by kidney

PHARMACODYNAMICS
Molecular pharmacology of GABA*vA receptor
- binds to molecular components of GABA*vA receptors
- GABA*vA receptors - neuron membranes in CNS
A model of the GABA_A receptor-chloride ion channel macromolecular complex (others could be proposed). A heterooligomeric glycoprotein, the complex consists of five or more membrane-spanning subunits. Multiple forms of a, b, and g subunits are arranged in different pentameric combinations so that GABA_A receptors exhibit molecular heterogeneity. GABA appears to interact with a or b subunits triggering chloride channel opening with resulting membrane hyperpolarization. Binding of benzodiazepines to g subunits or to an area of the a unit influenced by the g unit facilitates the process of channel opening but does not directly initiate chloride current.
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Chap 42: Bone Mineral Homeostasis

Introduction
- Ca + PO4 - 2 most important minerals for cell function
- Bone is major storage

• 98% of total 1-2kg of Ca
• 85% of 1kg of PO4

- 2 hormones important - PTH and Vit D
-
Non hormonal agents affecting bone mineral homeostasis
Bisphosphonates
- analog of pyrophosphate
- inhibit formation and dissolution of hydroxyapatite crystals in/out skeletal system
- predilection for bone - effects come from osteoclasts
- <10%> take with empty stomach --> 50% accumulates in bone, 50% renally excreted unchanged
- SE:

• gastric irritation/esophageal irritation --> glass of H2O, sitting upright 30 mins
• osteonecrosis of the jaw
• renal damage

- clinical uses

• alendronate - seemed to increases bone mineral density over 2 yrs hence used in osteoporosis/# NOF
• zolendronate - hyperCa 2ary to malignancy
• pamidronate - same as above but cheaper, less potent

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