MDP, Acute mania, Neuralgias

Valproic acid
 Insomnia-
Nature of sleep


disruption Duration of symptoms



• Difficulty falling asleep • Transient: <3 days.

 (sleep onset Stress. Sleep hygiene.
insomnia) Jet lag, Envn.
• Frequent or sustained • Short term: 3d-3weeks.
awakenings (sleep
maintenance Grief, Illness
insomnia) • Long term: >3 weeks.
• Persistent Medical problems,
sleepiness/fatigue psychiatric disorders.
despite sleep of
adequate duration 

 (non-restorative •
sleep).
 Pharmacotherapy
• Difficulty getting to sleep,
• Fast-onset, short-acting agent-
[TRIAZOLAM]
• Middle-of-the-night insomnia,
• Intermediate-onset, intermediate
acting
 Benzodiazepine-[Temazepam]
• Problems both falling asleep and
staying asleep,
• Fast onset, intermediate, longer-acting
agent [Flurazepam]
 Zaleplon

Rapid-onset,
short-acting Later peak, Late onset,
Longer-acting Intermediate-acting

PD Advantages-Selective action on GABA A

Subunitα1receptors
PK Advantages- rapid onset and short duration.
Non - Benzodiazepines
 Treatment of insomnia –Sleep hygiene
üGo to bed only when sleepy
üUse bed & bed room only for sleeping &
sex
üIf awake after 20 mts leave the bed room
üGetup same time every morning-regardless
of sleep at night
üDiscontinue coffee & Nicotine (at least
evenings)
üReg.ex.regimen
üAvoid alcohol
üRelaxation therapy*
M id a zo la m : Anesthesia-Inducing, maintianing, supplementing
Endoscopies , Angiographies , ECT ,
 Conscious sedation
• Altered level of consciousness
ü Respond to physical stimulation
ü Verbal commands,
ü Unassisted airway

Biopsy, radiologic imaging study,



endoscopic procedure, radiation

therapy, or bone marrow aspiration.
Impair learning , Short term memory , sedation
 Delirium tremens
Delirium , [mental confusion, agitation, and fluctuating
levels of consciousness] hallucinations , and autonomic
instability — develops 48 – 72 hours after alcohol
discontinuation .
 Delirium tremens
• Haloperidol 0.5–5 mg PO or IM every 48
h [↓Seizure threshold]
• Short-acting benzodiazepine such as
lorazepam -1–2 mg PO or IV)- ?CNS
Dep
• Ziprasidone -10 mg IM every 2h, up to 40
mg
• Olanzapine (2.5–10 mg IM repeated at 2
h and 6 h,
• Admission to a locked ward
 Denatured spirit poisoning
• There are three specific modalities of
treatment for severe methanol
poisoning:
1.Suppression of metabolism by alcohol
dehydrogenase to toxic products,
 Ethanol and Fomepezole
2. Hemodialysis to enhance removal of
methanol and its toxic products,
3. Alkalinization with Sod.
Bicarbonate to counteract
metabolic acidosis.
Name a GA preferred in asthmatic patient undergoing surgery

Halothane :

Bronchodilator
Non - irritant
Decrease secretions and vagal stimulations [Atropine] Amnesia and antiemitic
[Scopalamine]