Botanical and herbal medications are available anywhere and they don't need a prescription.  Although herbal medications possess numerous health benefits and low risks of tolerance and dependence developing, there is no guarantee that they are safe and effective. They were not approved by SAHPRA, thus we do not know their side effects or their interaction with other drugs.  If a patient considers taking herbal medication/supplements, they should first consult with a doctor or pharmacist. 

The following botanicals/herbal remedies can be used for anxiety and insomnia: Passion Flower, Ginseng, Valerian root, Lavender, Lemon Balm, Glycine, Magnesium, St. John's Wort and Melatonin. 

1.) Rate is determined by lipophilicity. High lipid solubility = rapid absorption from the gastrointestinal tract and good distribution of the drug to the brain. 

2.) Redistribution refers to when high lipid soluble drugs are distributed to organs with high blood flow such as the brain, heart and kidneys. This increases the duration of action of the drug.

3.) Metabolism of BD's:

•  Dealkylation of active metabolites
• Oxidation catalyzed by the Cytochrome P450 isozymes. 
• Conjugation of oxidized metabolite to form glucuronides that are excreted in the urine. 

4.) Diazepam, Chlorazepate, Chlordiazepoxide, Prazepam and Ketazolam.  They all undergo the 3 steps of biotransformation and prolong the duration of action. 

5.) Oxazepam, Lorazepam, Temazepam and Lormetazepam.

Can be used in patients who have a low Cytochrome P450 activity and can be used in neonates, the elderly and patients who suffer from Liver Cirrhosis. 

6.) Enzyme induction refers to an increase in the metabolic activity of a drug. 

Barbiturates (Phenobarbital, Thiopental, etc) are known for this effect.

An increase in the rate of metabolism will cause a decrease in the therapeutic effect of the drug

What does anterogade amnesia mean and which drugs cause this effect?

Anterogade amnesia refers to the inability to learn new information or when a person finds it difficult to remember past events. 

Alprazolam is an example of a drug that can cause anterogade amnesia

Name the effects of sedative-hypnotic drugs on normal sleep patterns and explain the significance to the patient.

Reduces the time it takes to fall asleep

Increase in the duration and quality of the sleep (longer hours of sleep)

Sedative-hypnotics can help patients who suffer from insomnia or have difficulty sleeping, and it also improves the quality of the sleep by decreasing the REM (rapid eye movement) sleep. 

Which of the sedative-hypnotics are used as supplementary therapy in anesthesia and why?

Midazolam, Diazepam or Thiopental

High doses thereof can lead to a loss of consciousness, followed by amnesia and suppression of the reflexes. 

Which of the sedative-hypnotics are used as anti-convulsant?

Clonazepam, Nitrazepam, Lorazepam, Diazepam and Phenobarbital

What is the mechanism of the muscle-relaxing effects of carbamates and benzodiazepines?

Possess inhibitory effects on polysynaptic reflexes and can depress transmission at the skeletal neuromuscular junction if administered at high doses

Discuss the effects of the sedative-hypnotic drugs in the respiratory and cardiovascular system

Sedative-hypnotics can cause respiratory depression (medullary respiratory center) in patients who suffer from pulmonary diseases. The effects depend on the dose.

Sedative-hypnotics in hypovolemic patients may cause cardiovascular depression, even if administered in normal doses, due to action of the medullary vasomotor centers. 

1.) Voltage-gated and Ligand-gated

2.) Voltage-gated channels:

• Reacts when there is a change in membrane potential
• Highly concentrated channels
• Calcium and Potassium acts on a slower time scale

Ligand-gated channels:

• Opens  when neurotransmitter binds to ligand directly
• Channels are weakly sensitive to membrane potential
• When the channel gets activated, the channels opens for a short time

3.) Ionotropic receptors are responsible for fast synaptic transmission and metabotropic receptors are responsible for slow postsynaptic inhibition. 

4.) Ionotropic receptors

• GABA = IPSP
• Nicotinic = EPSP
• Glutamate = EPSP
• 5-HT = EPSP

Metabotropic receptors

• 7 Transmembrane G-protein coupled receptor

5.)  EPSP causes the postsynaptic membrane generate an action potential, whereas the IPSP  causes the postsynaptic membrane to less likely generate an action potential. 

6.) Calcium stimulates the synaptic vesicles, to release the neurotransmitters.