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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
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