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Pre Reg Pharmacy > Chapter 4 - Insomnia > Flashcards

Chapter 4 - Insomnia Flashcards

1
Q

What is insomnia?

A

Difficulty getting to sleep
Difficulty staying asleep
Early wakening
Impaired daytime functioning e.g. impaired concentration, fatigue, mood affected

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2
Q

What is the difference between short and long term insomnia

A

Short term - less than3 months

Long term - symptoms occurring in more than 3 nights a week for more than 3 months

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3
Q

List some lifestyle advice for insomnia

A

Make sure that the bed is comfortable
Only use the bedroom for sleeping
Avoid blue light displays for 2 hours before bedtime
Don’t clockwatch (may help to remove clocks)
Avoid eating a large meal or drinking alcoholic for 2 hours before bed
Avoid caffeine after midday
Avoid exceeding within 4 hours before bed
Do exercise earlier in the day
Go to bed and wake up at the same time each day
Don’t nap in the day
Try not to go to bed too early

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4
Q

How is short term insomnia managed?

A

First, try lifestyle measures
Address triggers e.g. stress

If ineffective use a short term s-drug
Don’t prescribe routinely

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5
Q

How is long term insomnia managed?

A

Lifestyle advice
Address triggers

For severe exacerbations, a short course of hypnotics can be considered

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6
Q

What should be used for insomnia in the elderly?

A

Melatonin (over 55 years)

Initial duration over 3 weeks
If there is a response to treatment can do up to 10 weeks

Risks include falls and fractures (same with all hypnotics)

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7
Q

What are the main indications of benzodiazepines?

A

Short term use in anxiety and insomnia

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8
Q

What are the withdrawal symptoms associated with benzodiazepines?

A

Anxiety
Treat or
Rebound insomnia
Loss of appetite

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9
Q

How do you withdraw a benzodiazepine?

A
  1. Transfer the patient in a stepwise manner to the equivalent dose of diazepam
  2. Reduce the dose of diazepam gradually by 1-2mg every 2-4 weeks
    It may be necessary to reduce the dose by 500mcg near the end
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10
Q

List some examples of

a) long action benzodiazepines
b) short acting benzodiazepines

A

a) diazepam, nitrazepam, flurazepam

b) lorazepam, temazepam

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11
Q

Is withdrawal a bigger issue with long or short acting benzodiazepines?

A

Short acting

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12
Q

Why should benzodiazepines and a-drugs be avoided in the elderly?

A

They may lead to confusion, falls and injury

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13
Q

Which z-drugs are used in insomnia?

A

Zopiclone

Zolpidem

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14
Q

Are zolpidem and zopiclone short or long acting?

A

Short acting

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15
Q

Which antihistamines can be brought OTC for insomnia?

A

Promethazine

Diphenhydramine

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16
Q

What limits the use of antihistamines in insomnia?

A

Their long duration of action
This can often lead to drowsiness the next day

They are also associated with antimuscarinic side effects

17
Q

Should alcohol be used for sleep disorders?

A

No, they can worsen sleep disorders

18
Q

Why shouldn’t opioids and temazepam be co-prescribed?

A

Risk of respiratory depression

Symptoms include SOB

19
Q

What are the main side effects of temazepam?

A 
Respiratory depression
Sedation 
Paradoxical side effects 
Hypotension 
Withdrawal, tolerance, dependence
20
Q

What classification is temazepam?

A

CD3

21
Q

When should melatonin be taken?

A

Adults >55 - 1-2 hours before bedtime

Patients with learning difficulties - 30-60 minutes before bedtime

22
Q

How long should melatonin be used in:

a) jet lag
b) insomnia in adults over 55

A

a) 5 days

b) 13 weeks

23
Q

Should melatonin be taken with or without food?

A

Modified release - with food

Immediate release - empty stomach

24
Q

What doses of zopiclone should be given in insomnia?

A

Adult - 7.5mg at bedtime

Elderly - 3.75-7.5mg at bedtime

25
Q

How long should zopiclone or zolpidem be used for in insomnia?

A

Max 4 weeks

26
Q

List some contraindications of z-drugs

A

Pregnancy
Psychotic illnesses
Obstructive sleep apnoea
Neuromuscular respiratory weakness

27
Q

List some side effects of z-drugs

A

GI - nausea, vomiting, dry mouth
Neurological - confusion, dizziness, headache, respiratory depression
Psychiatric effects - depression, suicide ideation, aggression, delusions hallucinations, inappropriate behaviour
Dependance, tolerance, withdrawal

28
Q

How long should patients leave between taking zolpidem and driving?

A

8 hours

29
Q

What is narcolepsy?

A

A brain condition causing for people to suddenly fall asleep at inappropriate times

30
Q

What treatment options are there for narcolepsy?

A

CNS stimulants - modafinil, methylphenidate, pitolisant

CNS depressant - sodium oxybate - this is not yet funded on the NHS

31
Q

What classification is sodium oxybate?

A

CD2

32
Q

Can modafinil be used in pregnancy?

A

No, it can cause congenital malformations

Pre Reg Pharmacy (36 decks)

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