Sleep

Question 1

The primary drugs for insomnia are ______, which should not be used for longer than ____

Answer 1

hypnotics, benzodiazepines and benzodiazepine receptor agonists (BZRA)
melatonin
1st generation antihistamines

2-3 weeks

Question 2

First line treatment for insomnia are ____

Answer 2

Benzodiazepines (alprazolam, lorazepam)
BZRA (Zolpidem, zaleplon, escitalopram)
ramelteon (Melatonin receptor agonist)
1st gen antihistamine doxylamine

Question 3

The only pregnancy category A medication for sleep defect is __

Answer 3

Doxylamine succinate (antihistamine)

Question 4

Second line treatment for insomnia includes ___

Answer 4

short acting alternating BZRA (Zaleplon) with ramelteon
and
sedating antidepressants (ie Trazodone, amitriptyline, mirtazapine)
Doxepin

Question 5

Third line therapy for insomnia includes ______, and ____

Answer 5

antiepileptics like gabapentin

atypical antipsychotics such as olanzapine and quetiapine

Question 6

eszopiclone (Lunesta)

Answer 6

BZRA indicated for insomnia
need at least 6-8 hours of sleep
fatty meals can delay onset
2nd line treatment

Question 7

Zolpidem tartrate (Ambien)

Answer 7

BZRA

lasts for 2-3 hours

Question 8

Zaleplon (Sonata)

Answer 8

BZRA

5-6 hours

Question 9

suvorexant (Belsomra)

Answer 9

Orexin receptor agonist 
found in hypothalmus 
onset of action occurs within 30 minutes 
lass up to 6 hours 
need 7 hours planned sleep

Third line

Question 10

Ramelteon

Answer 10

melatonin receptor agonist
onset 45min
half life 1-2.6 hrs
1st and 2nd line treatment

do not take with fatty meal

Question 11

Two examples of 1st generation antihistamines used for insomnia are ___ and ___

Answer 11

diphenhydramine

doxylamine succinate