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Board Review > InsomniaFC > Flashcards

InsomniaFC Flashcards

1
Q

Drugs Likely to Contribute to Insomnia

A

Bupropion
Stimulants
OTC appetite supressants
Decongestants
MAO-B inhibitors
Fluoxetine
Caffeine
Steroids
Alcohol
Antihistamines or diuretics taken later in the day

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2
Q

Sleep Hygiene Methods to Improve Sleep

A

Keep the bedroom dark, comfortable, and quiet
Regular sleep schedule
Avoid daytime naps (limit to 30 mins)
Reserve bedroom for only sleep and sex
Turn the face of the clock away
Establish a pre-bedtime ritual
Avoid exercising before bed
Do not eat heavy meals before bed
Avoid Caffeine in the afternoon

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3
Q

Natural Products for Insomnia

A

St. John’s wort
Chamomile tea
Melatonin
Valerian

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4
Q

Non-Benzodiazepines MOA

A

Act selectively at the benzodiazepine receptors to increase GABA

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5
Q

Z drugs names

A

Zolpidem (Ambien, Zolpimist - oral spray, Edluar - SL tabs, Intermezzo - SL tabs for nighttime awakenings), Zaleplon (Sonata), Eszopiclone (Lunesta)

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6
Q

SE z drugs

A

-SE: increase risk of mortality, abuse, somnolence, dizziness, ataxia, parasomnias, lightheadedness, “pins and needles” feeling on skin

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7
Q

how to take the z drugs

A

Do not take with fatty food, a heavy meal, or Alcohol

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8
Q

why take z drus over bzds?

A

Preferred over benzodiazepines (due to decrease abuse, dependence, and tolerance)-

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9
Q

DDIs with z drugs

A

-Caution use with potent 3A4 inhibitors

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10
Q

Non-Benzodiazepines Patient Counseling : zolpimist

A

Zolpimist: spray directly into your mouth over your tongue (once for 5mg; twice for 10mg); prime if 1st-time use

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11
Q

how to take the z drugs ?food or no food?

A

heavy or high-fat meals may prevent medication from working

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12
Q

how long for wd sx to go away for z drugs

A

Withdrawal symptoms subside after 1-2 days

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13
Q

Melatonin Receptor Agonist name

A

Ramelteon (Rozerem)

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14
Q

melatonin SE

A

SE: somnolence, dizziness

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15
Q

dose of melatonin for insomnia

A

Dose: 8mg QHS

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16
Q

how to take melatonin

A

Do not take with fatty foods

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17
Q

adv of melatonin

A

not limited to short-term use

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18
Q

Tricyclic Antidepressants for insomina

A

Doxepin ER (Silenor), Generic Doxepin, trazodone, mirtazapine are used off-label for sleep

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19
Q

tcas contraindications

A

-CI: requires 2 week washout for MAOIs

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20
Q

why use TCAs for insomnia

A

-Used for difficulty “staying” asleep

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21
Q

SE of tcas

A

SE: somnolence, anticholinergic SEs, low incidence of nausea and upper respiratory infection

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22
Q

doxepin dose for insomnia

A

6mg qhs , 3mg if older than 65

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23
Q

Benzodiazepines MOA

A

Potentiate GABA, an inhibitory neurotransmitter, causing CNS depression

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24
Q

ativan

A

Lorazepam (Ativan)

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25
Q

restoril

A

Temazepam (Restoril)

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26
Q

caution for quazepam

A

Quazepam (Doral): Caution in elderly due to its long half-life (risk of falls and fractures)

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27
Q

caution with flurazepam

A

Flurazepam (Dalmane): Caution in elderly due to its long half-life (risk of falls and fractures)

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28
Q

caution and CI from triazolam

A

Triazolam (Halcion): associated with higher rebound insomnia and daytime anxiety; CI with efavirenz (Sustiva), delavirdine (Rescriptor), azole antifungals, PIs, and all 3A4 inhibitors

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29
Q

Benzodiazepines (SE & Monitoring)

A

Potential for abuse and dependence
SE: drowsiness, dizziness, ataxia, lightheadedness, anterograde amnesia
Withdrawal symptoms when discontinued

30
Q

which bzds to use in the elderly?

A

-L-O-T (lorazepam, oxazepam, & temazepam) can be used in elderly

31
Q

Antihistamines MOA

A

Block histamine H1 receptors

32
Q

benadryl, sominex, unisom generic and dose for insomnia

A

-Diphenhydramine (Benadryl, Sominex, Unisom): 25-50mg QHS

33
Q

aldex, unisom, generic and dose for insomnia

A

-Doxylamine (Aldex, Unisom): 25mg QHS

34
Q

SE of antihitimaines

A

SE: sedation, confusion, dry mouth, urinary retention, blurry vision, increase IOP, constipation

35
Q

which population to avoid antihistiamines

A

Best to Avoid use in elderly and patients with BPH or glaucoma

36
Q

non benzos over benzo why chose?

A

non benzo preferred b/c less abuse potential.

37
Q

parasomnias

A

common w/ non benzos.

38
Q

sleepign agents and fatty foods

A

non benzos and remelton should not be taken w/ fatty food b/c it delays the absorption.

39
Q

eszoplicone dosing

A

1 mg if difficulty falling asleep, 2 mg if difficulty staying asleep or 3 mg if helpful for a longer duration of sleep.

40
Q

non benzos substrates of?

A

cyp 3A4. so w/ inhibitors need lower dose (erythromycin and itraconazole)

41
Q

concerns with non benzos (z drugs)

A

they work the same way as the benzos and can cause increase the risk of death, even if used intermittently, due to issues such as difficulty breathing at night, increased risk of falls, infection and possibly cancer.

42
Q

how to go from immediate release to control release for a drug

A

making a drug controlled-release adds about 2.5 mg for each 10 mg of the immediate-release. In this case, it is exactly that amount.

43
Q

remelton brand and controlled status and MOA

A

rozerem. non controlled. melatonin receptor agonist instead of gaba.

44
Q

elderly benzos:

A

doral and dalman have high fall risk. and triazolam ANOTHER do not use benzo (high rebound insomnia and anxiety- psychiatric effects. slow tapering upon discontinuation and CI.

45
Q

which bz to use in elderly

A

Elderly, if using a benzodiazepine, should use L-O-T:
Lorazepam, for sleep or anxiety
Oxazepam, for anxiety
Temazepam, for sleep

46
Q

diphenhydramine brand names

A

benadryl and sominexx. recall benadryl can it more difficult to urinate; it will worsen prostate symptoms.

47
Q

Intermezzo SL what is it useflu for?

A

is a form of zolpidem that is useful for patients who wake up during the night and need to sleep at least four more hours.

48
Q

zolpidem other forms

A

tablet, a spray, a sublingual tab called Edluar and a new sublingual formulation that is for night-time awakening called Intermezzo.

49
Q

Ambien

A

Zolpidem

50
Q

Zolpimist

A

Zolpidem spray

51
Q

Edluar

A

Zolpidem SL tabs

52
Q

Intermezzo

A

Zolpidem SL tabs

53
Q

Sonata

A

Zaleplon

54
Q

Lunesta

A

Eszoplicone

55
Q

Rozerem

A

Ramelteon

56
Q

Silenor

A

Doxepin ER

57
Q

Remeron

A

Mirtazapine (off-label)

58
Q

Desyrel

A

Trazodone (off-label)

59
Q

Sinequan

A

Doxepin (off-label)

60
Q

Ativan

A

Lorazepam

61
Q

Restoril

A

Temazepam

62
Q

Prosom

A

Estazolam

63
Q

Doral

A

Quazepam

64
Q

Dalmane

A

Flurazepam

65
Q

Halcion

A

Triazolam

66
Q

Benadryl

A

Diphenhydramine

67
Q

Sominex

A

Diphenhydramine

68
Q

Unisom

A

Diphenhydramine

69
Q

Unisom nighttime

A

Doxylamine

70
Q

Aldex

A

Doxylamine

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