8 - Insomnia Flashcards Preview

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Flashcards in 8 - Insomnia Deck (22):
1

How often does insomnia need to occur for the diagnosis?

3 nights/week for 3 months

2

Everyone should be screened for ?

obstructive sleep apnea

3

Non-pharms?

sleep hygiene specific to the patient

4

What are the 3 categories for insomnia agents?

-Benzos
-BZD receptor agonists
-Other hypnotics

5

What are the 4 BZD approved by HC for insomnia?

Which ones are not recommended?

-flurazepam, nitrazepam, temazepam and triazolam

-the first 2 are not recommended, esp in elderly (long t1/2 and can accumulate)

6

Which benzos should you try first?

-temazepam
-triazolam

7

Which BZD is more suited for initial insomnia than maintenance insomnia?

triazolam - has fast onset and short DOA so more suited for initial insomnia than maintenance insomnia

8

Describe when patients should take oxazepam

Slow absorption
-take 60-90 mins before bed if used for initial insomnia
-take at bedtime if used for maintenance insomnia

9

What class is zopiclone from?

BZD receptor agonist

10

Zopiclone: patients should not drive until at least ___ hours after the dose

12

11

When is zolpidem used for?

for complex sleep disorders

12

Who should get a lower dose of Zolpidem?

women and elderly

13

Do not combine zolpidem with _____

alcohol

14

High doses of ______ may be useful in those who want to avoid BZD

L-tryptophan (> 1 g)

15

Should people try melatonin?

Yes - evidence for efficacy is controversial but bc it has low s/e everyone should try it

16

What is the TCA approved for sleep maintenance insomnia?

doxepin

17

______ can double doxepin serum concentrations

cimetidine

18

_____ is available in US only and has high selectivity for melatonin receptors. It is effective and well-tolerated.

Rameltron

19

What is Suvorexant?

-orexin 1 and 2 receptor antagonist
-not available in Canada
-next day somnolence can occur and can increase digoxin levels

20

What is orexin?

orexin sustains wakefulness, so blocking it's receptors promotes sleep

21

What can we recommend for pregnancy after non-pharms?

-although lacking evidence, zopiclone could be used intermittently (assess risk vs benefit)
-do not use BZD - can cause orofacial malformations

22

What can we recommend for breastfeeding after non-pharms?

BZD, zolpidem or zopiclone

*not doxepin

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