CBT for Insomnia- Hypnotics Flashcards
(24 cards)
What is meant by hypnotic ?
A drug used to induce sleep
They do not treat any underlying causes. They only provide relieve for insomnia symptoms
Why should hypnotics not be prescribed indiscriminately and why is routine prescribing undesirable ?
Increase risk of dependance
Risk of falls
Risk of cognitive impairments
Risk of accidents
Risk of dementia
Risk of withdrawal symptoms
Should non-pharmacological treatments be continued when patient is taking hypnotics ?
Yes including sleep hygiene and psychological approaches
Name 6 hypnotic medication
Clomethizole Zopiclone Melatonin Lorazepam Diazepam Promethazine
What is a benefit of using clomethiozole ?
Free from hangover effect
What is melatonin ?
Pineal hormone which is licences for short term treatment of insomnia and for short term treatment of jet lag in adults
What age is melatonin licenced from ?
55 years and over
Are antihistamine shush as Promethazine appropriate in managing chronic insomnia ?
No, licences for temporary sleeping difficulties (1-2 weeks)
Give examples of benzodiazepines
Nitrazepam Flurazepam Lorazepam Diazepam Temazepam
Give examples of ‘Z’
Zopiclone
Zolpidem
What are the most commonly used anxiolytics and hypnotics ?
Benzodiazepines
Where do benzodiazepines act at ?
The GABA receptor
What are benzodiazepines indicated for ?
Short term relief (2-4 weeks only) of anxiety that is severe, disabling or causing patient unacceptable distress, occurring alone or in association with insomnia and short term psychosomatic, organic or psychotic illness
Can you use benzodiazepines to treat ‘mild’ anxiety ?
No, it is inappropriate
Where else are benzodiazepines used in patients ?
Dental patients
What are the common features of nitrazepam, diazepam and flurazepam ?
Long-acting
Hangover effect is likely the next day
What are the common features in lorazepam and temazepam ?
Short acting
Has little or no hangover effect by more likely to have withdrawal effects
When are z-drugs (hypnotics() appropriate to use in insomnia ?
For short term treatment
When insomnia is severe, stabling or causing patient extreme distress
What is the mechanism of action for ‘Z’ hypnotics ?
Agonist of the GABA receptor complex and therefore enhances GABA-mediated neuronal inhibition
How is benzodiazepine withdrawal managed ?
- Transfer patient stepwise. One dose at a tome over a bout a week to equivalent daily dose of diazepam preferably taken at night
- Reduce diazepam dose, usually by 1-2mg every 2-4 weeks (in high doses, reduce the dose by up to one-tenth every 1-2 weeks)
- Reduce diazepam further, steps of 500mcg may be appropriate towards the end of withdrawal then stop completely
What are the disadvantages in using z drugs and benzodiazepines ?
Dependance
Tolerance
Increase risk of falls
Congestive impairments
How would you prescribe benzodiazepines ?
Discontinuation should be planned and gradual over at least 4-6 weeks (Longer in most cases)
Start with lowest licensed dose
Ensure non-pharmacological treatment interventions are continues
A review/stop date should be stated clearly in the prescribing
Intimate use odd z-hypnotics (everyone/3rd night) cam help prevent tolerance developing
What are the common withdrawal symptoms of benzodiazepines ?
Nausea Headaches Sweating Panic attacks Depression Anxiety’s Tremor Palpitations Loss of agitate Insomnia
What are the common withdrawal symptoms of Z-drugs ?
Rebound insomnia Impaired concentration Palpitations Abdominal crams Anxiety Depression Anxieperceptual disturbances
