Chapter 4 - Insomnia Flashcards Preview

Pharmacy Pre-Reg 2020/2021 > Chapter 4 - Insomnia > Flashcards

Flashcards in Chapter 4 - Insomnia Deck (32)
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1

What is insomnia?

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

2

What is the difference between short and long term insomnia

Short term - less than3 months
Long term - symptoms occurring in more than 3 nights a week for more than 3 months

3

List some lifestyle advice for insomnia

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

4

How is short term insomnia managed?

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

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

5

How is long term insomnia managed?

Lifestyle advice
Address triggers

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

6

What should be used for insomnia in the elderly?

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)

7

What are the main indications of benzodiazepines?

Short term use in anxiety and insomnia

8

What are the withdrawal symptoms associated with benzodiazepines?

Anxiety
Treat or
Rebound insomnia
Loss of appetite

9

How do you withdraw a benzodiazepine?

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

10

List some examples of
a) long action benzodiazepines
b) short acting benzodiazepines

a) diazepam, nitrazepam, flurazepam

b) lorazepam, temazepam

11

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

Short acting

12

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

They may lead to confusion, falls and injury

13

Which z-drugs are used in insomnia?

Zopiclone
Zolpidem

14

Are zolpidem and zopiclone short or long acting?

Short acting

15

Which antihistamines can be brought OTC for insomnia?

Promethazine
Diphenhydramine

16

What limits the use of antihistamines in insomnia?

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

They are also associated with antimuscarinic side effects

17

Should alcohol be used for sleep disorders?

No, they can worsen sleep disorders

18

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

Risk of respiratory depression
Symptoms include SOB

19

What are the main side effects of temazepam?

Respiratory depression
Sedation
Paradoxical side effects
Hypotension
Withdrawal, tolerance, dependence

20

What classification is temazepam?

CD3

21

When should melatonin be taken?

Adults >55 - 1-2 hours before bedtime

Patients with learning difficulties - 30-60 minutes before bedtime

22

How long should melatonin be used in:

a) jet lag
b) insomnia in adults over 55

a) 5 days
b) 13 weeks

23

Should melatonin be taken with or without food?

Modified release - with food
Immediate release - empty stomach

24

What doses of zopiclone should be given in insomnia?

Adult - 7.5mg at bedtime
Elderly - 3.75-7.5mg at bedtime

25

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

Max 4 weeks

26

List some contraindications of z-drugs

Pregnancy
Psychotic illnesses
Obstructive sleep apnoea
Neuromuscular respiratory weakness

27

List some side effects of z-drugs

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

How long should patients leave between taking zolpidem and driving?

8 hours

29

What is narcolepsy?

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

30

What treatment options are there for narcolepsy?

CNS stimulants - modafinil, methylphenidate, pitolisant

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