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Summer Pharm - Exam 2 > Insomnia > Flashcards

Insomnia Flashcards

1
Q

what NT keep you alert

A

NE

Ach

dopamine

histamine

hypocretin/orexin

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2
Q

what NT make you sleepy

A

adenosine

GABA

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3
Q

what drugs make you sleepy

A

anticholinergic

antihistamines

benzos

suvorexant

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4
Q

what meds keep you awake

A

amphetamines

adenosine antagonists

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5
Q

order of tx for insomnia

A
  1. address underlying causes
  2. assess for stimulating drugs
  3. CBT
  4. drugs
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6
Q

underlying causes of insomnia

A

sleep apnea

pain

RLS

anxiety/dpn

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7
Q

stimulating meds that might cause insomnia

A

caffeine

decongestants

stimulants

SSRIs

diuretics

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8
Q

preferred tx for insomnia

A

CBT

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9
Q

first line pharm for insomnia

A

nonbenzos → zolpidem, rameleton

short acting benzos → tamezepam

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10
Q

ability of drug to rapidly induce sleep is influenced by

A

rate of absorption

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11
Q

ability to maintain sleep is influenced by

A

t½

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12
Q

rebound insomnia is caused by __

and influenced by __

A

abrupt d/c

t½

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13
Q

what drug is first line for insomnia

A

zolpidem - ambien → “z drug”

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14
Q

3 z drugs to know

A

zolpidem → ambien

eszopiclone → lunesta

zaleplon → sonata

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15
Q

4 other drug agents for insomnia besides z drugs

A

benzos

orexin antagonists

melatonin agonists

1st gen antihistamines

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16
Q

2 benzos used for insomnia

A

temazepam → restoril

triazolam → halcion

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17
Q

orexin antagonist to know

A

suvorexant → belsomra

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18
Q

melatonin agonist to know

A

ramelteon → rozerem

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19
Q

2 1st gen antihistamines to know

A

diphenhydramine

doxylamine → Nyquil

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20
Q

t/f: there is no receptor for benzos

A

T!

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21
Q

where do benzos bind

A

binding site on GABA chloride channel

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22
Q

which drugs bind to alpha 1 subunit

A

benzos

z drugs

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23
Q

alpha 1 is located in the __

and has __ therapeutic action (2)

A

cortex

sleep/anticonvulsant

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24
Q

negative effects associated w. alpha 1 activation (benzos and z drugs)

A

amnesia

additive CNS dpn

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25
which drug binds to alpha2 and alpha5 subunits
benzos
26
alpha 2 and 5 subunits are located in the (2) and have __ therapeutic actions (2)
limbic system/brain stem anxiolytic myorelaxant
27
negative effects related to alpha 2 and 5 subunit activation (benzos)
motor incoordination tolerance/dependence addiction decreased REM
28
which chloride subunit do both benzos AND z drugs bind to
alpha 1
29
z drugs bind only to __ Cl subunit benzos bind to __ subunits (3)
z drugs: alpha 1 benzos: alpha1, alpha2, alpha5
30
tolerance to benzos occurs if used \> \_\_
1 week
31
benzos, etoh, and barbs all negatively affect which stage of sleep
REM
32
z drugs are rapidly absorbed and eliminated via __ meatbolism
hepatic
33
which sleep drug has the longest t½
escopiclone → lunesta
34
most widely prescribed agent for insomnia
zolpidem → ambien
35
immediate release ambien is used to
reduce sleep latency
36
sustained release ambien (CR) is used to
reduce nocturnal awakenings
37
low dose sublingual ambien (intermezzo) is used for
middle of the night awakening
38
which z drug is safe for long term use and used for sleep maintenance
escopiclone → lunesta
39
which z drug has minor role in insomnia, but is used to decrease time to sleep onset
zalepon → sonata ## Footnote **rapid oral onset**
40
common s.e of z drugs
drowsiness amnesia HA GI **rarely bizarre behavioral disturbances**
41
what class are Z drugs
IV
42
is dependence-withdrawal likely w. z drugs
yes, but unlikely
43
fatal overdoses are rare w. z drugs and benzos, unless
taken in combo w. other CNS depressants
44
what 2 benzos are used for insomnia
triazolam → halcion temazepam → restoril
45
t½ of: triazolam: temazepam:
trazolam: short temazepam: intermediate
46
which benzo used for insomnia can cause rebound insomnia
triazolam (halcion) *d.t rapid elimination*
47
which benzo has minimal effect on sleep latency
temazepam *dt longer t½*
48
triazolam has less \_\_ but more \_\_
daytime sedation rebound insomnia *dt short t½*
49
benzos have declining use for insomnia due to
daytime sedation/performance impairment rebound insomnia anterograde amnesia psychologic and physiologic dependence
50
4 insomnia drugs w. non GABA benzo binding site mechanisms
suvorexant ramelteon antidepressants antihistamines
51
hypothalamic neuropeptides that innervate all arousal systems and fxn to maintain wakefulness
orexins
52
what insomnia drug is an orexin antagonist
suvorexant
53
ADR of suvorexant
dose related next-day somnolence
54
what class is suvorexant
IV → abuse liability
55
suvorexant is FDA approved for \_\_ but is really only used when \_\_
sleep-onset/maintenance first line drugs have failed
56
what insomnia drug is an agonist a melatonin receptors
ramelteon
57
MT1 receptor fxn: MT2 receptor fxn:
MT1: induces sleep MT2: regulates circadian rhythms
58
ADRs of ramelteon
dizziness somnolence fatigue nausea
59
ramelteon is used for: but melatonin may be better for:
reducing sleep latency jet lag
60
what insomnia drug is a serotonin receptor antagonist and reuptake blocker
trazodone
61
ADRs of trazodone
oversedation orthostasis priapism
62
what class of drug is trazodone
antidepressant → SARI
63
pro of trazodone
no concerns w. tolerance or dependence
64
what insomnia drug is an antagonist at CNS histamine H-1 and muscarinic receptors
diphenhydramine - doxylamine
65
diphenhydramine/doxylamine might not be best for elderly due to what ADR
antimuscarinic
66
3 first line drugs for sleep onset
zeleplon → z drug zolpidem → z drug ramelton → melatonin receptor agonist
67
1st line for sleep onset and maintenance
zolpidem CR (extended release) → z drug eszopiclone → z drug
68
2nd line for insomnia: adjunctive for insomnia:
2nd line: trazodone → antidepressant +/- temazepam adjunctive: melatonin, diphenhydramine → antihistamine

Summer Pharm - Exam 2 (12 decks)

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