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Flashcards in Insomnia Deck (27):
0

What's the preferred tx for insomnia?

Changes to lifestyle

Not drugs, bcuz hypnotics are over-prescribed

1

Drugs likely to contribute to insomnia?

Bupropion

Stimulants (methylphenidate etc)

OTC appetite stimulants

Decongestants (Pseudoephedrine etc)

MAO-B inh, if taken late in day

Fluoxetine, if taken late in day

Caffeine

Steroids

Alcohol (initially induces sleep, but prevents deeper stages of sleep and causes nocturia)

Any drug that causes urinary retention or nocturia including antihistamines and diuretics taken later in the day

2

Nature pdts used for insomnia?

St. John's wort

Chamomile tea (taken in the evening)

Melatonin

Valerian

3

MOA of non-benzodiazepines?

Acts selectively at the BZD receptors to increases GABA

4

List non-benzodiazepines used in insomnia

Zolpidem (Ambien, Ambien CR)

Zolpidem (Intermezzo) - for night time awakening

Zaleplon (Sonata)

Eszopiclone (Lunesta)

5

Brand name of Zolpidem (non-benzodiazepines used in insomnia)?

Ambien

Ambien CR

6

Brand name of Zaleplon (non-benzodiazepines used in insomnia)?

Sonata

7

Brand name of Eszopiclone (non-benzodiazepines used in insomnia)?

Lunesta

8

Warnings ass with non-benzodiazepines used in insomnia?

Potential for abuse and dependence

9

SEs of non-benzodiazepines used in insomnia?

Somnolence

Dizziness, Ataxia

Parasomnias

10

Notes of Intermezzo SL?

Don't take unless planning to sleep 4+ more hrs

11

List Melatonin Receptor agonist agents

Ramelteon (Rozerem)

12

Ses of Ramelteon (Rozerem) - Melatonin Receptor agonist agents?

Somnolence

Dizziness

13

What should be avoided when taking non-BZD and Ramelteon (Rozerem)?

Fatty food

Non-BZD: heavy meal or alcohols (in addition)

14

List TCAs used in insomnia

Doxepin extended-release (Silenor)

Trazodone, Mirtazapine (used off-label)

15

Drugs interactions with Ambien, Sonata, Lunesta?

Caution with Potent 3A4 inh (Ritonavir, Indinavir, Saquinavir, Atazanavir, Ketoconazole, Itraconazole, Erythromycin and Clarithromycin)

16

BZD and geriatric pts?

May be potentially inappropriate for use on geriatric pts based on BEERS criteria

17

List BZD used in insomnia

Lorazepam (Ativan)

Temazepam (Restoril)

Estazolam (Prosom)

Quazepam (Doral)

Fluraxepam

Triazolam (Halcion)

18

What's the brand name of Lorazepam? BZD for insomnia

Ativan

19

What's the brand name of Temazepam? BZD for insomnia

Restoril

20

SEs of Lorazepam (Ativan) and Temazepam (Restoril)?

Drowsiness

Dizziness

Weakness

Ataxia

Lightheadedness

21

Which BZD should be chosen if elderly pt needs BZD? Why?

Lorazepam, Oxazepam, Temazepam (LOT)

Less potentially harmful for elderly or those with liver impairment

22

BZD counseling on pg 912

Look!

23

List antihistamines used in insomnia

Diphenhydramine (Benadryl)

Doxylamine (Aldex, Unisom Nightime)

24

Can antihistamines used in insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime)) be used in elderly?

No!

Possible anticholinergic SEs (sedation, confusion)

25

List peripheral anticholinergic SE of antihistamines used in insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime))?

Dry mouth

Urinary retention

Dry/blurry vision, risk increased IOP

Constipation

26

In what dx states should antihistamines used for insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime)) be avoided?

BPH (may worsen sx)

Glaucoma (may elevate IOP)

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