Insomnia drugs [3] Flashcards Preview

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Flashcards in Insomnia drugs [3] Deck (22):
1

Admin of which drug is most likely to produce memory disturbances such as anterograde amnesia?
(aka which one enhances GABA fxn?)

BDZ: Diazepam (anxiolytic)
Glutamate is active when forming memory
Enhancing GABA indirectly reduces Glu

(note: a1 enhance sleep, a2-5 lessens anxiety)

2

Phenelzine

MAOI

3

Monoaminergic cell groups activate cerebral cortex to facilitate PROCESSING of these thalamic inputs:

List the NT these red pathways secrete
- Locus ceruleus
- Raphe
- Tuberomamillary
- VTA
- Basal forebrain

- Locus ceruleus: NE
- Raphe: 5HT
- Tuberomamillary: His
- VTA: DA
- Basal forebrain: ACh

4

GABA is (select one) Off/ON when you are awake. _____ Enhances GABA and promote sleep.

OFF
BDZ
(GABA released from anterior hypothalamus

5

High ACh, 5HT, and GABA help you go towards (pick one) wakefulness/sleep

sleep

6

Z drugs are good at preserving which part of your sleep?

REM (20-25% of your sleep, stage of recall-able dreams)

7

Which stage of sleep predominates?

Stage 2 (50%)
- ligh sleep, EEG slower

8

BDZ for sleep

Triazolam
Temazepam
Flurazepam

9

Z drugs for sleep

zolpidem (closest to ideal)
zaleplon
eszopiclone

10

BDZ effects of stages of sleep
- Sleep latency
- Duration
- 1
- 2
- 3
- 4
- REM

- Sleep latency: ↓
- Duration: ↑
- 1: ↑
- 2: ↑
- 3: ↓
- 4: ↓
- REM: ↓

sleep faster + stay asleep
*note (latency, duration, 1 are like Z drugs)

11

Z drugs effects of stages of sleep
- Sleep latency
- Duration
- 1
- 2
- 3
- 4
- REM

- Sleep latency: ↓
- Duration: ↑
- 1: ↑
- 2: ↑
- 3: no effect
- 4: no effect
- REM: no effect

sleep faster + stay asleep

12

diff btwn a1 and a2-5 location effects

a1: cortex
- sleep
- anticonvulsant

a2-5: limbic system + brain stem
- anxiolytic
- myorelaxant

13

Diff btwn Z drugs and BDZ (triazolam)
for: hypnotic, anticonvulsant, myorelaxant
- quantal vs graded

Z drug:
quantal response: bam you asleep (immediate release)
upping the dose → see anticonvulsant and myorelaxant effects

BDZ:
Graded (gradual)
intially see anticonvulsant and myorelaxant → up the dose and get hypnotic effect
(feel relax b4 sleep unlike Z drug)

14

Why wont Tamazepam be impaired as you get older?

goes out phase II
(metab not affected by age)

15

Hangover effect is least likely seen in drugs with long or short half lives?

short

(hangover effect is seen in drugs with long half lives)

16

Which of the Z drugs:
- have the longest half life?
- reduces nocturnal awakenings?
- best for middle of the night awakenings?
- is best for sleep maintanence

Eszopiclone

Zolpidem

Zaleplon (short half life)

Eszopiclone (long half life)

17

Do BDZ or Z drugs cause anterograde amnesia?
Which has high therapeutic index relative to barbs?

Both (a1)
Both

18

Trazodone
- MOA
- ADRs
- clinical use

Mixed Serotonin receptor antagonist and reuptake blocker

Oversedation, orthostasis (a1), Priapism

*an antidepressant

19

Ramelteon
- MOA
- ADRs
- clinical use

Melatonin receptor agonist

dizziness, somnolence, fatigue, nausea

*sedative

20

Diphenhydramine (benadryl)
- MOA
- clinical use

H1 and muscarinic R antagonist

sedative, hypnotic, anxiolytic
(have to get into the brain to cause sleepiness - 1st gen)

21

Quetiapine effects on sleep

(atypical antipsychotic agent)
D2 antagonist
- leave Extrapyramidal side effects alone better than typical
- improve DA release in mesocortical pathway- control negative symp

Can be used as an adjunctive (just like melatonin and diphenhydramine)

22

which agents used in tx of insomnia are likely to cause anticholinergic side effects?

1st gen antihistamines
(block muscarinic receptors as well as H1)
- Diphenhydramine
- Doxylamine