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InsomniaFC Flashcards

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1
Q

Drugs Likely to Contribute to Insomnia

A

Bupropion
Stimulants
OTC appetite supressants
Decongestants
MAO-B inhibitors
Fluoxetine
Caffeine
Steroids
Alcohol
Antihistamines or diuretics taken later in the day

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2
Q

Sleep Hygiene Methods to Improve Sleep

A

Keep the bedroom dark, comfortable, and quiet
Regular sleep schedule
Avoid daytime naps (limit to 30 mins)
Reserve bedroom for only sleep and sex
Turn the face of the clock away
Establish a pre-bedtime ritual
Avoid exercising before bed
Do not eat heavy meals before bed
Avoid Caffeine in the afternoon

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3
Q

Natural Products for Insomnia

A

St. John’s wort
Chamomile tea
Melatonin
Valerian

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4
Q

Non-Benzodiazepines MOA

A

Act selectively at the benzodiazepine receptors to increase GABA

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5
Q

Z drugs names

A

Zolpidem (Ambien, Zolpimist - oral spray, Edluar - SL tabs, Intermezzo - SL tabs for nighttime awakenings), Zaleplon (Sonata), Eszopiclone (Lunesta)

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6
Q

SE z drugs

A

-SE: increase risk of mortality, abuse, somnolence, dizziness, ataxia, parasomnias, lightheadedness, “pins and needles” feeling on skin

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7
Q

how to take the z drugs

A

Do not take with fatty food, a heavy meal, or Alcohol

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8
Q

why take z drus over bzds?

A

Preferred over benzodiazepines (due to decrease abuse, dependence, and tolerance)-

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9
Q

DDIs with z drugs

A

-Caution use with potent 3A4 inhibitors

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10
Q

Non-Benzodiazepines Patient Counseling : zolpimist

A

Zolpimist: spray directly into your mouth over your tongue (once for 5mg; twice for 10mg); prime if 1st-time use

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11
Q

how to take the z drugs ?food or no food?

A

heavy or high-fat meals may prevent medication from working

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12
Q

how long for wd sx to go away for z drugs

A

Withdrawal symptoms subside after 1-2 days

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13
Q

Melatonin Receptor Agonist name

A

Ramelteon (Rozerem)

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14
Q

melatonin SE

A

SE: somnolence, dizziness

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15
Q

dose of melatonin for insomnia

A

Dose: 8mg QHS

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16
Q

how to take melatonin

A

Do not take with fatty foods

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17
Q

adv of melatonin

A

not limited to short-term use

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18
Q

Tricyclic Antidepressants for insomina

A

Doxepin ER (Silenor), Generic Doxepin, trazodone, mirtazapine are used off-label for sleep

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19
Q

tcas contraindications

A

-CI: requires 2 week washout for MAOIs

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20
Q

why use TCAs for insomnia

A

-Used for difficulty “staying” asleep

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21
Q

SE of tcas

A

SE: somnolence, anticholinergic SEs, low incidence of nausea and upper respiratory infection

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22
Q

doxepin dose for insomnia

A

6mg qhs , 3mg if older than 65

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23
Q

Benzodiazepines MOA

A

Potentiate GABA, an inhibitory neurotransmitter, causing CNS depression

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24
Q

ativan

A

Lorazepam (Ativan)

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25
restoril
Temazepam (Restoril)
26
caution for quazepam
Quazepam (Doral): Caution in elderly due to its long half-life (risk of falls and fractures)
27
caution with flurazepam
Flurazepam (Dalmane): Caution in elderly due to its long half-life (risk of falls and fractures)
28
caution and CI from triazolam
Triazolam (Halcion): associated with higher rebound insomnia and daytime anxiety; CI with efavirenz (Sustiva), delavirdine (Rescriptor), azole antifungals, PIs, and all 3A4 inhibitors
29
Benzodiazepines (SE & Monitoring)
Potential for abuse and dependence SE: drowsiness, dizziness, ataxia, lightheadedness, anterograde amnesia Withdrawal symptoms when discontinued
30
which bzds to use in the elderly?
-L-O-T (lorazepam, oxazepam, & temazepam) can be used in elderly
31
Antihistamines MOA
Block histamine H1 receptors
32
benadryl, sominex, unisom generic and dose for insomnia
-Diphenhydramine (Benadryl, Sominex, Unisom): 25-50mg QHS
33
aldex, unisom, generic and dose for insomnia
-Doxylamine (Aldex, Unisom): 25mg QHS
34
SE of antihitimaines
SE: sedation, confusion, dry mouth, urinary retention, blurry vision, increase IOP, constipation
35
which population to avoid antihistiamines
Best to Avoid use in elderly and patients with BPH or glaucoma
36
non benzos over benzo why chose?
non benzo preferred b/c less abuse potential.
37
parasomnias
common w/ non benzos.
38
sleepign agents and fatty foods
non benzos and remelton should not be taken w/ fatty food b/c it delays the absorption.
39
eszoplicone dosing
1 mg if difficulty falling asleep, 2 mg if difficulty staying asleep or 3 mg if helpful for a longer duration of sleep.
40
non benzos substrates of?
cyp 3A4. so w/ inhibitors need lower dose (erythromycin and itraconazole)
41
concerns with non benzos (z drugs)
they work the same way as the benzos and can cause increase the risk of death, even if used intermittently, due to issues such as difficulty breathing at night, increased risk of falls, infection and possibly cancer.
42
how to go from immediate release to control release for a drug
making a drug controlled-release adds about 2.5 mg for each 10 mg of the immediate-release. In this case, it is exactly that amount.
43
remelton brand and controlled status and MOA
rozerem. non controlled. melatonin receptor agonist instead of gaba.
44
elderly benzos:
doral and dalman have high fall risk. and triazolam ANOTHER do not use benzo (high rebound insomnia and anxiety- psychiatric effects. slow tapering upon discontinuation and CI.
45
which bz to use in elderly
Elderly, if using a benzodiazepine, should use L-O-T: Lorazepam, for sleep or anxiety Oxazepam, for anxiety Temazepam, for sleep
46
diphenhydramine brand names
benadryl and sominexx. recall benadryl can it more difficult to urinate; it will worsen prostate symptoms.
47
Intermezzo SL what is it useflu for?
is a form of zolpidem that is useful for patients who wake up during the night and need to sleep at least four more hours.
48
zolpidem other forms
tablet, a spray, a sublingual tab called Edluar and a new sublingual formulation that is for night-time awakening called Intermezzo.
49
Ambien
Zolpidem
50
Zolpimist
Zolpidem spray
51
Edluar
Zolpidem SL tabs
52
Intermezzo
Zolpidem SL tabs
53
Sonata
Zaleplon
54
Lunesta
Eszoplicone
55
Rozerem
Ramelteon
56
Silenor
Doxepin ER
57
Remeron
Mirtazapine (off-label)
58
Desyrel
Trazodone (off-label)
59
Sinequan
Doxepin (off-label)
60
Ativan
Lorazepam
61
Restoril
Temazepam
62
Prosom
Estazolam
63
Doral
Quazepam
64
Dalmane
Flurazepam
65
Halcion
Triazolam
66
Benadryl
Diphenhydramine
67
Sominex
Diphenhydramine
68
Unisom
Diphenhydramine
69
Unisom nighttime
Doxylamine
70
Aldex
Doxylamine

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