Sleep Disorder Treatment Flashcards by Alicia Daum

Goals of Therapy

Promote patient’s ability to fall sleep, maintain sleep, & awaken refreshed
Meds as short a time as possible
Use minimal dose with least amount of SE

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Types of Benzodiazepines

Alprazolam (Xanax)
Estazolam (ProSom)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)

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MOA of Benzodiazepines

Facilitate the effects of GABA in the ascending reticular activating system

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Examples of Short Acting Benzodiazepines

Triazolam (Halcion)

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What are short acting benzodiazepines used for?

Difficulty falling asleep

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Examples of Intermediate Acting Benzodiazepines

Temazepam (Restoril)

Estazolam (ProSom)

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What are intermediate acting benzodiazepines used for?

Trouble maintaining or staying asleep

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Examples of Long Acting Benzodiazepines

Flurazepam (Dalmane)

Quazepam (Doral)

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What are long acting benzodiazepines used for?

Trouble falling asleep

Maintaining sleep

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Benzodiazepine SE

Drowsiness
Impaired motor function
Prolonged use can lead to physical dependency
Confusion
Shakiness

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Interactions with Benzodiazepines

Alcohol

Low-dose contraceptives: benzo’s not cleared as quickly

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Contraindications of Benzodiazepines

Acute narrow-angle glaucoma
Pregnancy
Lactation

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What were benzodiazepine receptor agonists developed for?

Improve the safety profile of barbiturate-type compounds

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Half-life of Benzodiazepine Receptor Agonists

5 hours

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Examples of Benzodiazepine Receptor Agonists

Eszopiclone (Lunesta)
Zolpidem (Ambien)
Zaleplon (Sonata)

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MOA of Eszopiclone (Lunesta)

Interacts with GABA receptors located near benzodiazepine receptors

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What affects the absorption of eszopiclone (Lunesta)?

High fat meals

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When does eszopiclone (Lunesta) peak?

Within 1 hour

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What is the half-life of eszopiclone (Lunesta)?

5-7 hours

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Eszopiclone (Lunesta) SE

Headache
Dry mouth
Dizziness
Unpleasant taste in mouth

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Contraindications for Eszopiclone (Lunesta)

Hypersensitivity

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Pregnancy Category of Eszopiclone (Lunesta)

Pregnancy C

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MOA of Zolpidem (Ambien, Ambien CR)

Modulates the GABA receptors to suppress neurons

Sedation & relaxation

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Who needs a decreased dose of zolpidem (Ambien, Ambien CR)?

Elderly

Women

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Half-life of Zolpidem (Ambien, Ambien CR)

2.5 hours

Onset of Zolpidem (Ambien, Ambien CR)

30 minutes

Duration of Zolpidem (Ambien, Ambien CR)

6-8 hours

Zolpidem (Ambien, Ambien CR) SE

``` Morning drowsiness Hangover effect Headache Dizziness Nausea ```

Contraindications of Zolpidem (Ambien, Ambien CR)

Hypersensitivity

Pregnancy Category of Zolpidem (Ambien, Ambien CR)

Pregnancy C

MOA of Zaleplon (Sonata)

Interacts with GABA-BZ omega 1 receptor Sedation Relaxation Anti-convulsant activity

What is the 2nd line for falling asleep?

Zaleplon (Sonata)

Duration of Zaleplon (Sonata)

5 hours

Onset of Zleplon (Sonata)

Within 1 hour

Half-life of Zaleplon (Sonata)

1 hour

Zaleplon (Sonata) SE

``` Back or chest pain Migraine Constipation Dry mouth Nervousness ```

Contraindications of Zaleplon (Sonata)

Hypersensitivity

Pregnancy Category of Zaleplon (Sonata)

Pregnancy C

MOA of Diphenhydramine (Benadryl)

Acts as CNS depressant

Contraindications of Diphenhydramine (Benadryl)

Hypersensitivity

Pregnancy Category of Diphenhydramine (Benadryl)

Pregnancy B

Diphenhydramine (Benadryl) SE

``` Excessive daytime drowsiness Impaired psychomotor function Dry mouth Delirium Anti-cholinergic effect Constipation Urinary retention ```

Examples of Antidepressants Used for Insomnia

Imipramine (Tofranil) Amitriptyline hydrochloride (Elavil) Nortriptyline (Pamelor)

Newer Antidepressant Agents

``` Neazodone hydrochloride (Serzone) Venlafaxine (Effexor) ```

MOA of Doxepin (Silenor)

Antagonizes histamine receptor | Increases synaptic concentrations of serotonin & norepinephrine in the CNS

Doxepin (Silenor) SE

Drowsiness Dizziness Constipation Blurred vision

How long after eating does one need to wait to take doxepin (Silenor)?

3 hours

Contraindications of Doxepin (Silenor)

Glaucoma Urinary retention Constipation

Black Box Warning of Doxepin (Silenor)

Suicide thinking/behavior

Pregnancy Category of Doxepin (Silenor)

Pregnancy C

MOA of Trazodone

Inhibits repute of serotonin Causes adrenoreceptor subsensitivity Induces change in 5-HT presynaptic receptor adrenoreceptors Block histamine receptors

Onset of Trazodone

1-3 hours

Half-life of Trazodone

7-9 hours | Longer in obese patients

Trazodone SE

Dizziness Drowsiness Blurred vision Confusion

Contraindications of Trazodone

Use of MAOI's | Patients receiving linezolid or IV methylene blue

Pregnancy Category of Trazodone

Pregnancy C

Black Box Warning for Trazodone

Suicidal thoughts

MOA Amitriptyline (Elavil)

Increases synaptic concentration of serotonin and/or norepinephrine in CNS

Half-life of Amitriptyline (Elavil)

13-36 hours

Amitriptyline (Elavil) SE

``` Sedation Dizziness Headache Weight gain Sexual SE ```

Contraindications of Amitriptyline (Elavil)

Hx of MI | MAOI's

Pregnancy Category of Amitriptyline (Elavil)

Pregnancy C

Black Box Warning for Amitriptyline (Elavil)

Suicidal thoughts

MOA of Ramelteon (Rozerem)

Potent, selective agonist of melatonin receptors MT1 & MT2 within the suprachiasmic nucleus of the hypothalamus

Half-life of Ramelteon (Rozerem)

1-2 hours

Ramelteon (Rozerem) SE

``` Somnolence Headache Fatigue Dizziness Nausea ```

Contraindications for Ramelteon (Rozerem)

Fluvoxamine (Luvox)

Pregnancy Category of Ramelteon (Rozerem)

Pregnancy C

Melatonin Agonist

Ramelteon (Rozerem)

Orexin Receptor Antagonist

Suvorexant (Belsomra)

MOA of Suvorexant (Belsomra)

Blocks binding of wake-promoting neuropeptides orexin A & orexin B to receptors OZ1R & OX2R AKA: Blocks wakening of the patient

Duration of Suvorexant (Belsomra)

7 hours

When can you not take Suvorexant (Belsomra)?

Immediately after a meal

Half-life of Suvorexant (Belsomra)

12 hours

Onset of Suvorexant (Belsomra)

30 minutes

Suvorexant (Belsomra) SE

``` Drowsiness Headache Abnormal dreams Lower extremity weakness Cough ```

Contraindications of Suvorexant (Belsomra)

Narcolepsy

Pregnancy Category of Suvorexant (Belsomra)

Pregnancy C

Medications for Insomnia

``` Alprazolam (Xanax) Estazolam (ProSom) Flurazepam (Dalmane) Lorazepam (Ativan) Quazepam (Doral) Temazepam (Restoril) Triazolam (Halcion) Eszopiclone (Lunesta) Zolpidem (Ambien) Zaleplon (Sonata) Imipramine (Tofranil) Amitriptyline hydrochloride (Elavil) Nortriptyline (Pamelor) Nefazodone hydrochloride (Serzone) Venlafaxine (Effexor) Doxepin (Silenor) Trazodone Ramelteon (Rozerem) Suvorexant (Belsomra) ```

First Line Narcolepsy Medication

Modafinil (Provigil)/Armodafinil (Nuvigil)

MOA of Modafinil (Provigil)/Armodafinil (Nuvigil)

Not well understood | May increase dopaminergic signaling

Modafinil (Provigil)/Armodafinil (Nuvigil) SE

Headache Nausea Nervousness Dry mouth

Contraindications of Modafinil (Provigil)/Armodafinil (Nuvigil)

Hypersensitivity

Pregnancy Category Modafinil (Provigil)/Armodafinil (Nuvigil)

Pregnancy C

Second Line Narcolepsy Medication

Dextroamphetamine

MOA of Dextroamphetamine

Not well understood Stimulates CNS activity Blocks reuptake & increases release of norepinephrine & dopamine in extra neuronal space

Dextroamphetamine SE

HTN Anorexia Addiction

Pregnancy Category of Dextroamphetamine

Pregnancy C

Black Box of Dextroamphetamine

High abuse potential | Cardiac events

Medication for REM Sleep Behavior Disorder

Melatonin

MOA of Melatonin

Prepares the body for sleep

Melatonin SE

Abnormal heartbeat Dizziness Fatigue

Medications for Movement Disorders

``` Carbidopa-levadopa (Sinemet) Pramipexole (Mirapex) Ropinirole (Requip) Rotigotine (Neupro) Gabapentin (Neurontin) ```

Carbidopa-levodopa (Sinemet) SE

Sleepiness | GI problems

Examples of Dopamine Agonists for Movement Disorders

Pramipexole (Mirapex) Ropinirole (Requip) Rotigotine (Neupro)

MOA of Dopamine Agonists

Stimulating of postsynaptic dopamine D2-type receptors within the caudate putamen in the brain

Dopamine Agonist SE

``` Nausea Lightheadedness Stuffiness Edema Daytime sleepiness ```

Pregnancy Category of Dopamine Agonists

Pregnancy C

MOA of Gabapentin (Neurontin)

Thought to reduce presynaptic GABA release

Gabapentin (Neurontin) SE

Fatigue Dizziness Blurred vision

Pregnancy Category for Gabapentin (Neurontin)

Pregnancy C

Sleep Disorder Treatment Flashcards

(101 cards)