221017 PA Insomnia

Question 1

Insomnia
Chronic insomnia

Answer 1

• sleep disturbance from 3 nights/week and from 3 months
• AIM restorative sleep (achieve, initiate, maintain)
• results in Associated distress or Impaired daily function

Question 2

Insomnia
NREM

Answer 2

75% adult sleep time
Occur within 1st hour

Question 3

Insomnia
REM

Answer 3

25% adult sleep time
eyes move rapidly and limbs paralyzed
Occurs in 2nd hour
Dream

Question 4

Insomnia
Hormonal mediator of sleep cycle

Answer 4

melatonin

Question 5

Insomnia
Risk factor: medications

Answer 5

Stimulants: CNS + respiratory
Antidepressant
Appetite suppressants
Beta + alpha agonist
Decongestants

Question 6

Insomnia
Medical condition

Answer 6

Cancer, chronic pain
Pulmonary
Hypertension, diabetes
Hyperthyroidism

Question 7

Insomnia
OTC

Answer 7

Antihistamine
Melatonin
Valerian root

Question 8

Insomnia
antihistamine

Answer 8

diphenhydramine
doxylamine
chlorpheneramine
30-60’ before HS
Less and equal 4x/week, less than 14 days
CI: increased IOP, delirium, urinary obstruction

Question 9

Insomnia
melatonin

Answer 9

Jet lag
60’ before HS

Question 10

Insomnia
valerian root

Answer 10

60’ before HS
Not: pregnancy, breastfeeding, cause hepatoxicity
Evident: menopause (?)

Question 11

Insomnia
BZD receptor agonist

Answer 11

1st line for short term: zopiclone, zolpidem
7-day course
Lowest dose -> titrate to max
SE: impaired cognitive function, memory disturbances

Question 12

Insomnia
BZD off-label

Answer 12

Drug off label
Diazepam
Oxazepam
Lorazepam

Question 13

Insomnia
BZD

Answer 13

1st line for short term
7-day course
SE: fall risk, memory impairment

Question 14

Insomnia
Preferred in elderly

Answer 14

LOT (immediate: balance risk of dependence and risk of morning handover)
Lorazepam
Oxazepam
Temazepam

Question 15

Insomnia
avoid in elderly

Answer 15

No Flavor
Nitrazepam (immediate)
Flurazepam (long-acting)

Question 16

Insomnia
Trazodone

Answer 16

25-100mg
Reduce sleep-onset latency
Low risk of morning hangover
SE: orthostatic hypotension, priapism, cardiac conduction

Question 17

Insomnia
Doxepin (tricyclic depression)

Answer 17

Sleep maintainance insomnia
3-6mg
No fall risk
Depression: 150-300mg

Question 18

Insomnia
Pregnancy

Answer 18

1st: non pharm
Severe: zopiclone
Switch long to short-acting before delivery to minimize SE on fetus

Question 19

Insomnia
Breastfeeding

Answer 19

Low dose + intermittent: BZD short (lorazepam) or BZD receptor agonist

Question 20

Insomnia
Therapeutic tips

Answer 20

Lowest dose
Shortest duration
Taper dose and frequency to d/c
Not combine: hypnotic + alcohol/other CNS depressants

Question 21

Insomnia
Which of the following is not considered a common medication cause of Insomnia?
a. Adderall
b. Concerta
c. Benadryl
d. Theophylline

Answer 21

c. Benadryl

Question 22

Insomnia
Which of the following would be best suited to use for initial insomnia based on half life and duration of action?
a. Temazepam
b. Triazolam
c. Diazepam
d. Flurazepam

Answer 22

b. Triazolam