Chapter 68: Sleep Disorders - Insomnia, RLS & Narcolepsy Flashcards
A diagnosis of chronic insomnia occurs when:
The patient has symptoms at least 3 times per week for at least 3 months
Key drugs that can worsen insomnia
Acetylcholinesterase inhibitors (e.g., donepezil) Alcohol Antiretrovirals Aripiprazole Atomoxetine Bupropion Caffeine Decongestants Diuretics Fluoxetine, if taken late in the day Steroids Stimulants Varenicline
What are some natural products used for insomnia
- Melatonin (note: it is a 1A2 substrate and if taken with inhibitors like cipro or fluvoxamine, can cause prolonged effects)
- Valerian
- Chamomile tea
What is first-line treatment for insomnia
Non-drug treatment like CBT, keep bedroom dark, regular sleep schedule, avoid daytime naps, etc.
What drugs can be used if a patient complains of not being able to fall asleep
Eszopiclone
Zolpidem
Ramelteon
Zaleplon
What drugs can be used for a patient who needs help staying asleep
Eszopiclone
Zolpidem
Doxepin
Suvorexant
What drugs can be used in a patient who needs help falling and staying asleep
Eszopiclone
Zolpidem
Patients may self-treat insomnia short-term with which OTC products
antihistamines like Benadryl or doxylamine
The American Academy of Sleep Medicine (AASM) guidelines state that the following treatments are not recommended for chronic use:
Benadryl, melatonin, tiagabine, trazadone, and valerian
MOA of hypnotics
The non-BZDs act selectively at BZD receptors to increase GABA, an inhibitory NT which causes CNS depression
Eszopiclone brand name
Lunesta
Zolpidem brand name
Ambien, Ambien CR
Edluar, Intermezzo (SL tabs)
What drug schedule are hypnotics
Schedule IV
Dosing for Ambien, Edular, Zolpimist
Female/Elderly: 5 mg PO/SL/spray QHS
Male: 5-10 mg PO/SL/spray QHS
T/F: Hypnotics do not have potential for abuse and dependance
False
SE of hypnotics
Somnolence, dizziness, ataxia, can cause parasomnias (unusual actions while sleeping, which the pt may be unaware of)
MOA for orexin receptor antagonists
Block the orextin neuropeptide signaling system, which promotes wakefulness
Which drug is an orexin receptor antagonist
Suvorexant (Belsomra)
What schedule of drugs is orexin receptor antagonists
C-IV