Class Presentations Flashcards
Ambien, general
Acts like a benzo, but contains a very different chemical structure
Bonds, selectively, with benzodiazepine sites
o GABA-A receptors
● Acts a hypnotic but with none/few of the anti-anxiety effects
Contradicted for elderly and potential pregnancies
Does not improve memory
No-go Pills in US Airforce
Ambien: Side Effects
Sleep/drowsy driving
Impaired driving ability / Car accidents
Sleep-walking
Memory loss
Cancer
Early death
Stimulates those in permanent vegetative states
Ambien: Abuse
euphoria, visual distortions, and hallucinations
Benzodiazepine withdrawal symptoms
o Sleep disturbances, memory problems, panic/anxiety, difficulty concentrating, confusion, psychosis, seizures, suicide
When mixed with alcohol,
o Irregular heart and breathing rates, permanent liver damage and death
Lunesta, General
Approved in 2004 #1 most prescribed branded sleep aid
Nonbenzodiazepine hypnotic agent
Mechanism of action is unknown, it likely interacts with GABA receptors
Transient/Chronic Insomnia in adults
Caution with elderly (use lower dose)
Lunesta: Side Effects
Common: dizziness, drowsiness, headache, common cold symptoms, bad taste/dry mouth
Serious: complex behaviors while not being fully awake, abnormal thoughts and behavior*, memory loss, anxiety, severe allergic reactions
○ *includes more outgoing or aggressive behavior than normal, confusion, agitation, hallucinations, worsening of depression, and suicidal thoughts or actions
Lunesta: Contraindications
Other medications that can make you sleepy
History of depression, mental illness, suicidal ideation
History of drug or alcohol abuse or addiction
Liver disease, impaired respiratory function, drug metabolism or hemoglobin responses
Pregnant or breastfeeding
Lunesta: Key Treatment Consideration
If insomnia does not remit after 7-10 days, a full sleep evaluation is recommended to determine if another psychiatric or medical condition is causing sleeplessness, and potentially identify other relevant interventions
Buspar, General
Discontinued in U.S, Now available as generic
Partial Agonist
Indications:
- Anxiety in both adults and children
- GAD
- Tourette Syndrome
- Anxiety and irritability in children PDD
- Augment effectiveness of SSRI’s for depression
- Childhood and adult ADHD
Buspar: Side Effects
Do NOT prescribe with MAOIs
Less sedation than benzodiazepines
Mild-moderate side FX: headache, dizziness, nausea, drowsiness, restlessness, trouble sleeping
More severe side FX: chest pain, shortness of breath, tremors, ataxia, muscle stiffness, involuntary motor movements, tardive dyskinesia
Grapefruit juice may increase concentration of buspirone and lead to unwanted side FX.
Provigil, General
Stimulant, Eugeroic (good arousal)
Primarily used for narcolepsy
DA and NE reuptake inhibitor
Activatesion of orexin peptides to promote wakefulness
Activate glutamatergic circuits / inhibit GABA neurotransmission
2nd line for ADHD, not as effective as Adderall or Ritalin
Provigil: Side Effects
Headaches, blurred vision, asthenia, dizziness
Stevens-Johnson Syndrome and other rashes (<1% of patients)
• Requires discontinuation and hospitalization. May be fatal
Provigil: Contraindications
Comorbid psychiatric symptoms
• Anxiety, suicide/self-harm, impulsivity, hostility, psychosis, bipolar/mania, insomnia
Pre-existing medical conditions
• Uncontrolled moderate to severe hypertension and in patients with cardiac arrhythmias - ECG and blood pressure tests prior to prescribing
• Lactose intolerance
Provigil vs Adderall
Less risk for abuse / dependence
Not approved for ADHD but is still prescribed as 2nd line
Much more expensive than Adderall
