Clinical and pharmacological approaches for treatment of insomnia

Question 1

define insomnia

Answer 1

habitual sleeplessness

Question 2

effects of insomnia

Answer 2

easy fatigue, 
disturbed concentration, memory loss, 
anxiety, 
agitation, 
increased risk of depression

Question 3

epidemiology of insomnia

Answer 3

more common in the elderly and in women more than men

Question 4

type of insomnia in 18-30 yo

Answer 4

difficulty w/ sleep initiation

Question 5

type of insomnia in elderly yo

Answer 5

difficulty w/ sleep maintenance

Question 6

types of insomnia

Answer 6

acute sleeplessnes
moderate
chronic

Question 7

acute sleeplessnes

Answer 7

1 to several nights, causes

• noise,
• changes in diurnal rhythm,
• changes in environmental temperature,
• use of excitatory CNS drugs

Question 8

Moderate sleepless-

Answer 8

disturbances for several weeks to a month

Question 9

Chronic sleepless

Answer 9

more than a month
usually linked to chronic disorders
-apnea
-arthritic pain

Question 10

approaches in insomnia of the young

Answer 10

hypnotic
fast onset
short DOA

to facilitate sleep initiation and minimise morning fatigue

Question 11

approaches in insomnia of the elderly

Answer 11

long acting hypnotic with duration of action of 6-8 hrs

to prevent sleep breaks

Question 12

approaches in insomnia of mixed type

Answer 12

combination

Question 13

initial non pharm approach

Answer 13

avoid stim drinks (coffee)

drink hot cocoa

early dinner

comfy bed

quiet room

Question 14

first line rx of insomnia when non pharm fails

Answer 14

natural sedatives

• melissa herb
• valeriana

Question 15

rx when sedativss fail

Answer 15

hypnotics w/

• short 1/2 life
• no active metabolites

to decrease morning drowsiness ADR

Question 16

why are benzodiazepines EUHYPNOTICS

Answer 16

dont disturb normal REM sleep

Question 17

effects of benzo’

Answer 17

sedation at half dose of barb

antiepileptic effect

anti axiolytic effect

Question 18

benzo antidote

Answer 18

FLUMAZENIL

-comp binds w/ gabaergic receptors

Question 19

benzo used in young insomnia

Answer 19

TRIAZOLAM
- fast onset
short doa

Question 20

benzo in old

Answer 20

TEMAZEPAM

- long acting

Question 21

benzo phk

Answer 21

abs: good oral abs due to lipophillic nature

Question 22

benzo class

Answer 22

short acting;

• triazolam
• oxazepam

moderate

• alprazolam
• temazepam

long acting

• clonazepam
• diazepam

Question 23

benzo ADR

Answer 23

Dependance and tolerance

slowed reflexes and myorelaxation

antegrade amnesia

Question 24

conraindication of benzo

Answer 24

PREG- cross pb

elderly- amnesia

liver insuff- lipophilic

childhood-

Question 25

benzo drug intrxn

Answer 25

ez inducer
reduced effect of

1) phenytoin
2) phenobarbital

Enzyme inhibitors

chloramphenicol, omeprazole
cimetidine

Question 26

why are barbiturates less commonly used to rx insomnia

Answer 26

abolish REM phase of sleep

active met cause morning sleepiness

supress Resp centre in brain

Question 27

phenobarb tab 100mg effects

Answer 27

anti epileptic

megaloblastic anemia after long-term use, positive Wassermann test

Question 28

adrs

Answer 28

Morning sleepiness
Easy fatigue
Tolerance and dependence
Ataxia

Question 29

benzo like drugs

Answer 29

zolpidem tab. 10mg
zopiclon tab. 7.5mg

bind to GABA- ergic receptors in the CNS

Question 30

difference between the benzo like drugs

Answer 30

zolpiDEM
- tolerance

-fast acting

zolpiCLON
- no tolerrance

-long doa 6-8 HR SLEEP