CLINICAL PHARMACOLOGY OF SEDATIVE_HYPNOTICS-TREATMENT OF SLEEP PROBLEMS

Question 1

Sleep disorders are common and often result from inadequate treatmentof underlying medical conditions or psychiatric illness.

True
primary insomnia is rare.

Nonpharmacologic therapies that are useful
for sleep problems include __________________.

Answer 1

• proper diet and exercise,
• avoiding stimulants before retiring,
• ensuring a comfortable sleeping environment,
• and retiring at a regular time each night

Question 2

In some cases, however, the
patient will need and should be given a sedative-hypnotic for a limited period. It should be noted that the abrupt discontinuance of
many drugs in this class can lead to __________

Answer 2

rebound insomnia.

Question 3

Benzodiazepines can cause a dose-dependent decrease in both _______________, though to a lesser extent than the
barbiturates.

Answer 3

REM and slow-wave sleep

Question 4

The newer hypnotics_____________are less likely than the benzodiazepines to change
sleep patterns.

However, so little is known about the clinical
impact of these effects that statements about the desirability of a particular drug based on its effects on sleep architecture havemore theoretical than practical significance.

Answer 4

zolpidem, zaleplon, and
eszopiclone

ZEZ- So kapag ayaw mo change sleep patter. Give ZEZ 0 lol

Question 5

Clinical criteria of
efficacy in alleviating a particular sleeping problem are more
useful.

The drug selected should be one that _________________

Answer 5

• provides sleep of fairly rapid onset (decreased sleep latency)
• and **sufficient​ **duration,
• with minimal “hangover” effects such as drowsiness, dysphoria, and mental or motor depression the following day.

Question 6

Older drugs such as __________
continue to be used occasionally, but zolpidem, zaleplon,
eszopiclone, or benzodiazepines are generally preferred in the treatment of sleep problems

Answer 6

chloral hydrate, secobarbital, and pentobarbital

Question 7

Daytime
sedation is more common with ____________ that have slow
elimination rates (eg, lorazepam)and those that arebiotransformed
to active metabolites (eg, flurazepam, quazepam).

Answer 7

benzodiazepines

Question 8

​ If benzodiazepines are used nightly, tolerance can occur, which
may lead to dose increases by the patient to produce the desired
effect.

____________ occurs to some degree with all benzodiazepines
used for hypnosis.

Answer 8

Anterograde amnesia

Question 9

**__________ **have efficacies similar
to those of the hypnotic benzodiazepines in the management of
sleep disorders.

Answer 9

Eszopiclone, zaleplon, and zolpidem

Question 10

Favorable clinical features of zolpidem and the
other newer hypnotics include ______________

Answer 10

• rapid onset of activity
• and modest day-after psychomotor depression with few amnestic effects.

Question 11

___________ one of the most frequently prescribed hypnotic
drugs in the United States, is available in a biphasic release
formulation that provides sustained drug levels for sleep maintenance.

Answer 11

Zolpidem,

Question 12

__________acts rapidly, and because of its short half-life,
the drug has value in the management of patients who awaken
early in the sleep cycle.

Answer 12

**Zaleplon **

Note:** At recommended doses, zaleplon and eszopiclone** (despite its relatively long half-life) appear to cause
less amnesia or day-after somnolence than zolpidem or benzodiazepines.
The drugs in this class commonly used for sedation
and hypnosis are listed in Table 22–3 together with recommended
doses.

Note: The failure of insomnia to remit after 7–10 days of treatment may indicate the presence of a primary psychiatric or medical
illness that should be evaluated.

Question 13

Long-term use of hypnotics is
an irrational and dangerous medical practice.