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Neuro Pharm > Drugs for Insomnia > Flashcards

Drugs for Insomnia Flashcards

1
Q

What are some of the general concerns in regards to the development of drugs for insomnia?

A

Daytime somnolence, unconscious nighttime activity, and suicidal ideation.

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2
Q

Most of the benzodiazepines, benzo receptor agonists, and barbituates act on what receptors in the CNS?

A

GABA

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3
Q

Which of the benzo-structure related drugs does not work on the GABA receptors?

A

Ramelteon (melatonin receptor)

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4
Q

T/F: These drugs work in place of endogenous GABA.

A

F: modifies response pattern of GABA to ligand

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5
Q

T/F: Binding of benzodiazepines and their receptor antagonists produces only allosteric modification.

A

True

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6
Q

ADE of Benzos and their receptor agonists

A

Sedation, cognitive impairment rebound insomnia, and withdrawal.

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7
Q

What are the 3 distinct structural subgroups in the GABA receptor?

A

BZ-1, BZ-2, BZ-3

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8
Q

Benzos work on what receptor subgroups?

A

All three

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9
Q

Benzodiazepine receptor agonists work on what receptor subgroups?

A

BZ-1

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10
Q

Benzos with long half lives usually cause what type of effects?

A

Cumulative through multiple dosings

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11
Q

Which benzodiazepine works on CYP 2B6?

A

Quazepam

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12
Q

Which two benzodiazepines has miniman metabolism accumulation?

A

Estazolam and Temazepam

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13
Q

What preggo category are benzos?

A

Category X

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14
Q

Benzos are contraindicated in what dxs?

A

COPD, Depression, hepatic diseases, closed angle glaucoma

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15
Q

Preggo category of benzo receptor agonists.

A

C

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16
Q

Shared characteristics of benzo receptor agonists?

A

CYP-mediators, hepatic dx, cautioned with COPD, depression and driving

17
Q

Which benzo receptor agonist can be available in both sublingual and oral spray prep?

A

Zolpidem

18
Q

Which Benzo receptor agonist can be taken in the middle of the night?

A

Zolpidem

19
Q

Special ADE of Zolpidem?

A

Different dosing recommendations for women due to diminished elimination rate (next day impairment).

20
Q

Benzo and Benzo receptor antagonist

A

Flumazenil

21
Q

Flumazenil causes what?

A

Abrupt awakening (does NOT reverse barbituates, opiate agonists and TCAs)

22
Q

Melatonin works on receptors located where?

A

Suprachiasmatic nucleus

23
Q

MT1 attenuates what?

A

SCN activity and induces sleep

24
Q

MT2 binds and dmaintains what?

A

Circadian rhythm

25
Q

Melatonin receptor agonist?

A

Ramelteon

26
Q

Special characteristics of Ramelton

A

No residual effects and no abuse

27
Q

What CYP does ramelton work on?

A

CYP1A2

28
Q

ADE of ramelton

A

Headache, somnolence, nausea, insomnia, naso-pharyngitis, upper RTI

29
Q

Antidepressants used in insomnia?

A

Doxepin, mirtazapine, trazodone

30
Q

Clinical utility in insomnia of antidepressants involves what?

A

Histaminergic signaling (tuberomammillary nucleus)

31
Q

Which antidepressant works on sedation, and bloacks M, NE, and 5-HT receptors?

A

Doxepin

32
Q

ADE of antidepressants?

A

Suicidal ideation, interactions with alcohol, and CYP metab

33
Q

2 1st gen antihistamines used in antihistamines

A

Diphenhydramine and Doxylamine

34
Q

ADE of 1st Gen antihistamines

A

Rapid tolerance and anticholinergic actions

35
Q

What population do you avoid with first gen antihistamines

A

Elderly and those with narrow-angle glaucoma

36
Q

What should you do if someone is being fucked by drug-induced insomnia?

A

Change the drug or reduce the dose before starting polydrugs for the problem

37
Q

Home remedies for insomnia

A

Melatonin, meditation, yoga and music

38
Q

Home remedies that dont work for insomnia

A

Chamomile and valerian

39
Q

MOA of suvorexant

A

Targets orexin receptors

Neuro Pharm (10 decks)

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