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Pharm > Drugs To Treat Insomnia > Flashcards

Drugs To Treat Insomnia Flashcards

1
Q

Before prescribing sleeping pills…

A

1) Cognitive behavioral therapy and sleep hygiene
2) Work-up for underlying cause
3) Sedative-Hypnotic options

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2
Q

Potential underlying causes of insomnia:

A

Substance use disorder
Psychiatric illness (mood or anxiety disorders)
Medial illness
Restless leg syndrome

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3
Q

Sedative-Hypnotic Options

A 
Benzodiazepines
Non-benzodiazepine agonists
Melatonin receptor agonists
Anti-histamines
Herbal preparations that affect GABA transmission
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4
Q

Will sleeping pills cure insomnia?

Can behavioral/psychological technqiues cure insomnia?

A

NO!

Sometimes

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5
Q

FDA approved benzodiazepines for insomnia Rx

A 
Estazolam
Temazepam
Quazepam
Flurazepam
Triazelam
Lorazepam
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6
Q

Which FDA approved benzo is used most often to treat insomnia?

A

Temazepam

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7
Q

How long can benzos be used to treat insomnia?

How many days in a week can a pt use sleeping pills for insomnia?

A 
Short term (1-3 months)
No more than 3 days/week
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8
Q

Which drugs should be used to treat insomnia in elderly pt?

A

LOT!
Lorazepam
Oxazepam
Temazepam

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9
Q

Problems with benzos

A 
Rebound insombia
Psychological dependence
Tolerance
Physiological dependence
Risk of withdrawal
Substance abuse disorder
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10
Q

Which patients are at the high risk of substance abuse with benzos?

A

Pts with other substance issues

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11
Q

Signs of substance abuse:

A

Running out of meds early, wanting a higher dose, losing meds, going to multiple doctors for prescriptions (IL PMP)

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12
Q

Non-benzodiazepines agonists approved for sleep disorders

A 
Imidazopyridine:
Zolpidem, Zaleplon
Pyrrolopyrazine:
Eszopiclone
"Z meds to get more zzz's"
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13
Q

Side effects of Non-benzo agonists

A

sleep walking, sleep driving, sleep eating

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14
Q

Relative costs of the non-benzo agonists vs. benzos

A

Benzos are the LEAST expensive
Zolpidem and Zaleplon are more expensive but no unreasonable
Eszopiclone is expensive

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15
Q

Ramelteon

A

M1 & M2 melatonin receptor agonist

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16
Q

Down side of Ramelteon

A

COST- typically requires prior approval by insurance company, or trying less expensive drugs first

17
Q

Sedating drugs with anti-histamineric actions: Tricyclic antidepressants

A

Amitriptyline
Doxepin
Imipramine

18
Q

Sedating drugs with anti-histamineric actions: Mixed action antidepressants

A

Mirtazapine

Trazadone

19
Q

Benefit of using antidepressants to treat insomnia

A

Also treat depression and anxiety, which may be the underlying cause of patient’s insomnia

20
Q

Sedating drugs with anti-histamineric actions: H1 histamine receptor antagonists

A

Cyclobenzapine
Dihenhydramine
Hydroxyzine

21
Q

Of the antihistamines, which is preferred for use in the elderly?

A

Hydroxyzine (NOT muscarinic)

22
Q

Herbal Insomnia Rx: Valeriana officinalis

A 
sesquiterpene: mediate GABA release and inhibit GABA breakdown
No morning after hangover
No aversive effects
No serious drug interactions
Useful for 4 weeks
23
Q

Herbal Insomnia Rx: Chamomile

A

Apigenin: benzo agonist

relaxing

24
Q

Herbal Insomnia Rx: Kava

A

Contains compounds that facilitate binding of GABA

Reported calming effects

25
Q

Herbal Insomnia Rx: Passion Flower

A

Chrysin: a benzo partial agonist

Reported to be safe and effective (unsubstantiated)

26
Q

Over the counter meds (no longer available)

A

Compoz (pyrilamine +methapyrilene)
Nytol (methapyrilene + salicylamide)
Sominex (methapyrilene + salicylamide + scopalamine)
Sleep-Eze (methapyrilene + scopalamine)

Produce tolerance and rebound insomnia, NOT more effective than placebo

27
Q

Currently available OTC sleep aids

A

Unisom (doxylamine)
ZzzQuil (diphenhydramine)

*both antihistamines

28
Q

Buspirone site of action

A

5HT-1A partial agonist

29
Q

Buspirone t1/2

A

short (2.5 hours)

30
Q

Buspirone Side Effects

A

Headaches, dizziness, nervousness, sedation, nausea

31
Q

Buspirone DDI

A

DO NOT use with MAOI

32
Q

Buspirone Clinical Consideration

A

Generalized Anxiety Disorder
C antidepressants for major depression
C antidepressants for anxiety disorders

33
Q

Advantage of Buspirone vs. benzos

A

No risk of dependence, no withdrawal, no GABA cross tolerance

34
Q

Advantage of Buspirone vs. anti-depressants

A

Low/no sexual side effects, weight neutral, no withdrawal

35
Q

Disadvantages of Buspirone

A

Effectiveness?

Pharm (20 decks)

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