Exam 2: Hypnotics Flashcards
1
Q
BZD MOA
A
bind to GABAa receptors, allosteric site
2
Q
BZD AE overview (4)
A
- daytime sedation
- psychomotor impairment
- cognitive deficits
- anterograde amnesia
3
Q
BZD cautions (10)
A
- older adults
- tolerance and dependence within 4-6 weeks of use
- withdrawal
- rebound insomnia
- AVOID IN HX OF DRUG USE
- AVOID W/ ALCOHOL USE OR OPIOD USE
- BOXED WARNING W OPIODS
- AVOID IN SLEEP APNEA
- AVOID IN PREGNANCY
- can worsen depression, PTSD, suicidal ideation
4
Q
BZD drugs (2)
A
- tamezepam
- 7.5-50mg dose
- sleep onset/maintenance
- slow onset - Triazolam
- 0.125-0.25 mg
- rapid onset
- sleep onset use
5
Q
BZE Adverse Effects (7)
A
- CNS depression
- sedation
- respiratory depression - psychomotor impairment
- ataxia
- falls in elderly - Confusion
- Agression
- Disinhibition
- Amnesia
- anterograde
- retrograde - Dependence and abuse
6
Q
Non-BZD Receptor Agonist
Z-Drugs
MOA
A
Bind to GABAa receptor, allosteric site
-more selective subunits
7
Q
Z-drugs
Adverse effects (4)
A
- Daytime sedation
- cognitive deficits
- amnesia
- complex sleep behaviors
8
Q
Z-drugs
Cautions (6)
A
- older adults
- tolerance and rebound insomnia < BZDs
- rx for significant withdrawal
- AVOID concomitant CNS depressants, including alcohol and opioids
- can worsen depression, suicidal ideation
- BOXED WARNING:
April 2019
-serious injuries or death in 66 patients, caused by parasomnias
9
Q
Z-Drug pearls (1)
A
Rapid onset; food delays by 1-2 hours
10
Q
Melatonin Agonist
MOA (1)
A
- melatonin analogue; binds melatonin 1 & 2 receptors (hypothalamus)
11
Q
Melatonin Agonist Sleep Benefits (3)
A
- Regulates circadian rhythms (phase shifting)
- direct effect on decreasing sleep latency
- no effect on sleep maintenance
12
Q
Melatonin Agonist AE (4)
A
- HA
- Dizziness
- daytime somnolence
- GI upset
13
Q
Melatonin Agonist Caution (2)
A
- may increase prolactin level in men & women
2. decreased testosterone levels in men
14
Q
Melatonin Agonist Pearls (5)
A
- SAFE in sleep apnea, COPD, hx of substance use disorder
- may require 3 weeks of nightly use for maximum effect on sleep onset
- high-fat meal decreased effectiveness
- affected by CYP1A2 and CYP3A4 inhibition/induction
- brand-only $$$
15
Q
Orexin Agonist MOA
A
Antagonism or orexin receptor 1 and 2 in the hypothalamus
-when activated they promote waking