Hypnotic Agents

Question 1

What type of hypnotic would you use for a person that is unable to fall asleep?

Answer 1

Ultra short-acting hypnotic

Question 2

Which type of hypnotic would you use for a person that has difficulty staying asleep?

Answer 2

Short-acting hypnotic

Question 3

Which type of hypnotic would you use for someone that wakes up too early in the night?

Answer 3

Long-acting hypnotic

Question 4

What is short-term insomnia?

Answer 4

Trigger or stressor related, self resolves

Question 5

What is chronic insomnia?

Answer 5

> 3 weeks without any identifiable trigger, may resolve and may require combination therapy

Question 6

Which patients are contraindicated for hypnotics?

Answer 6

Sleep apnea, ETOH use, pregnancy, suicidal risk

Question 7

Which BZDs are used for hypnotic treatments

Answer 7

Triazolam
Temazepam
Flurazepam

Question 8

Which BZD is ultra-short acting for hypnotics?

Answer 8

Triazolam

Question 9

Which BZD is short-acting for hypnotics?

Answer 9

Temazepam

Question 10

Which BZD is long-acting for hypnotics?

Answer 10

Flurazepam

Question 11

Which BZD hypnotic has a high incidence of anterograde amnesia?

Answer 11

Triazolam

Question 12

Which BZD hypnotic is associated the most with residual daytime drowsiness?

Answer 12

Flurazepam

Question 13

Which BZD hypnotic is associated with rebound insomnia the most?

Answer 13

Triazolam

Question 14

Which BZD hypnotic is most effective on the second night?

Answer 14

Flurazepam

Question 15

Which BZD hypnotic has the least likelihood to have rebound insomnia?

Answer 15

Flurazepam

Question 16

Which BZD hypnotic has the longest lasting metabolites of up to 74-90 hours?

Answer 16

Flurazepam

Question 17

What is the MOA of non-BZDs for hypnotic agents?

Answer 17

Allosteric agonists at BZD receptor on GABAa

Selective for Alpha-1 subunit only (sedation, amnesia, ataxia)

Question 18

What are the effects of non-BZDs?

Answer 18

ONLY hypnotic and amnesia effects

Question 19

Do Non-BZDs suppress REM and N3 sleep?

Answer 19

No

Question 20

What are the non-BZD hypnotics?

Answer 20

Zolpidem
Eszopiclone
Zapeplon

Question 21

Which non-BZDs require a lower dose for women?

Answer 21

Zolpidem

Eszopiclone

Question 22

Which non-BZD has no limitation on how long it can be used?

Answer 22

Eszopiclone

Question 23

What is the duration of action for all non-BZDs?

Answer 23

Ultra-short acting

Question 24

What is orexin?

Answer 24

neuropeptides responsible for wakefulness and regulating sleep cycle

Question 25

What is the MOA of Suvorexant?

Answer 25

Blocks Orexin 1 Receptor and Orexin 2 receptor to prevent binding of Orexin A and B
Blocks wakefulness

Question 26

What is the side effect of suvorexant use?

Answer 26

Mild cataplexy (leg weakness)

Question 27

Why is suvorexant not used frequently?

Answer 27

Because it is a new drug and its use is not clear

Question 28

What is melatonin?

Answer 28

Hormone involved in the circadian rhythm and sleep awake cycle
Stimulates MT1 and MT2 G-protein receptors

Question 29

What is the MOA of Ralmeteon?

Answer 29

Agonist of MT1

Ultra-short acting

Question 30

What is the main use for Ralmeteon (melatonin)?

Answer 30

Prevention of jet lag

Question 31

Why is melatonin/Ralmeteon not used primarily for insomnia?

Answer 31

The effect is not great, small effect