Hypnotic Agents Flashcards
What type of hypnotic would you use for a person that is unable to fall asleep?
Ultra short-acting hypnotic
Which type of hypnotic would you use for a person that has difficulty staying asleep?
Short-acting hypnotic
Which type of hypnotic would you use for someone that wakes up too early in the night?
Long-acting hypnotic
What is short-term insomnia?
Trigger or stressor related, self resolves
What is chronic insomnia?
> 3 weeks without any identifiable trigger, may resolve and may require combination therapy
Which patients are contraindicated for hypnotics?
Sleep apnea, ETOH use, pregnancy, suicidal risk
Which BZDs are used for hypnotic treatments
Triazolam
Temazepam
Flurazepam
Which BZD is ultra-short acting for hypnotics?
Triazolam
Which BZD is short-acting for hypnotics?
Temazepam
Which BZD is long-acting for hypnotics?
Flurazepam
Which BZD hypnotic has a high incidence of anterograde amnesia?
Triazolam
Which BZD hypnotic is associated the most with residual daytime drowsiness?
Flurazepam
Which BZD hypnotic is associated with rebound insomnia the most?
Triazolam
Which BZD hypnotic is most effective on the second night?
Flurazepam
Which BZD hypnotic has the least likelihood to have rebound insomnia?
Flurazepam
Which BZD hypnotic has the longest lasting metabolites of up to 74-90 hours?
Flurazepam
What is the MOA of non-BZDs for hypnotic agents?
Allosteric agonists at BZD receptor on GABAa
Selective for Alpha-1 subunit only (sedation, amnesia, ataxia)
What are the effects of non-BZDs?
ONLY hypnotic and amnesia effects
Do Non-BZDs suppress REM and N3 sleep?
No
What are the non-BZD hypnotics?
Zolpidem
Eszopiclone
Zapeplon
Which non-BZDs require a lower dose for women?
Zolpidem
Eszopiclone
Which non-BZD has no limitation on how long it can be used?
Eszopiclone
What is the duration of action for all non-BZDs?
Ultra-short acting
What is orexin?
neuropeptides responsible for wakefulness and regulating sleep cycle
What is the MOA of Suvorexant?
Blocks Orexin 1 Receptor and Orexin 2 receptor to prevent binding of Orexin A and B
Blocks wakefulness
What is the side effect of suvorexant use?
Mild cataplexy (leg weakness)
Why is suvorexant not used frequently?
Because it is a new drug and its use is not clear
What is melatonin?
Hormone involved in the circadian rhythm and sleep awake cycle
Stimulates MT1 and MT2 G-protein receptors
What is the MOA of Ralmeteon?
Agonist of MT1
Ultra-short acting
What is the main use for Ralmeteon (melatonin)?
Prevention of jet lag
Why is melatonin/Ralmeteon not used primarily for insomnia?
The effect is not great, small effect
