hypnotics

Question 1

Anti-histamine used for insomnia, and dose?

Answer 1

promethazine

25-50mg , take 20 mins before going to bed.

note: useful if problems sleeping combined with coryzal/ allergy symptoms

Available OTC - ‘Night nurse’

Question 2

What are the two Z-drugs, used for treating insomnia?

Answer 2

Zopiclone

Zolpidem

Question 3

How do Z-drugs work?

Answer 3

Facilitate and enhance binding of GABA to the GABA_a receptor - DEPRESSES synaptic transmission

(note: similar MOA to benzodiazepines)

Question 4

What problem can occur after stopping Z-drugs?

Answer 4

Rebound insomnia

If used for >4 weeks then dependence and withdrawal symptoms - including headache, muscle pains and anxiety.

Question 5

Cautions of Z-drugs (2)

Answer 5

Elderly - more sensitive

Can cause respiratory failure during sleep with obstructive sleep apnoea, resp. depression/ resp muscle weakness

Question 6

Z-drugs enhance the sedative effect of which drugs? (3)

Answer 6

Alcohol

anti-histamines

benzodiazapines

Question 7

Doses

Zopiclone

Zolpidem

Answer 7

Zopiclone 7.5mg

Zolpidem 10mg

** have doses for elderly **

Question 8

Patient advice and z-drugs? (4)

Answer 8

1. Try sleep hygiene first
2. only for short-term use
3. Drowsiness can last into the next day
4. Don’t drive/ operate heavy machinery