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Psychopharmacotherapy > Hypnotics > Flashcards

Hypnotics Flashcards

1
Q

Which hypnotics are typically free of residual effects in the morning?

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Triazolam (Halcion)

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2
Q

Which hypnotics are good for sleep latency issues?

ie rapid onset of action

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Triazolam (Halcion)

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3
Q

Which hypnotics are good for sleep maintenance?

ie slow elimination

A

Temazepam (Restoril)
Estazolam (Prosom)
Flurazepam

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4
Q

What are good hypnotics to use if a patient is struggling from depression?

A

Trazodone

Amitriptyline

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5
Q

What adjustments should be made for elderly patients?

A

Use smaller doses

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6
Q

What caution needs to be taken when coming off the drug?

A

Taper the drug down to avoid rebound insomnia

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7
Q

Which hypnotics are most likely to cause rebound insomnia?

A

Large doses of short-acting agents

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8
Q

What are the general side effects of hypnotics?

A 
Risk of fall
Respiratory depression
Amnesia/Drowsiness/Confusion
Hypokinesia
Dizziness
Abnormal coordination
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9
Q

What is the stongest aspect of tolerance and dependence with long-term use of these agents?

A

Psychological&raquo_space; physical

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10
Q

What are the benefits of Zolpidem?

A

Rapid onset and duration (~4 hrs)

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11
Q

Which type of insomnia is zolpidem and Zaleplon useful for treating?

A

Sleep-onset

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12
Q

What are some specific side effects for zolpidem?

A 
Disinhibition
Dissociation
Sleep-walking
Hallucination
Amnesia
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13
Q

What is the benefit of Zaleplon (Sonata)?

A

Rapid onset of action and ultra-short duration (~2 hrs)

- Allows for usage of 2nd dose in the middle of the night if needed

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14
Q

What drug may significantly increase the level of Zaleplon?

A

Cimetidine

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15
Q

What is the main advantage of eszopiclone (Lunesta)?

A

Studies have shown long term effectiveness

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16
Q

When should eszopiclone be prescribed for insomnia?

A

To decrease sleep latency and improve sleep maintenance

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17
Q

What medications can increase or decrease the blood levels of eszopiclone?

A

CYP3A4 and CYP2E1 inhibitors and inducers

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18
Q

What are some specific side effects of eszopiclone?

A

Dysgeusia
Headache
Coldlike symptoms
Euphoric effects (6 to 12 mg dose)

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19
Q

What may happen within 48 hrs after discontinuing eszopiclone?

A

Anxiety
Abnormal dreams
Nausea
Upset stomach

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20
Q

What is dysgeusia?

A

Foul, salty, rancid, or metallic taste sensation

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21
Q

Which receptors are affected by rozerem (ramelteon)?

A

MT1 and MT2

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22
Q

What type of food decreases the effectiveness of rozerem?

A

High fat

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23
Q

What patient population should not take Rozerem?

A

Those with hepatic impairment

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24
Q

What drug should not be combined with rozerem?

A

Fluvoxamine

25
Q

Which enzyme metabolizes rozerem?

A

CYP1A2

26
Q

What is a the main benefit of using rozerem over other hypnotics?

A

Less respiratory depression

27
Q

What benzos are approved for use to treat insomnia?

A

Estazolam (ProSom)
Triazolam (Halcion)
Flurazepam (Dalmane)
Temazepam (Restoril)

28
Q

What is the benefit of estazolam (ProSom)?

A

Intermediate-acting

Slow onset and long duration

29
Q

What type of insomnia is estazolam suited for treating?

A

Sleep maintenance

30
Q

What are the disadvantages of estazolam?

A 
More sedative then other hypnotics- Falls, impaired cognition
Respiratory depression
Hepatic dysfunction
Low albumin
Renal disease
Pulmonary disease
31
Q

What is the benefit of using trazolam (halcion)?

A

Short acting

32
Q

What type of insomnia is triazolam suited for treating?

A

Sleep-onset

33
Q

What are some specific precautions associated with triazolam?

A

Rebound insomnia
Hepatic dysfunction, low albumin, renal impairment, and pul. dis
Risk of daytime sedation

34
Q

What is the benefit of flurazepam (dalmane)?

A

Long-acting metabolites

35
Q

What type of insomnia is flurazepam suited for treating?

A

Sleep maintenance

36
Q

What are some specific precautions with flurazepam?

A

Do not mix with other CNS depressants

Low albumin or hepatic impairment

37
Q

What is the benefit of temazepam (restoril)?

A

Short to intermediate action with longer latency to onset and half-life

38
Q

What type of insomnia is temazepam well suited to treat?

A

Sleep maintenance

39
Q

What are some specific precautions when using temazepam?

A 
Drowsiness
Headacahe
Nervousness
Dizziness
Other CNS depressants
low albumin or hepatic impairment
40
Q

What risk do elderly face when taking benadryl?

A

Delirium

41
Q

What herbal products can be used for insomnia?

A

Kava kava
Valerian
Melatonin

42
Q

What are some risks associated with kava kava?

A

Not useable with other sedatives

Hepatotoxic

43
Q

What type of “insomnia” can melatonin help treat?

A

Jet lag

44
Q

What is the MOA of trazodone (desyrel)?

A

5-HT2 antagonist

Inhibits 5-HT uptake

45
Q

What substances should be avoided while on trazodone?

A

Alcohol, barbituates, and CNS depressants
Digoxin and phenytoin (increase serum levels)
Warfarin (may decrease effectiveness of warfarin)

46
Q

Common side effects of trazodone?

A 
Dry mouth
blurred vision
Constipation
Urinary retention
Priapism 
Hypotension
Syncope
Drowsiness or dizziness
47
Q

What is the MOA of nefazodone (serzone)?

A

Antagonist of 5-HT2

Inhibits 5-HT uptake

48
Q

What medications are contraindicated in a patient taking nefazodone?

A 
MAOIs
Astemizole
Carbamazepine
Cisapride
Terfenadine
49
Q

The effectiveness of which drugs are decreased by the use of nefazodone?

A 
Anticoagulants
Hypoglycemics 
Diuretics 
Clonidine
Methyl dopa
50
Q

The effectiveness of which drugs are increased when taking nefazodone?

A

Digoxin
Carbamazepine
MAOIs

51
Q

What are some specific precautions when using nefazodone?

A 
Hepatotoxic
Cardiac disease
Cerebrovascular disease
Seizures
Priapism
52
Q

What TCA can be used to treat insomnia

A

Amitriptyline (Elavil)- Inhibits 5-HT and NE uptake

53
Q

What drug may decrease the effectiveness of amitriptyline?

A

Phenobarbital

54
Q

What drugs might increase the levels of amitriptyline?

A

CYP2D6 inhibitors (Cimetidine, quinidine)

55
Q

What precautions should be monitored when using amitriptyline?

A 
Anticholinergic effects
- Urinary retention
- Constipation
- Blurred vision
Cardiac conduction disturbances
56
Q

What are the adverse effects of mirtazapine?

A 
Somnolence
Dry mouth
Increase appetite/Weight gain
Dizziness
Agranuocytosis
57
Q

What substances are contraindicated with mirtazapine?

A

MAOIs
Alcohol
Benzos

58
Q

What is the staple for the treatment of insomnia?

A

Sleep hygiene

Psychopharmacotherapy (8 decks)

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