Hypnotics/ADHD Flashcards
FDA approved sleep aid medication, takes forever to work and lasts forever (like Slak). It should be avoided in elderly patients.
Diphenhydramine
What are the major ADRs associated w/diphenhydramine?
- anticholinergic effects
- next day impairment
- large doses = hallucinogenic effect
What medication is beneficial for sleep maintenance but must be avoided in pt w/CVD?
Doxepin (TCA)
When should you consider BZDs for sleep? Which has the quickest onset?
Last resort!
Quickest onset: Triazolam
Anterograde amnesia and complex sleep related behaviors are an adverse drug reaction from what class of meds?
BZDs and NBRAs
Which class of medications is approved for short term use for both sleep onset and sleep maintenance, but has minimal efficacy?
NBRAs
List the 3 NBRAs
Zaleplon
Zolpidem
Eszopiclone
“z drugs”
Which class of meds require a lower dose for the elderly and women and are also on the Beer’s list?
NBRAs
Which NBRA commonly has a metallic aftertaste?
Eszopiclone
What is the benefit of NBRAs over BZDs?
less tolerance, dependence, withdrawal, abuse
Melatonin is best for treating which type of sleep issues?
Sleep latency (falling asleep)
Which medication is used for the treatment of non-24hr sleep wake disorder?
Tasimelteon
What are the 2 orexin receptor antagonists used to treat sleep latency +/- sleep maintenance?
- suvorexant
- lemborexant
In general, ADs, 2nd gen antipsychotics, and AEDs/neuropathic analgesics should only be used to treat insomnia if _____.
they are already being taken to treat an underlying comorbid disease
What is the 1st and 2nd step for treatment of insomnia?
- Nonpharm (CBT)
- Pharm - if necessary.
- start low and go slow
- 4-5x higher mortality in pt on rx drug for sleep
Ritalin generic
Methylphenidate
Adderall generic
Amphetamine-dextroamphetamine
Vyvanse generic
Lisdexamphetamine
Which 3 drugs do stimulants typically interact with?
- anti-HTN meds
- MAOI, linezolid
- sympathomimetics, caffeine
You recently started your patient on methylphenidate for their ADHD. What do you need to warn the patient/family about regarding potential ADRs?
- **anorexia, wt loss, appetite disturbance
- sleep disturbance
- feeling zombie-like, less spontaneous
The methylphenidate you prescribed is causing too many issues for your patient and you want to take them off. What do you do?
TAPER - important with all stimulants
What monitoring is important for patients who are on stimulants?
BP/Pulse
Growth rate in children
Also
- s/s of depression, aggression, hostility
- signs of CNS stimulation
Your patient has been diagnosed with ADHD and while doing a thorough family hx, they mention a Fhx of Tourettes. What meds should you avoid?
Stimulants
What are 3 non stimulants for ADHD?
- Atomoxetine (SNRI)
- Guanfacine
- Clonidine
What drugs should you avoid for patients with atomoxetine?
MAOI
Linezolid
Which ADHD med has a BBW?
Atomoxetine (SNRI) - suicidal ideation
Which 2 meds for ADHD have interactions with anti-HTN & vasodilators AND additive sedations w/other CNS depressants?
Guanfacine
Clonidine
What is the major side effect of Guanfacine?
somnolence
hypotension
What is the major side effect of clonidine?
sedation
other: irritability, emotional flattening, depression, insomnia, nightmares, withdrawal syndrome
Which non stimulants must be tapered over 1-2wk?
Guanfacine
Clonidine
What are the short acting simulants?
- Methylphenidate - Ritalin
- Dexmethylphenidate - Focalin
- Dextroamphetamine - Dexadrine
- Amphetamine-Dextroamphetamine - Adderall
What are the intermediate acting stimulants?
- Methylphenidate - Ritalin (swallow whole)
2. Dextroamphetamine - Dexedrine Spansule
What are the long acting stimulants?
- Methylphenidate - Ritalin or Concerta
- Dexmethylphenidate - Focalin
- Amphetamine-Dextroamphetamine - Adderall
- Lisdexamphetamine - Vyvanse
Used for difficulty falling asleep
Consider when abuse or dependence is a concern, for elderly pt prone to falls or CNS effects, for travelers, or for pt with chronic insomnia
Ramelteon
