Hypnotics & Anxiolytics Flashcards
What are Hypnotics used for?
To treat insomnia
Give examples of Hypnotics?
Temazepam, diazepam, loprazolam, nitrazepam
When is a hypnotic prescribed?
After the cause of the insomnia and the underlying factors have been found
Who are short acting hypnotics given to?
Patients with sleep onset insomnia, when sedation is undesirable the following day
OR
When prescribing for the elderly
Who are long acting hypnotics given to?
Patients with poor sleep maintenance that causes day time effect
When anxiolytic effect is needed during the day
When sedation the following day is acceptable
Who normally gets transient insomnia and what should be given to them?
Normally occurs in people who normally sleep well (e.g. due to jet lag or noises)
If hypnotic needed, give one that is rapidly eliminated and only 1 or 2 doses should be given
Who normally gets short term insomnia and what should be given to them?
Normally people who have an emotional problem or serious medical illness.
Short acting drug is most appropriate and should not be given for more than 3 weeks.
Which hypnotics should not be given to the elderly and why?
Benzodiazepines and Z-drugs should be avoided in elderly patients.
Because the elderly have a greater risk of becoming ataxic and confused, leading to falls and injury
Which hypnotics are normally given to dental patients?
Temazepam OR diazepam.
Temazepam is preferred as it has minimal residual effects the following day
Examples of long acting Benzodiazepines?
Do they have any effects?
Nitrazepam and flurazepam.
They can give rise to residual effects the following day
Examples of shorter acting Benzodiazepines?
Do these have any effects?
Loprazolam, lormetazepam, temazepam.
They have little to no hang over effect.
But are most found to have withdrawal effects.
What should be given to a patient with insomnia associated with daytime anxiety?
Why?
Long Acting benzodiazepine anxiolytic, like diazepam.
Take as a single dose at night.
Because it treats both symptoms
Examples of non-benzodiazepines?
What are the pros and cons of them?
Zolpidem & Zopiclone.
They are called z drugs.
They have a short duration of action (short acting).
But they are not licensed for long term use.
Which Benzodiazepines are most appropriate in elderly patients?
Short acting benzodiazepines
What else can be used to treat as a hypnotic to treat insomnia?
What information must be known about them?
Clomethiazole - useful in elderly as they don’t cause hangover effects.
Antihistamines - like promethazine hydrochloride. But their prolonged duration of action can cause drowsiness the following day.
Alcohol - but this is a poor hypnotic because the diuretic action interferes with sleep. And alcohol can also disturb sleep pattern and worsen sleep disorders.
Melatonin - is a pineal hormone. Is licensed for short term treatment of insomnia in adults over 55 yeas and short term jet lag.
