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Insomnia Flashcards

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1
Q

Antihistamines

A

Less effective than benzos
Tolerance develops quickly
Daytime drowsys and anticholinergic side effects
H1 Receptor antagonists

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2
Q

Diphenhydramine

A 
Benadryl
IND: Sleep aid
MOA: H1A
BOX: n/a
CON: n/a
ADR: Anticholinergic
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3
Q

Doxylamine

A 
IND: Sleep aid
MOA: H1A
BOX: n/a
CON: n/a
ADR: Anticholinergic
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4
Q

Non-Benzos

A

Preferred agent for insomnia
Different than benzos but still act on the GABA receptor Cl channel
Potential for tolerance, dependence, and abuse.
CONTROLLED SUBSTANCES

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5
Q

Zolpidem

A

Ambien
IND: Insomnia, short term
MOA: GABA receptor agonist. Does not reduce time spent in REM, little to no rebound.
BOX: Complex sleep behaviors; sleep walking, driving, or other activities. Has resulted in death
CON:
ADR: HA, drowsy, dizzy

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6
Q

Zaleplon

A 
IND: Insomnia, short term
MOA: Binds to omega-1 receptor on alpha subunit of the GABA-A (same as Ambien for BIlly). Good for sleep induction, not great for sleep maintenance
BOX: Complex sleep behaviors
CON:
ADR: HA
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7
Q

Eszopiclone

A 
IND: Insomnia, long term
MOA: GABA receptor agonist. Reduced onset of action with high-fat or large meal
BOX: Complex sleep behaviors
CON:
ADR: HA, dysgeusia
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8
Q

Benzodiazepines

A

MOA: Agonists on post-synaptic GABA neuron in the CNS; results in less excitable state and stabilization
CONTROLLED SUBSTANCES
BOX: Use with opioids; profound sedation/respiratory depression, coma, and death. Only prescribe to pts with no viable alternatives. Limit duration/quantity
Abuse, misuse, addiction
Dependence and LIFE-THREATENING WITHDRAWAL RXNS

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9
Q

Temazepam

A 
IND: Insomnia
MOA: Benzo
BOX: Benzo
CON: Pregnancy
ADR: Drowsy and hangover effect. Anxiety/confusion
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10
Q

Triazolam

A 
IND: Insomnia
MOA: Benzo
BOX: Benzo
CON: Use with CYP inhibitors
ADR: Drowsy
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11
Q

Estazolam

A 
IND: Insomnia
MOA: Benzo
BOX: Benzo
CON: Use with Itraconazole or Ketoconazole. Pregnancy
ADR:
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12
Q

Ramelteon

A

IND: Insomnia
MOA: Melatonin receptor agonist in the hypothalamus. MT1: Induces sleepiness. MT2: Sleep-wake cycle
BOX: n/a
CON: Hx of angioedema with previous Ramelteon. Use with Fluvoxamine
ADR: Droswy

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13
Q

Suvorexant

A 
IND: Insomnia
MOA: Orexin receptor antagonist. Controlled Substance
BOX: n/a
CON: Narcolepsy
ADR: Narcolepsy
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14
Q

Valerian Root

A

Herbal supplement from Valeriana
400-600mg/day
No adverse effects. Thought to work on GABA receptors

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15
Q

Non-pharmacologic Treatments

A

1st line for all insomnia

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Psych (9 decks)

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