Insomnia

Question 1

Daridorexant

Answer 1

Orexin A & B Antagonist
Onset and Maintenance
Lower in mod hepatic, avoid in severe hepatic
Empty stomach
CI: Narcolepsy
Major 3A4 substrate

Question 2

Diphenhydramine

Answer 2

Competes with histamine at H1 receptors
Latency and total sleep time
Not recommended
Residual sedation
Rapid tolerance - do not use longer than 10 days
Anticholinergic ADRs

Question 3

Doxepin

Answer 3

Selective H1 Antagonist
Maintenance
Good for those with substance abuse concerns
Lower in hepatic
Should not take within 3 hours of eating

Question 4

Doxylamine

Answer 4

Competes with histamine at H1 receptors
Not recommended
Residual sedation
Anticholinergic effects
Rapid tolerance - do not use longer than 10 days

Question 5

Estazolam

Answer 5

Modulation of GABA-A receptor
Not frequently used d/t long half-life

Question 6

Eszopiclone

Answer 6

Modulation of GABA-A receptor
Onset and Maintenance
Improvement seen in pts with depression &/or anxiety
Bitter taste
Empty stomach
Lower in hepatic
Major 3A4 substrate

Question 7

Flurazepam

Answer 7

Modulation of GABA-A receptor
Not frequently used d/t long half-life

Question 8

Lemborexant

Answer 8

Orexin A & B Antagonist
Onset and Maintenance
Residual drowsiness
Lower in moderate hepatic, avoid in severe hepatic
CI: Narcolepsy
Major 3A4 substrate

Question 9

Quazepam

Answer 9

Modulation of GABA-A receptor
Not frequently used d/t long half-life

Question 10

Ramelteon

Answer 10

MT1 & MT2 Agonist
Onset
Good for patients with substance abuse concerns
Safe option for pts with OSA/COPD
Avoid in severe hepatic
Empty stomach (high-fat meal)
Substrate: 1A2, 2C9, 3A4

Question 11

Suvorexant

Answer 11

Orexin A & B Antagonist
Onset and Maintenance
Residual drowsiness
Safe in OSA/COPD
Avoid in severe hepatic
Empty stomach
CI: Narcolepsy
Major 3A4 substrate

Question 12

Temazepam

Answer 12

Modulation of GABA-A receptor
Onset and Maintenance
Inexpensive

Question 13

Triazolam

Answer 13

Modulation of GABA-A receptor
Onset
“Speech disorder”
Empty stomach

Question 14

Zaleplon

Answer 14

Modulation of GABA-A receptor
Onset
Lower in mild-mod hepatic, avoid in severe hepatic
Empty stomach
Limit use to 30 days
Major 3A4 substrate

Question 15

Zolpidem

Answer 15

Modulation of GABA-A receptor
Onset and Maintenance
Improvements seen in pts with depression &/or anxiety
SL&ER formulations
Lower in mild-mod hepatic, avoid in severe hepatic
Empty stomach
Major 3A4 substrate