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*Pharm III > Insomnia > Flashcards

Insomnia Flashcards

1
Q

Difficulty staying asleep

Experiencing non–‐restorative sleep

A

Insomnia

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2
Q

how many sleep cycles per night?

A

4-5 cycles

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3
Q

by what age do most children stay awake all day and sleep ~10 hours at night

A

6

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4
Q

when do the later stages of sleep begin to diminish?

A

by age 40

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5
Q

how long does acute insomnia last?

A

several days- 4 weeks

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6
Q

how long is chronic insomnia

A

greater than 4 weeks

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7
Q

what are conditions that can cause chronic insomnia?

A

RLS
sleep apnea
substance abuse
conditioned anxiety

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8
Q

5 things that you need at least 2 of for at least a month to be diagnosed w/ a primary sleep disorder

A 
Difficulty initiating sleep
Difficulty maintaining sleep
Poor sleep efficiency
Sleep disturbances on > 3 nights/week
Significant impairment in social, occupational, or other areas of functioning
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9
Q

Used to assess and record variables that characterize sleep and aid in diagnosis of sleep disorders

A

Polysomnography

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10
Q

Insomnia that occurs following the discontinuation of sedative substances

A

rebound insomnia

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11
Q

drugs that cause rebound insomnia

A

EtOH, antihistamines, BZDs
antidpressants (TCAs, MAOIs, SSRIs)
opiates, Marijuana, Cocaine

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12
Q

screening questions for insomnia (REST)?

A

Restorative sleep
Excessive daytime sleepiness, tiredness, or fatigue?
Snoring nightly?
Total sleep time?

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13
Q

Non-pharm tx for insomnia

A

Cognitive- sleep hygiene
CBT
sleep diary

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14
Q

indications for antihistamines

A

insomnia
anxiety
allergy

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15
Q

3 antihistamines for sleep

A

diphenhydramine
hydroxyzine
doxylamine

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16
Q

what do antihistamines supress

A

REM sleep

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17
Q

how long do antihistamines work for insomnia

A

1 week

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18
Q

ADRs w/ antihistamines

A 
Anticholinergic effects (prob in elderly)
dizziness, confusion, next day sedation
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19
Q

Do high doses of antihistamines increase sedation?

A

No, only increase side effects

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20
Q

what are 3 Z-Hynpotics

A

Zolpidem
Zaleplon
Eszopiclone

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21
Q

what are Z-hypnotics selective for?

A

BZ-1 receptor of GABAa receptor

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22
Q

Z-Hypnotic only used as a hypnotic. should only be used for 7-10 days

A

zolpidem

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23
Q

advantages of Zolpidem

A

no withdrawal
minimal rebound insomnia
little or no tolerance

24
Q

ADRs w/ zolpidem

A

GI upset

agitation, HA, nightmares, dizziness, daytime drowsiness

25
Q

how is zolpidem metabolized?

A 
P450
rifampin (shortens 1/2 life)
26
Q

what is the ideal agent for sleep latency?

A

zaleplon

27
Q

what z-hypnotic is more rapidly eliminated so have fewer psychomotor and cognitive effects?

A

Zaleplon

28
Q

Proven to fall asleep quickly, maintain sleep through the night
1st product approved for long tem use (6 months)

A

Eszopiclone

29
Q

ADRs w/ eszopiclone

A

anxiety, dry bouth, chest pain

Ha, migraine, peripheral edema, somnolence, unpleasant taste

30
Q

Advantages of eszopiclone

A

low abuse potential/ no withdrawal
no tolerance for up to 12 months
rarely associated w/ behavior changes

31
Q

Melatonin receptor agonist
More potent at MT1 and MT2 than MT3
No appreciable activity at GABA receptor

A

Ramelteon

32
Q

what is ramelteon indicated for?

A

use in insomnia characterized by difficultly w/ sleep onset

33
Q

precautsions w/ ramelteon

A

don’t give in conjunction or shortly after high fat meals (won’t be absorbed)

34
Q

warnings w/ ramelteon

A

caution in patients w/ moderate hepatic impairment

don’t use w/ severe hepatic impariment

35
Q

ADRs for ramelteon

A

Somnolence, fatigue, dizziness, nausea, myalgia

36
Q

off label use for benzos

A

insomnia

37
Q

what benzo reduces sleep-induction and number of awakenings. Increases duration of sleep and effective up to 4 weeks

A

Flurazepam

38
Q

benzos that Reduces number of awakenings

Peak sedative effect 2-3 hours after oral dose (so take 2-3 hours before wanting to fall asleep)

A

temazepam

39
Q

benzo that Induces sleep
Tolerance develops with days
Withdrawal of drug results in rebound insomnia

A

triazolam

40
Q

Best documented if used for restoring sleep in SSRI- induced insomnia

A

5HT2 blockers

41
Q

what are the 3 5HT2 blockers, increase sleep continuity and time

A

Nefazodone
mirtazapine
trazodone

42
Q

ADRs w/ 5HT2 blockers

A 
Nausea
xerostomia
constipation
drowsiness, HA
rebound insomnia
priapism
43
Q

Efficacy in insomnia has not been proven except for specific diagnoses: Anxiety and Depressive Disorders, not FDA indicated for insomnia

A

TCA’s

43
Q

what are 2 TCAs

A

Doxepin

Amtriptyline

43
Q

ADRs w/ TCAs

A 
orthostatic HPOTN
dizziness
sedation
xerostomia
blurred vision
constipation
urinary hesitancy
43
Q

ADR of valarian root

A

Severe HA

44
Q

ADRs of melatonin

A

abdominal cramps
HA
irritability

45
Q

natural product that increases GABA in synaptic cleft. Mild hypnotic, improves sleep latency and quality of sleep.

A

Valarian root

46
Q

what is modafinil approved for?

A

tx of residual daytime sleepiness despite traditional approaches (eg- CPAP)

47
Q

non-pharm tx for sleep apnea

A

weight loss
positional change
CPAP

48
Q

pharm tx for sleep apnea

A

modafinil (C-IV)

49
Q

what is modafinil approved for?

A

tx of residual daytime sleepiness despite traditional approaches (eg- CPAP)

50
Q

Creepy, crawly sensations in legs at rest, relieved by movement
Worse in evening or night

A

Restless Leg Syndrome

51
Q

Repetitive, rhythmic limb movements (legs) in series lasting minutes, with movements occuring every 20-40 sec

A

Periodic Limb Movement Disorder

52
Q

Pharm txs for RLS and periodic limb movement disorder (off-label)

A

Ropinirole

Pramipexole

*Pharm III (8 decks)

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