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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
how is zolpidem metabolized?
``` P450 rifampin (shortens 1/2 life) ```
26
what is the ideal agent for sleep latency?
zaleplon
27
what z-hypnotic is more rapidly eliminated so have fewer psychomotor and cognitive effects?
Zaleplon
28
Proven to fall asleep quickly, maintain sleep through the night 1st product approved for long tem use (6 months)
Eszopiclone
29
ADRs w/ eszopiclone
anxiety, dry bouth, chest pain | Ha, migraine, peripheral edema, somnolence, unpleasant taste
30
Advantages of eszopiclone
low abuse potential/ no withdrawal no tolerance for up to 12 months rarely associated w/ behavior changes
31
Melatonin receptor agonist More potent at MT1 and MT2 than MT3 No appreciable activity at GABA receptor
Ramelteon
32
what is ramelteon indicated for?
use in insomnia characterized by difficultly w/ sleep onset
33
precautsions w/ ramelteon
don't give in conjunction or shortly after high fat meals (won't be absorbed)
34
warnings w/ ramelteon
caution in patients w/ moderate hepatic impairment | don't use w/ severe hepatic impariment
35
ADRs for ramelteon
Somnolence, fatigue, dizziness, nausea, myalgia
36
off label use for benzos
insomnia
37
what benzo reduces sleep-induction and number of awakenings. Increases duration of sleep and effective up to 4 weeks
Flurazepam
38
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)
temazepam
39
benzo that Induces sleep Tolerance develops with days Withdrawal of drug results in rebound insomnia
triazolam
40
Best documented if used for restoring sleep in SSRI- induced insomnia
5HT2 blockers
41
what are the 3 5HT2 blockers, increase sleep continuity and time
Nefazodone mirtazapine trazodone
42
ADRs w/ 5HT2 blockers
``` Nausea xerostomia constipation drowsiness, HA rebound insomnia priapism ```
43
Efficacy in insomnia has not been proven except for specific diagnoses: Anxiety and Depressive Disorders, not FDA indicated for insomnia
TCA's
43
what are 2 TCAs
Doxepin | Amtriptyline
43
ADRs w/ TCAs
``` orthostatic HPOTN dizziness sedation xerostomia blurred vision constipation urinary hesitancy ```
43
ADR of valarian root
Severe HA
44
ADRs of melatonin
abdominal cramps HA irritability
45
natural product that increases GABA in synaptic cleft. Mild hypnotic, improves sleep latency and quality of sleep.
Valarian root
46
what is modafinil approved for?
tx of residual daytime sleepiness despite traditional approaches (eg- CPAP)
47
non-pharm tx for sleep apnea
weight loss positional change CPAP
48
pharm tx for sleep apnea
modafinil (C-IV)
49
what is modafinil approved for?
tx of residual daytime sleepiness despite traditional approaches (eg- CPAP)
50
Creepy, crawly sensations in legs at rest, relieved by movement Worse in evening or night
Restless Leg Syndrome
51
Repetitive, rhythmic limb movements (legs) in series lasting minutes, with movements occuring every 20-40 sec
Periodic Limb Movement Disorder
52
Pharm txs for RLS and periodic limb movement disorder (off-label)
Ropinirole | Pramipexole

*Pharm III (8 decks)

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