Insomnia

Question 1

Changes in sleep architecture with hypnotics

Answer 1

reduce deep sleep and REM

Question 2

Tolerence to hypnotics

Answer 2

after 3 days effects decline, chronic use can cause a rebound effect

Question 3

Short-acting hypnotic

Answer 3

triazolam

Question 4

Long-acting hypnotic

Answer 4

flurazempam

Question 5

Benefits of short acting hypnotic

Answer 5

helps fall asleep, no day time drowsiness

Question 6

Benefits of long-acting hypnotic

Answer 6

residual anti-anxiety effects
more effective on second night
tolerance does not develop
rebound less likely

Question 7

Disadvantages of short acting hypnotic

Answer 7

no day time anti-anxiety
rebound can occur quickly.
anteriograde amnesia
sleep walking

Question 8

Disadvantages of long-acting hypnotic

Answer 8

residual day time drowsiness

Question 9

MOA of zolpidem

Answer 9

binds alpha-1 subunit GABA-A receptors only at benzodiazepine sites

Question 10

pharmacokinetic of zolpidem

Answer 10

short half life, women get half the dose, metabolized by CYP3A4, can’t take with orange juice

Question 11

Advantages of zolpidem

Answer 11

does not alter sleep architecture
no daytime drowsiness
low risk of tolerance

Question 12

Disadvantages of zolpidem

Answer 12

sleep walking, driving, etc

Question 13

Other alpha-1 selective hypnotics

Answer 13

Eszopiclone and zaleplon

Question 14

Melatonin receptor agonist

Answer 14

Ramelteon

Question 15

Ramelteon MOA

Answer 15

agonist at M1 and M2 melatonin receptors

Question 16

Thereapeutic use of ramelteon

Answer 16

for difficulty falling asleep, shift work

Question 17

SE of ramelteon

Answer 17

somnolence, dizziness, fatigue