Insomnia Flashcards
Drugs likely to contribute to insomnia?
Bupropion
Stimulants (methylphenidate etc)
OTC appetite stimulants
Decongestants (Pseudoephedrine etc)
MAO-B inh, if taken late in day
Fluoxetine, if taken late in day
Caffeine
Steroids
Alcohol (initially induces sleep, but prevents deeper stages of sleep and causes nocturia)
Any drug that causes urinary retention or nocturia including antihistamines and diuretics taken later in the day
Nature pdts used for insomnia?
St. John’s wort
Chamomile tea (taken in the evening)
Melatonin
Valerian
MOA of non-benzodiazepines?
Acts selectively at the BZD receptors to increases GABA
List non-benzodiazepines used in insomnia
Zolpidem (Ambien, Ambien CR)
Zolpidem (Intermezzo) - for night time awakening
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Brand name of Zolpidem (non-benzodiazepines used in insomnia)?
Ambien
Ambien CR
Brand name of Zaleplon (non-benzodiazepines used in insomnia)?
Sonata
Brand name of Eszopiclone (non-benzodiazepines used in insomnia)?
Lunesta
Warnings ass with non-benzodiazepines used in insomnia?
Potential for abuse and dependence
SEs of non-benzodiazepines used in insomnia?
Somnolence
Dizziness, Ataxia
Parasomnias
Notes of Intermezzo SL?
Don’t take unless planning to sleep 4+ more hrs
List Melatonin Receptor agonist agents
Ramelteon (Rozerem)
Ses of Ramelteon (Rozerem) - Melatonin Receptor agonist agents?
Somnolence
Dizziness
What should be avoided when taking non-BZD and Ramelteon (Rozerem)?
Fatty food
Non-BZD: heavy meal or alcohols (in addition)
List TCAs used in insomnia
Doxepin extended-release (Silenor)
Trazodone, Mirtazapine (used off-label)
Drugs interactions with Ambien, Sonata, Lunesta?
Caution with Potent 3A4 inh (Ritonavir, Indinavir, Saquinavir, Atazanavir, Ketoconazole, Itraconazole, Erythromycin and Clarithromycin)
BZD and geriatric pts?
May be potentially inappropriate for use on geriatric pts based on BEERS criteria
List BZD used in insomnia
Lorazepam (Ativan)
Temazepam (Restoril)
Estazolam (Prosom)
Quazepam (Doral)
Fluraxepam
Triazolam (Halcion)
What’s the brand name of Lorazepam? BZD for insomnia
Ativan
What’s the brand name of Temazepam? BZD for insomnia
Restoril
SEs of Lorazepam (Ativan) and Temazepam (Restoril)?
Drowsiness
Dizziness
Weakness
Ataxia
Lightheadedness
Which BZD should be chosen if elderly pt needs BZD? Why?
Lorazepam, Oxazepam, Temazepam (LOT)
Less potentially harmful for elderly or those with liver impairment
BZD counseling on pg 912
Look!
List antihistamines used in insomnia
Diphenhydramine (Benadryl)
Doxylamine (Aldex, Unisom Nightime)
Can antihistamines used in insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime)) be used in elderly?
No!
Possible anticholinergic SEs (sedation, confusion)
List peripheral anticholinergic SE of antihistamines used in insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime))?
Dry mouth
Urinary retention
Dry/blurry vision, risk increased IOP
Constipation
In what dx states should antihistamines used for insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime)) be avoided?
BPH (may worsen sx)
Glaucoma (may elevate IOP)
What’s the preferred tx for insomnia?
Changes to lifestyle
Not drugs, bcuz hypnotics are over-prescribed
