Insomnia

Question 1

Drugs likely to contribute to insomnia?

Answer 1

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

Question 2

Nature pdts used for insomnia?

Answer 2

St. John’s wort

Chamomile tea (taken in the evening)

Melatonin

Valerian

Question 3

MOA of non-benzodiazepines?

Answer 3

Acts selectively at the BZD receptors to increases GABA

Question 4

List non-benzodiazepines used in insomnia

Answer 4

Zolpidem (Ambien, Ambien CR)

Zolpidem (Intermezzo) - for night time awakening

Zaleplon (Sonata)

Eszopiclone (Lunesta)

Question 5

Brand name of Zolpidem (non-benzodiazepines used in insomnia)?

Answer 5

Ambien

Ambien CR

Question 6

Brand name of Zaleplon (non-benzodiazepines used in insomnia)?

Answer 6

Sonata

Question 7

Brand name of Eszopiclone (non-benzodiazepines used in insomnia)?

Answer 7

Lunesta

Question 8

Warnings ass with non-benzodiazepines used in insomnia?

Answer 8

Potential for abuse and dependence

Question 9

SEs of non-benzodiazepines used in insomnia?

Answer 9

Somnolence

Dizziness, Ataxia

Parasomnias

Question 10

Notes of Intermezzo SL?

Answer 10

Don’t take unless planning to sleep 4+ more hrs

Question 11

List Melatonin Receptor agonist agents

Answer 11

Ramelteon (Rozerem)

Question 12

Ses of Ramelteon (Rozerem) - Melatonin Receptor agonist agents?

Answer 12

Somnolence

Dizziness

Question 13

What should be avoided when taking non-BZD and Ramelteon (Rozerem)?

Answer 13

Fatty food

Non-BZD: heavy meal or alcohols (in addition)

Question 14

List TCAs used in insomnia

Answer 14

Doxepin extended-release (Silenor)

Trazodone, Mirtazapine (used off-label)

Question 15

Drugs interactions with Ambien, Sonata, Lunesta?

Answer 15

Caution with Potent 3A4 inh (Ritonavir, Indinavir, Saquinavir, Atazanavir, Ketoconazole, Itraconazole, Erythromycin and Clarithromycin)

Question 16

BZD and geriatric pts?

Answer 16

May be potentially inappropriate for use on geriatric pts based on BEERS criteria

Question 17

List BZD used in insomnia

Answer 17

Lorazepam (Ativan)

Temazepam (Restoril)

Estazolam (Prosom)

Quazepam (Doral)

Fluraxepam

Triazolam (Halcion)

Question 18

What’s the brand name of Lorazepam? BZD for insomnia

Answer 18

Ativan

Question 19

What’s the brand name of Temazepam? BZD for insomnia

Answer 19

Restoril

Question 20

SEs of Lorazepam (Ativan) and Temazepam (Restoril)?

Answer 20

Drowsiness

Dizziness

Weakness

Ataxia

Lightheadedness

Question 21

Which BZD should be chosen if elderly pt needs BZD? Why?

Answer 21

Lorazepam, Oxazepam, Temazepam (LOT)

Less potentially harmful for elderly or those with liver impairment

Question 22

BZD counseling on pg 912

Answer 22

Look!

Question 23

List antihistamines used in insomnia

Answer 23

Diphenhydramine (Benadryl)

Doxylamine (Aldex, Unisom Nightime)

Question 24

Can antihistamines used in insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime)) be used in elderly?

Answer 24

No!

Possible anticholinergic SEs (sedation, confusion)

Question 25

List peripheral anticholinergic SE of antihistamines used in insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime))?

Answer 25

Dry mouth

Urinary retention

Dry/blurry vision, risk increased IOP

Constipation

Question 26

In what dx states should antihistamines used for insomnia (Diphenhydramine (Benadryl), Doxylamine (Aldex, Unisom Nightime)) be avoided?

Answer 26

BPH (may worsen sx)

Glaucoma (may elevate IOP)

Question 27

What’s the preferred tx for insomnia?

Answer 27

Changes to lifestyle

Not drugs, bcuz hypnotics are over-prescribed