Management Strategies Flashcards
1
Q
Target symptoms
A
1.) Increased Sleep latency
- consider non pharm first or as an add on
- medications with fast onset and shorter duration
2.) Increased nocturnal awakenings and early morning awakenings
- medications with longer duration of action may be important
3.) excessive daytime sleepiness
- medications with short duration of action to avoid excessive daytime sedation
2
Q
OTC products
A
- Diphenhydramine
- Melatonin
- Valerian
- L-tryptophan
3
Q
Diphenhydramine
A
- Duration increased in elderly
- Avoid in pts older than 65 yrs
4
Q
Melatonin
A
- A hormone produced and secreted by the pineal gland, secretion decreases with age
- Considered for pts with disrupted sleep/wake cycles
- 1mg to 5mg stat sig improvement in sleep
5
Q
Valerian Root
A
- Possible agonist at GABA-A and 5-HT5a receptors
- Usual dose is 200-1000 mg taken 30-60 min prior to bed
6
Q
L - Tryptophan
A
- An amino acid
- Increases serotonin and melatonin
- Dietary sources: turkey, milk, eggs, cheese, fish
- Modest improvement in SL and wake after sleep onset.
- Modest reduction in wakefulness and increase in total sleep time
7
Q
Benzodiazepines (BZD)
A
Positive GABA-A allostreric modulators - longer acting
- Estazolam (Prosom)
- Quazepam (Doral)
- Temazepam (Restoril)
- Flurazepam (Dalmane)
8
Q
Non-Benzo
A
Alpha-1 subunit of GABA-A Agonist
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Zolpidem (Ambien)
9
Q
Doxepin (Silenor)
A
- Tricyclic Antidepressant
- Reduces frequent nocturnal awakenings
- MOA: Histamine-1 antagonist
