NERVOUS SYSTEM - SLEEP DISORDERS + SUBSTANCE DEPENDENCE Flashcards
What is insomnia?
Sleeping problem
List 4 symptoms of insomina?
difficulty sleeping
difficulty staying asleep
early morning awaking
poor sleep quality
What is transient insomnia caused by?
Environmental factors (use 1-2 doses of short-acting hypnotic - midazolam)
e.g. jet lag
What is short-term insomnia caused by?
Emotional or serious illness
How to treat short-term insomnia?
Use short-term hypnotic intermittent (use for <3 weeks)
What is chronic insomnia caused by?
Psychiatric or physical illness- treat the underlying cause.
List the 3 types of insomnia?
Transient
Short-term
Chronic
What 2 classes of drugs are given for insomnia?
Z drugs
Benzodiazepines
List 2 Z drugs used in insomnia?
Zopiclone
Zolpidem
What drug schedule are Z drugs?
CD4 part 1
List Benzos used in insomnia? (8)
Nitrazepam
Flurazepam
Diazepam
Temazepam
Lorazepam
Loprazolam
Lormetazepam
Oxazepam
Are zopiclone + zolpidem short or long acting?
Short acting
What Z drug causes taste disturbances
Zopiclone
What Z drug causes GI disturbances?
Zolpidem
What is 1 counselling point to tell the patient regarding zolpidem and driving?
Drowsiness may still persist the next day - leave 8 hours before driving.
What Benzo is commonly used in dental procedures + preferred?
Diazepam
Lorazepam
Temazepam - preferred
What 2 benzos help with insomnia linked to anxiety?
Lorazepam
Oxazepam
What 2 Z drugs are short-acting?
Zopiclone + Zolpidem
Who should benzos + Z drugs be avoided in?
Elderly - risk of falls
What is MOA of Z drugs?
Acts on benzodiazepine sites on GABA receptors + increases GABA binding.
What is indication of Z drugs?
Severe insomnia -SHORT TERM
What 3 benzos are long acting?
Diazepam
Flurazepam
Nitrazepam
What 5 benzos are SHORT acting?
Temazepam
Lorazepam
Loprazolam
Lormetazepam
Oxazepam
What effect is more prominent in long-acting benzodiazepines?
Hangover effect
Anxiolytic effect during day (diazepam single dose at night).
What are 3 SEs of Z -drugs?
Daytime sleepiness
Respiratory depression
Dependence + tolerance
What does label say for Z-drugs?
this medicine makes you feel sleepy. If you still feel sleepy the next day, do not drive or use tools/ machines.
Do not drink alcohol.
What can happen if a benzo is given with opioid?
CNS depression effect- monitor when starting, new dose
If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, when to monitor methadone?
2 weeks of initiation as CNS depression effect delayed
What other patient counselling should be given regarding respiratory depression?
Report signs of slow and shallow breathing, sedation + blue lips
What are some cautions surrounding dependence on Z drugs?
Substance misuse + MH disorder
What class drugs can interact with Z drugs + increase CNS depression / sedation?
-Alcohol, opioids, sedating antihistamines, Antipsychotics, Benzos, (CNS depressant)
-Azole antifungals, Macrolides, Diltiazem + verapamil (enzyme inhibitors)
What drug types/enzyme —- can interact with Z drugs to increase CNS depression?
CNS depressants
Enzyme inhibitors - increase toxicity of Z drug = sedation
What is narcolepsy?
Excessive sleepiness in the daytime + may also suddenly fall asleep during any activity.
What is 1st line management of narcolepsy?
Modafinil
What is alcoholism?
Strong, uncontrollable desire to drink.
What are 2 1st line drug treatments for alcohol withdrawal symptoms?
Chlordiazepoxide
OR
Diazepam
What drug can help alcohol with-drawal patient with seizures?
Lorazepam
What drug can help alcohol withdrawal patient with delirium tremens?
Oral lorazepam
What drug can help alcohol with-drawal patient with persistant delirium tremens OR if declines?
Parenteral Lorazepam
OR
Haloperidol
What is 1st line treatment for alcohol dependence?
Acamprostate OR naltexone + psychological therapy
What drug is used to reduce the alcohol consumption in patient with alcohol dependence with high risk of drinking ?
Nalmefene
What drug is used to help treat Wernicke’s Encephalopathy?
Thiamine
What is nicotine dependence?
Nicotine which is present in tobacco is addictive and smoking causes lung cancer + COPD.
What is the most effective approach in stopping smoking?
Abrupt quiting
Cessation aids + behavioural support
What are 2 drug treatments to help stop smoking?
Varenicline
Long + short acting NRT.
What are examples of short acting NRT?
Gum, Lozenge, Nasal + oral spray, sublingual tablet, inhalator.
(helps with urge to smoke + prevent cravings).
What are examples of long acting NRT?
patch - for strong cravings on waking
What are 2 durations of the patch?
16 hours
24 hours
What is an SNRI drug which is also used for smoking cessation?
Bupropion
What is an MHRA warning regarding the use of bupropion and serotonergic drugs?
Increased risk of serotonin syndrome
What patient counselling can be given to the SNRI Bupropion?
Report any worsening of depression, suicidal behaviour.
What 2 drugs are given for opioid dependence?
Methadone
Buprenorphine
What is frequency of dose for opioid dependence drugs?
OD
What is a SE of methadone?
QT prolongation
What is a SE of buprenorphine?
Precipitates withdrawal - take 1st dose on withdrawal signs.
describe half life of methadone?
Long half life
What is more sedating; methadone or buprenoprhine?
Methadone
What to do if they miss 3 days of methadone?
Cannot give- overdose risk
What to do if they miss 5 days of methadone?
risk of misuse - cannot give.
Which opioid dependence drug has a lower risk of overdose?
Buprenorphine
What 3 conditions to avoid varenicline in ?
CVD
Epilepsy
Psychiatric illness
What 3 conditions to avoid bupropion in?
Eating disorders
seizures
psychiatric illness
What NRT to use if pregnant?
16 hour patch if pregnant or nightmares +
short term reliever - e.g. gum, lozenges
What is max supply for opioid dependance treatment?
14 days - FP10MDA FORM
How many missed does of methadone means refer back?
3 or more missed doses
Can treatment for opioid dependence carry on when pregnant?
YES
