Neuro/MH Flashcards
Five most
common
medications likely
to disrupt sleep
- Levodopa
- Prednisone
- Venlafaxine
- Fluvoxamine
- Rotigotine
Initial treatment for chronic insomnia
CBT-I is recommended as the initial treatment for chronic insomnia2,3,4,5
Benzodiazipines in elderly. Which are safe for insomnia?
Avoid in the elderly due to risk of cognitive and behavioural adverse effects, falls and fractures
Flurazepam, oxazepam, triazolam are indicated for primary insomnia, but are not recommended2
Treatment of insomnia duration with pharmacotherapy
1-2 weeks
Evidence suggests that
pharmacotherapy should be used no
longer than _____ due to the risk of
dependence and tolerance
1 month
Doxepin SE
• A/E: anticholinergic side effects with higher doses• A/E: anticholinergic side effects with higher doses
Safest and best studied medication for insomnia for older adults and dosing
Doxepin 3-6 mg
Sedative hypnotics can increase total
sleep time by ______
25 minutes
Average adult > 60 years only requires ___ hours of sleep
6
Sedative hypnotics can decrease sleep
latency by _____
10 minutes
General approach to tapering, follow up interval
1-4 weeks
Avoid benzodiazipines and Z drugs in older adult for which common adverse effects (BEERS)
Falls, fractures, change in cognition, delirium, MVC (increased hospitalizations with Z drugs)
Which 4 classes of medications should be avoided in dementia/cognitive impairment? (BEERS)
Antipsychotics
Anticholinergics
Benzos
Z drugs
Which class of medications is associated with higher risk of CVA and mortality with persons with dementia?
Antipsychotics
What duration of therapy should be ordered for cyclobenzaprine for appropriate head/neck pain?
No longer than 2 weeks
