Nonbenzodiazepine hypnotics

Question 1

Nonbenzodiazepine hypnotics

Answer 1

zolpidem
Zaleplon
ezZopiclone 
(ZZZ mattresses) 
Melatonin 
Ramelteon 
(let sleepless nights melt away)

Question 2

Z hypnotics how they work

Answer 2

bind to the same allosteric site on the GABA-A receptor as benzos, potentiating the Cl transmission through the channel in the CNS causing inhibition (Cab-A diner guy and sleep person getting in same door)

Question 3

onset of action for Z hypnotics

Answer 3

zaleplon and zolpidem have rapid onset (fall asleep FAST)

Question 4

duration of action for Z hypnotics

Answer 4

short duration due to rapid metabolism by liver (quick jump and fall of sheep with liver spots)

Question 5

what z hypnotics treat

Answer 5

zaleplon and zolipidem treat sleep onset insomnia (fall asleep FAST)
eszopiclone has a longer half life and is effective for both sleep onset and sleep maintenance insomnia

Question 6

z hypnotic side effects

Answer 6

similar to benzos but less severe
elderly patients are more sensitive to them (cognitive impairment and delirium, ataxia) (older man confused and toppling over the blankets)
less likely to cause tolerance, dependence, or withdrawal (returns not tolerated)

Question 7

z hypnotic interactions

Answer 7

cant combine with other CNS depressants (antihistamine, alcohol, benzos, barbiturates) (cant combine with other CoupoNS)

Question 8

reversing z hypnotic effects

Answer 8

flumazenil, still precipitates seizures

Question 9

how melatonin and ramelteon work

Answer 9

maintain circadian rhythm (dark and light)
MT1 and MT2 melatonin receptor agonists, located in the suprachiasmatic nucleus of the hypothalamus (nucleus above X fan)

Question 10

which insomnia drugs should be given to elderly patients

Answer 10

melatonin and ramelteon have few side effects and are safe