pharm-insomnia Flashcards
Meds that contribute to insomnia (8)?
- anti-depressants
- stimulants
- antihypertensives
- sedatives
- decongestants/ antihistamines
- analgesics
- herbal supplements
- substances of abuse
Define sedative + hypnotic?
Sedative: drug that reduces excitement + calm the patient
- Aka anxiolytics
- do not induce sleep
Hypnotic: drug that results in drowsiness that promotes sleep
What does next day impairment mean?
- May cause next-day impairment of activities requiring alertness (driving car) despite feeling fully awake
- Use only when 7-8 hrs of planned sleep
- Wait≥ 12 hrs before driving/ machinery
What drug is a benzodiazepines R agonist?
Zopliclone
What drug is a dual orexin antagonist?
Lemborexant
What drug is a TCAs used for insomnia?
Doxepin
What drug is a GABA-A R agonist (enhances Cl-movement → enhances effect of GABA inhibition)
Benzodiazepine
What drug is an allosteric modulator of GABA-A R (enhanced inhibition)?
Zopiclone
(benzo R agonist)
What drug normalities sleep-wake function by ↓ wakefulness + unwanted trasnition btwn wake + sleep?
Lemborexant
(Dual Orexin Antagonist)
What drug is a selective histamine H1 antagonist at low doses?
Doxepin (TCA)
What drug is indicated for insomnia in elderly?
low dose Doxepin for sleep maintenance
lemborexant: favourable safety and efficacy profile in eldery for up to 6 mos of use
What drug is the preferred drug class for general population?
Zopiclone
ataxia, dizziness; dependence/ withdrawal symptoms, impaired memory, risk of abuse
Benzodiazepines
Bitter/ metallic taste, dry mouth, dizziness + somnolence
Complex sleep behaviours (nighttime eating + somnambulism w/ no recollection of such activities)
Zopliclone
Somnolence
Less common: sleep paralysis, hypnagogic/ hypnopompic hallucinations, cataplexy-like symptoms
Complex sleep behaviours (night eating, somnambulism w/ no recollection of such activates)
May cause next-day impairment (Wait ≥ 9 hrs before driving)
Lemborexant
Somnolence, sedation, nausea
Take within 3 hrs of meal to ↓ next day drowsiness
[not associated w/ rebound insomnia, dependence, next-day impairment]
Doxepin
which drug has minimal next day impairment potential and abuse potential?
Lemborexant
(9 hours instead 12 for driving)
What is considered the most suitable benzodiazepine?
Temazepam
What benzodiazepine has a higher abuse, dependent, and rebound insomnia potential?
Triazolam
Which benzo’s not recommended due to their long half lives?
Flurazepam + nitrazepam
3 types of off-label drugstore insomnia?
- anti-convulsants (gabapentin) for insomnia due to centralized pain (fibromyalgia)
- antihistamine for insomnia associated w/ allergic conditions
- Sedating antidepressants for mood disorders
What to do for insomnia with children?
1st line = non-pharmacologic options
- antihistamine not recommended
- drug should target comorbidity
