Sedative-Hypnotics Agents Flashcards
What are the clinical uses of sedative-hypnotics?
-Treatment of insomnia (main)
-Anxiolytic
-Adjunctive sedation and anterograde amnesia before medical and surgical procedures
-Anticonvulsant (treatment of epilepsy and seizures states)
-Control of alcohol withdrawal
What are examples of sleep disorders?
-Primary insomnia (difficult initiating or maintaining sleep)
-Dysomnia (affects amount, quality, or timing of sleep)
-Primary hyperinsomnia
-Narcolepsy
-Circadian rhythm disorders (i.e jet lag)
-Parasomnias (related to abnormal/pathologic events)
What can be done for those with sleep disorders before initiating medication?
-Cognitive behavioral therapy
-Good sleep hygiene (regular sleep/wake schedule)
-Evaluate administration times of current medications
What can help someone have a regular sleep/wake schedule?
-Bedroom-> dark, quiet, comfortable
-Avoid daytime naps
-Exercise early in the day
-Avoid heavy meals, alcohol, stimulants (caffeine)
-Establish pre-bedtime ritual and/or regular schedule of activities
What are examples of pharmacological treatments for sleep disorders?
-FDA-approved “hypnotics”
-Benzodiazepines
-Zolpidem (Ambien)
-Zaleplon (Sonata)
-Eszopiclone (Lunesta)
-Ramelteon (Rozerem)
What are examples of Benzodiazepines that are prescribed for treatment of sleep disorders?
-Estazolam (ProSom)
-Quazepam (Doral)
-Temezepam (Restoril)
-Triazolam (Halcion)
Additional treatment considerations for sleep disorders:
-Screen for underlying physical psychiatric illness
-Treatment of underlying illnesses may help to alleviate sleep difficulties
-Ensure pain control is adequate for those with chronic pain
Zolpidem (Ambien) binds to ____ receptors, similar to benzodiazepines
GABA-A
Zolpidem (Ambien) is good for ___-__ treatment of insomnia, about 7-10 days
Short-term
Zolpidem (Ambien) has a rapid onset of action of ___ minues
30
The duration of action of Zolpidem (Ambien) is ___-___ hours
7-8
Zolpidem (Ambien) is a schedule ____ controlled substance
IV
Zolpidem (Ambien) is helpful for disturbances that affect ____ portions of sleep
All
Zolpidem (Ambien) has less ____ residual effects than other sleep medications
Daytime
Zolpidem (Ambien) has no ____ metabolites
Active
Ambien ___ mg is given before bedtime
10
Ambien ___ mg can be given to the elderly or those with hepatic dysfunction
5
Ambien ___ is a non-narcotic and non-benzodiazepine formulated to offer a new indication for sleep maintenance, in addition to sleep induction
CR
Ambien CR is a bi-layered tablet; the first layer dissolved quickly to ____ sleep and the second layer is released more gradually into the body to help provide more continuous sleep
Induce
____ is a sublingual dosage form of Zolpidem; it absorbs much faster than the oral form so it requires a smaller dose (dose is also smaller for women than men because men absorb it even faster)
Intermezzo
What is the dose of Intermezzo for women?
1.75 mg
What is the dose of Intermezzo for men?
3.5 mg
What are some common side effects of Zolpidem (Ambien)?
-Nausea
-Dizziness
-Headache
-Dry mouth
A ____ mg dose of Zolpidem (Ambien) can be used for the treatment of Major Depressive Disorder
10
The FDA has requested that all manufacturers of sedative-hypnotic drugs products strengthen their product labeling to include stronger language concerning potential ____ such as severe allergic reactions and complex sleep-related behaviors
Risks
Zaleplon (Sonata) binds to ____ receptors similar to benzodiazepines
GABA-A
Zaleplon (Sonata) is used for ___-___ treatment of insomnia (7-10 days)
Short-term
Zaleplon (Sonata) is a schedule ____ drug (controlled substance)
IV
Zaleplon (Sonata) has a rapid onset of action of ___-___ minutes
30-60
The duration of action of Zaleplon (Sonata) is less than ____ hours, which reduces the risk of a “hang-over” effect
4
Zaleplon (Sonata) is very similar to ____
Ambien
Zaleplon (Sonata) has no ____ metabolites
Active
A ___-___ mg dose of Zaleplon (Sonata) is given before bedtime
5-20
Sonata ___ mg should be given to elderly patients/those with hepatic dysfunction
5
Eszopiclone (Lunesta) interacts with GABA-RC near the ____ binding site
Benzodiazepine