Sketchy Pharm: Nonbenzodiazepine Hypnotics, Melatonin, Ramelteon

Question 1

What are the three nonbenzodiazepine hypnotics?

Answer 1

Catching some Zs? Try zolpidem, zaleplon, and eszolpiclone.

Question 2

What receptor do the nonbenzodiazepine hypnotics target?

Answer 2

The GABA(A) receptor (think of the Cab-a A cab)

Question 3

Describe the use and effect of zaleplon and zolpidem.

Answer 3

They are fast-acting sleep aids – without the anxiolytic effect of the benzodiazepines –that are hepatically metabolized; because they are fast-acting, they are best at helping people get to sleep, but may not help people stay asleep. (Think of the sheep jumping quickly over the fence and returning to the ground.)

Question 4

What is the main adverse effect of nonbenzodiazepines?

Answer 4

Confusion and delirium (particularly in the elderly) –same as the benzodiazepines (think of the confused man stacking blankets).

Question 5

You should not combine zolpidem and zaleplon with ____________.

Answer 5

any other CNS depressant (alcohol, barbiturates, benzodiazepines, and 1st gen antihistamines)

Question 6

What is the antidote to zolpidem, zaleplon, and eszolpiclone?

Answer 6

Flumazenil

Question 7

What is ramelteon?

Answer 7

An agonist to the melatonin receptors (“let your worries melt away”)

Question 8

What is unique about ramelteon?

Answer 8

It has been shown to be safe in the geriatric population –with few side effects.

Question 9

Melatonin and ramelteon bind to the __________ receptors.

Answer 9

MT1 and MT2 in the suprachiasmatic nucleus of the hypothalamus (think of the base of the x-shaped fan)