Sleep Flashcards
Estazolam (ProSom)
Benzo (CIV); used for sleep onset or maintenance insomnia; CI in pegnancy or w/ Itraconazole/Ketoconazole; SE is Hypokinesia
Eszopiclone (Lunesta)
Z-drug (CIV); Delayed onset of action if taken w/ food; used for sleep onset or maintenance insomnia; duration of 6-9 hours; can be used long term (<6 mo); monitor use w/ Itraconazole/Ketoconazole; SE are HA, dysgeusia, anxiety, xerostomnia, infection, stomach upset
Zopiclone (Imovane)
Z-drug (CIV); treatment shouldn’t exceed 7-10d; CI in severe respiratory impairment, myasthenia gravis, severe hepatic insufficiency; excreted in human milk
Zaleplon (Sonata)
Z-drug (CIV); short acting, rapid onset; avoid taking after high fat meal; used for short term treatment of onsomnia (Not for sleep maintenance); duration of effect 3-4 hrs; excreted in breat milk; SE are HA, nausea, abdominal pain; interacts with CYP3A4 inducers (cimetidine. rifampin)
Zolpidem (Ambien)
Z-drug (CIV); avail IR tab/spray, ER tab, SL tab (Intermezzo – take if more than 4 hrs remain before waking + pt has trouble falling back asleep); used for sleep onset/maintenance; rapid onset, short t1/2, CI in severe hepatic impairment, SE are HA, nausea
Trazodone
Off label use; BW for suicidal thoughts and behaviors; useful in pts with hx of substance abuse; SE are carry over sedation and alpha adrenergic blockade (possibly orthostasis, priaprism); when dc’ing gradually taper
Suvorexant (Belsomra)
CIV DORA; assists in getting to sleep and maintaining sleep; <30min for onset of action, 12hr t1/2, interacts w/ CYP3A4 inhib/induc; SE are drowsiness, dizziness, HA, sleep paralysis, abnormal dreams, URTI; CI in narcolepsy
Lemborexant (DayVigo)
CIV DORA; assists in getting to sleep and maintaining sleep; <30min for onset of action, 17-19hr t1/2, interacts w/ CYP3A4 inhib/induc; need at least 7 hours before planned time of awakening; NEXT DAY DROWSINESS and INC RISK OF FALLING; SE are drowsiness, dizziness, HA, complex sleep behaviors, abnormal dreams (nightmares); CI in narcolepsy
Ramelteon (Rozerem)
Melatonin receptor agonist; onset of action 30min, t1/2 1-2.6hr; for sleep-onset insomnia and long term use; don’t use in pts w/ severe liver disease; not as effective in those already treated with a BZDRA; SE are HA, dizziness, somnolence; CI w/ Fluvoxamine
Melatonin
Beneficial for sleep-onset latency, shift workers, jet lag; avoid in those with autoimmune conditions; don’t use in those w/ alzheimers
Doxepin
TCA; used for sleep maintenance insomnia; SNRI; BBW for suicidality; don’t take w/in 3 hrs of a meal
USE FOR ELDERLY
CBT-I, Ramelteon, Eszopiclone, Zolpidem, Low-dose doxepin
USE FOR PREG
Diphenhydramine, Doxylamine, Low-dose doxepin
Modafnil (Provigil)
CIV; effects on Dopamine, GABA, 5-HT; AE are HA, Nausea, Anx/nervousness, dizziness, Dyspepsia, xerostomia, back pain, rhinitis; don’t use in pregnancy; might dec contraceptive effectiveness; use w/ caution in pts w/ CVD
Armodafinil (Nuvigil)
CIV; EDS; effects on Daopamine (R-enantiomer); AE: HA, insomnia, dizziness, Nausea, Xerostomia; don’t use in pregnancy; might dec contraceptive effectiveness; use w/ caution in pts w/ CVD
Solriamfetol (Sunosi)
CIV; EDS; Dopamine ane NE reuptake inhib; CI w/ use of MAOI, AE are HA, anx, insomnia, dec appetitie, nausea; avoid in pts w/ unstable CVD/arrythmias
Pitolisant (Wakix)
Histmaine-3 receptor antagonist/reverse agonist; EDS; lower MDD for CYP2D6 poor metab; CI in severe hepatic impairment; may prolong QT (avoid in pts w/ arrrythmias); AE are HA, anx, MUSKEL Pain, URI
Amphetamines and Methylphenidate
Meds used for Narcolepsy
Sodium Oxybate (Xyrem)
CIII; EDS; BBW for CNS Depression, Abuse/misuse, Restricted access; dosed at bedtime w/ 2nd dose 2.5-4 hrs later; AE: confusion, HA, Dizziness, weight loss/dec appetite, urinary incontinence, drowsiness, depression, somnambulism, anx; REMS program
Meds used for Cataplexy in Narcolepsy
Fluoxetine, Venlafaxine, Atomoxetine, Clomipramine, Imipramine, Nortriptyline, Pitolisant, Sodium Oxybate
Jet Lag
Napping, timed light exposure, Melatonin, Ramelteon, short acting BZDRA
Shift Work Disorder
sleep scheduling, sleep hygiene, naps before or during shift, exposure to bright lights at night and darkness during the day, melatonin, ramelteon, short-acting BZDRA, Modafinil/Armodafinil to improve wakefulness
Parasomnias
Benzos, SSRIs, TCAs
Intermittent RLS Sympt
Carbidopa-levodopa, BZDRA (Clonazepam), low-dose opioid
