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Meds > Sleep and nightmare meds > Flashcards

Sleep and nightmare meds Flashcards

1
Q

which medications are used for insomnia

A

mirtazapine
trazadone
zolpidem
eszopiclone
zaleplon

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2
Q

which meds are used for nightmares

A

topiramate
prazosin

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3
Q

brand name for mirtazapine

A

remeron

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4
Q

brand name for trazadone

A

desyrel

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5
Q

brand name for topiramate

A

topamax

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6
Q

brand name for prazosin

A

minipress

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7
Q

brand name for zolpidem

A

ambien

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8
Q

brand name for eszopiclone

A

lunesta

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9
Q

brand name for zaleplon

A

sonata

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10
Q

dosage of remeron for insomnia

A

7.5mg QHS

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11
Q

total dosage range for mirtazapine

A

15-45mg QHS

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12
Q

geriatric considerations for mirtazapine

A

lower doses
careful with hepatic impairment

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13
Q

labs to monitor for mirtazapine

A

fasting glucose
lipids

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14
Q

pregnancy risk with mirtazapine

A

moderate

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15
Q

patient teaching for mirtazapine for insomnia

A

need 8-10 hours of sleep

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16
Q

what is the dose dependent sedation effect of mirtazapine

A

sedation decreases as dosage increases

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17
Q

what is mirtazapine particularly good for

A

anxious depression

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18
Q

serious mirtazapine side effect

A

stevens johnson syndrome

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19
Q

when should you avoid mirtazapine

A

with ETOH abuse

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20
Q

dosage range for trazadone for insomnia

A

25-50 QHS
can go up to 100mh if needed

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21
Q

uses for trazadone

A

insomnia
depression
anxiety

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22
Q

uses for mirtazapine

A

MDD
panic disorder
GAD
PTSD
insomnia

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23
Q

pregnancy risk for trazadone

A

moderate

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24
Q

contraindication for trazadone

A

after MI

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25
Q

starting dose for topiramate for nightmares

A

12.5mg QHS

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26
Q

dosage range for topiramate for nightmares

A

25-300mg QHS

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27
Q

FDA approved uses for topiramate

A

seizures
migraine prophylaxis
weight management

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28
Q

off label uses for topiramate

A

bipolar
binge eating disorder
psychotropic drug induced weight gain
tremor
PTSDl

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29
Q

abs to monitor with topiramate

A

baseline bicarb and creatinine

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30
Q

pregnancy risk with topiramate

A

avoid

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31
Q

topiramate and oral contraceptives

A

topiramate decreases effectiveness of oral contraceptives

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32
Q

topiramate and alcohol

A

do not use within 6 hours of each other

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33
Q

side effects of topiramate

A

dose dependent weight loss
metabolic acidosis
kidney stones

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34
Q

topiramate in renal impairment

A

half dose

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35
Q

dosage range for prazosin

A

1-16mg QHS

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36
Q

how to dose prazosin if it is for flashbacks

A

may divide doses and give smaller one in am

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37
Q

FDA approved uses for prazosin

A

HTN
PTSD nightmares

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38
Q

geriatric considerations with prazosin

A

higher risk of orthostatic hypotension and syncope

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39
Q

pregnancy risk with prazosin

A

avoid

40
Q

consideration when dc prazosin

A

taper to avoid rebound HTN

41
Q

dosage for ambien

A

10mg for men
5mg for women

42
Q

elderly considerations for ambien

A

5mg max
increased risk for confusion and falls

43
Q

pregnancy risk with ambien

A

avoid

44
Q

should you take ambien with food

A

food decreases effectiveness

45
Q

when should you not ue ambien

A

hx of substance abuse
impaired respiration/OSA

46
Q

ambien dose with renal/hepatic impairment

A

5mg max

47
Q

dose range for eszopiclone

A

1-3mg

48
Q

geriatric dosage of eszopiclone

A

start at 1mg
max 2mg

49
Q

pregnancy risk with eszopiclone

A

avoid

50
Q

cautions for eszopiclone

A

hepatic impairment
ETOH abuse

51
Q

benzodiazepines typically used for insomnia

A

temazepam, flurazepam, triazolam

52
Q

3 nonbenzodiazepine agonists

A

zolpidem
zaleplon
eszopiclone

53
Q

nonbenzodiazepine agonists with high fat meal

A

delayed absorption by up to an hour

54
Q

peak plasma and half-life of zolpidem

A

peak plasma in 1.6h w/ half-life of 2.6h

55
Q

peak plasma and half-life of zaleplon

A

peak plasma in 1h w/ half-life of 1h

56
Q

peak plasma and half-life of eszopiclone

A

peak plasma in 1h w/ half-life of 6h

57
Q

what can reverse effects of zolpidem and zaleplon

A

flumazenil

58
Q

rebound insomnia and tolerance development with nonbenzodiazepine agonists

A

not typically associated with rebound insomnia and tolerance does not seem to develop

59
Q

what else in zolpidem indicated for besides insomnia

A

10mg QID to decrease bradykinesia and rigidity in Parkinson’s can be tolerated for several years

60
Q

main side effects of zolpidem and zaleplon

A

dizziness
drowsiness
dyspepsia
diarrhea

61
Q

nonbenzodiazepine agonists in pregnancy and lactation

A

avoid

62
Q

dose-dependent side effects of eszopiclone in the elderly

A

dry mouth
pain
unpleasant taste

63
Q

what med can increase plasma concentration of zaleplon

A

cimetidine

64
Q

which meds decrease metabolism of zaleplon thereby increasing concentration

A

rifampin
phenytoin
carbamazepine
phenobarbital

65
Q

which enzymes metabolize eszopiclone

A

3A4 and 2E1

66
Q

max dose of zaleplon

A

20mg

67
Q

zaleplon dose for elderly and those with hepatic impairment

A

5mg

68
Q

typical dose of eszopiclone

A

2-3mg (2mg for elderly)

69
Q

starting dose of eszopiclone for severe hepatic impairment and 3A4 inhibitors

A

1mg

70
Q

starting dose of zolpidem

A

5mg for females
5-10mg for males

71
Q

melatonin receptor agonist for sleep onset insomnia

A

ramelteon

72
Q

brand name for ramelteon

A

rozerem

73
Q

how does ramelteon work

A

mimics melatonin w/ high affinity for M1 and M2

74
Q

max plasma concentration and half-life of ramelteon

A

max plasma in 45 minutes w/ half-life of 1-2.6h

75
Q

ramelteon and 1st pass metabolism

A

84% absorbed but extensive first pass metabolism results in bioavailability of 2%

76
Q

which enzyme metabolizes ramelteon

A

1A2

77
Q

elimination of ramelteon

A

mostly in urine

78
Q

most common side effect of ramelteon

A

HA

79
Q

cautions and contraindications for ramelteon

A

contraindicated in pregnancy and lactation and severe hepatic impairment
not recommended with severe sleep apnea or severe COPD

80
Q

what should yo umonitor for in r/t prolactin levels in women taking ramelteon

A

may increase prolactin
monitor for meses cessation, galactorrhea, decreased libido, and fertility problems

81
Q

what hormones are reduced with use of ramelteon

A

decrease blood cortisol and testosterone

82
Q

dosage of ramelteon

A

8mg 30min prior to sleep

83
Q

where is melatonin produced

A

pineal gland
retina
GI tract

84
Q

how is melatonin synthesized

A

amino acid tryptophan is converted to serotonin then to melatonin

85
Q

where are melatonin receptors

A

suprachiasmatic nucleus of the hypothalamus

86
Q

half-life of melatonin

A

0.5-6 minutes

87
Q

elimination of melatonin

A

mostly in urine

88
Q

melatonin and 1st pass metabolism

A

90% eliminated by first pass metabolism

89
Q

melatonin effects on male fertility

A

reduces sperm motility

90
Q

melatonin effects on the fertility of women

A

inhibits ovarian function

91
Q

which meds should you be cautious with when administering melatonin

A

blood thinners
antiseizure meds
other meds that lower BP

92
Q

drug class of prazosin

A

A1-adrenergic receptor antagonist

93
Q

peak plasma and half-life of prazosin

A

peak plasma in 3h w/ half-life of 2-3h

94
Q

typical dosage of prazosin

A

6-15mg in divided doses

95
Q

what should be done to prazosin dosage when adding a diuretic or antihypertensive

A

decrease dosage to 1-2mg TID and retitrate

96
Q

prazosin in pregnancy and lactation

A

avoid

97
Q

prazosin and PE5 inhibitors

A

can cause further drop in BP that can be dangerous

Meds (12 decks)

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