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Behavioral Health > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

Benzodiazepine MOA, SE, and CI

A

MOA: selectively act of polysynaptic CNS neuronal pathways

-Enhance GABA (inhibitory) effects - block arousal

SE: Drowsiness, impaired motor function, physical dependency with prolonged use

CI: Acute narrow-angle glaucoma, Pregnancy (X), Lactation

DI: ETOH caution, OCP decrease clearance

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2
Q

Short Term Benzodiazepines

A

Triazolam (Halcion)

For difficulties falling asleep

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3
Q

Intermediate-acting Benzodiazepines

A

Temazepam (Restoril)

Estazolam (ProSam)

Used for trouble maintaining sleep

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4
Q

Long-acting Benzodiazepines

A

Flurazepam (Dalmane)

Quazepam (Doral)

Rapid onset and last longer

Used for help falling asleep and maintaining sleep

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5
Q

Benzodiazepine Receptor Agonists (BRA)

A

Help eliminate benzo use

Shorter 1/2 life - less groggy

All are Prego C and only CI is hypersensitivity

Eszopiclone (Lunesta)

Zolpidem (Ambien)

Zaleplon (Sonata)

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6
Q

Eszopiclone (Lunesta)

A

MOA: Interacts with GABA receptors near Benzo receptors

For sleep maintenance

Lower dose in elderly; 1/2 life 5-7 hours; peak serum in 1 hour

SE: HA, dizziness, dry mouth, unpleasant taste in mouth

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7
Q

Zolpidem (Ambien)

A

MOA: modulates GABA receptors to suppress neurons - relaxation and sedations

1st line for trouble falling asleep - Have to take w/ 6-8 hrs before wakeup

Lower dose w/ elderly and women; 1/2 2.5 hours; 30 min response

SE: Morning drowsiness, hangover, HA

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8
Q

Zaleplon (Sonata)

A

MAO: Interacts with GABA-BZ omega 1 receptor

2nd line for difficulty falling asleep - 5 hours of sleep needed

also mild anticonvulsant activity

Onset and 1/2 life w/in 1 hour

SE: Back/chest pain, migraine, constipation

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9
Q

Antihistamine

A

Most common OTC sleep inducing agent - Benadryl

CNS depressant, non-addictive

SE: excessive daytime drowsiness (long 1/2 life), impaired psychomotor function, anticholinergic SE

Pregnancy B

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10
Q

Antidepressants

A

Used off-label or with anxiety/pain subcomponent to insomnia

Only Doxepin FDA labelled for insomnia

Doxepin (Silenor)

Trazodone

Amitriptyline (Elavil)

All have BBW for suicidal thoughts

All are pregnancy C

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11
Q

Doxepin (Silenor)

A

Only antidepressant labelled for use in insomnia

Used to maintain sleep

MOA: Increases serotonin and norepinephrine concentration in the synapse

Cannot take w/in 3 hours of eating, really bad w/ concomitant constipation

CI: glaucoma, urinary retention

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12
Q

Trazodone

A

Serotonin antagonist and reuptake inhibitor

MOA: changes serotonin receptor and inhibits serotonin reuptake

CI: MAOI, linezolid, IV methylene blue

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13
Q

Amitriptyline (Elavil)

A

Commonly used for insomnia

MOA: Increases synaptic concentrations of serotonin and/or norepinephrine

Half-life: 13-36 hours

CI: History of MI, MAOI

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14
Q

Melatonin Agonist

A

Ramelteon (Rozerem)

Good for sleep onset insomnia

MOA: selective agonist of MT1 and MT@ within suprachiasmatic nucleus

Take w/in 30 minutes, half-life 1-2 hours

CIL Fluvoxamine (Luvox) - SSRI

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15
Q

Orexin Receptor Antagonist

A

Suvorexant (Belsomra)

Used for sleep onset or maintenance - suppresses wake drive

MOA: block binding to wake-promoting neuropeptides (Orexin A&B) to receptors OZ1R and OX2R

Need 7 hours of sleep, take 30 minutes before bed

CI: Narcolepsy

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16
Q

Narcolepsy

A

1st line: Modafinil (Provigil) or Armodafinil (Nuvigil)

-stimulate alpha wave, decrease delta and theta waves

2nd line: Dextroamphetamine

  • stimulant; blocks reuptake and increases release of NE and dopamine
  • BBW: high abuse potential and cardiac events

Take both in AM

17
Q

REM Sleep Behavior Disorder

A

1st line: Melatonin

MOA: prepares body for sleep - endogenous hormone that responds to darkness and circadian rhythm

Also used for insomnia - take at night and titrate up to 10 mg

SE: Abnormal heartbeat, dizziness, fatigue

18
Q

Movement Disorder Treatment

A

Dopamine Agonists - 1st line

Dopaminergic agents (Carbidopa-levodopa)

Anticonvulsants (Gabapentin)

19
Q

Dopaminergic Agents

A

Carbidopa-levodopa (Sinemet)

Also used to treat Parkinson’s and insomnia

Give in evening/@ bedtime/ or upon awakening during the night

20
Q

Dopamine Agonists

A

1st line for movement disorders

Pramipexole (Mirapex)

Ropinirole (Requip)

Rotigotine (Neupro) - patch

SE: nausea, lightheadedness, nasal stuffiness, edema

21
Q

Anticonvulsants

A

Gabapentin (Neurontin)

Off-label for RLS - normally used to treat pain

MOA: Thought to reduce GABA release

SE: fatigue, dizziness, blurred vision

Behavioral Health (15 decks)

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