Sleep Disorders and Tx Flashcards
What are the Sleep Disorders Medication classes?
Benzodiazepines
Bensodiazepines Receptors Agonist
Antihistamines
Antidepressants
Dopaminergic Agents
Dopamine Agonists
Anticonvulsants
Drug Classes used for Insomnia
Orexin Receptor Antagonists
Melatonin Agonists
Antidpressants
Antihistamines
Benzodiazepine receptor agonists
Benzodiazepines
Benzodiazepines:
- drug names
- MOA
- what are the short, intermediate, and long acting meds?
Drug names:
- Xanax (alprazolam)
- ProSom (estazolam)
- Dalmane (Flurazepam)
- Ativan (Lorazepam)
- Doral (Quazepam)
- Restoril (Temazepam)
- Halcion (Triazolam)
MOA:
-enhances the effects of GABA in the CNS (inhibitory NT)
Short:
-Triazolam (Halcion)
Intermediate:
- Temazepam (Restoril)
- Estazolam (ProSom)
Long acting;
- Flurazepam (Dalmane)
- Quazepam (Doral)
When is it a good idea to use short, intermediate and long acting Benzos for insomnia?
Short: those who have difficulty falling asleep
Intermediate: those who have trouble staying asleep
Long: those who have difficultng falling asleep and maintaining sleep.
Benzodiazepines:
- Adverse Effects
- Interactions
- CI
Adverse Effects:
- drowsiness
- impaired motor function
- prolonged use (physical dependency*)
- short term memory loss, confusion, shakiness
Interactions:
- caution with alcohol
- low dose contraceptives; decreases clearance of benzos
CI:
- acute narrow-angle glaucoma
- Preg X
- Lactation
Benzodiazepine Receptors Agonists (BRA)
- half life
- develop dependency?
- medication names
Half life: 5hrs
*Short half life, limits sleepiness or grogginess the next day.
Do not develop dependency
Drugs:
- Lunesta (Eszopiclone)
- Ambien (Zolpidem)
- Sonata (Zaleplon)
Lunesta (Eszopiclone)
- MOA
- Dosage
- good for what type of insomnia?
- adverse effects
- CI
- Preg Category
MOA: interacts with GABA receptors located near benzodiazepine receptors
Dosage:
- start at 2mg immediately before bed, can increase to 3mg
- elderly: start at 1mg, can increase to 2mg
Good for those with sleep maintenance issues
Adverse Effects;
-HA, dry mouth, dizziness, unpleasant taste with high dosages
CI:
-hypersensitivity; basically no CI.
Preg Cat. C
Lunesta:
- half life?
- peak concentration?
- special instructions
Half life: 5-7hrs; this is the longest half life of non-benzos)
Peak concentrations: 1hr
Special instructions:
-dont take after eating mean high in fat content, this delays absorption of medication.
Ambien (Zolpidem)
- MOA
- Dosage
- Adverse Effects
- CI
- Preg Category
MOA: modulates GABA receptors to suppress neurons
Dosage:
- 5-10mg PQ qhs
- ER (extended release) 6.25-12.5PO qhs
- lower doses on the elderly and women
Adverse Effects:
- morning drowsiness
- hangover
- HA
CI:
hypersensitivity; clean drug
Preg Cat: C
Ambien
- Half life
- response time
- used first line for what type of insomnia?
Half life: 2.5hrs
Response time is immediate, 30minutes
ER:
works in 30minutes, half life is 3 hrs, duration is 6-8hrs
Used first line for those with trouble falling asleep.
Sonata (Zaleplon)
- MOA
- dosage
- what type of insomnia?
- onset and halflife
- adverse effects
- CI
- pregnancy cat
MOA: interacts with GABA-BZ omega 1 receptor; causes sedation, muscle relaxation, anticonvulsant activity
Dosage:
- 10mg PO qhs
- range 5-20mg qhs
Good for those who have difficulty falling asleep, 2nd line to ambien. can be taken within 5hrs of scheduled wake up time.
Onset 1hr, half life is 1hr
Adverse Effects:
- back or chest pain
- migraine
- constipation
CI: hypersensitivity; clean drug :)
Pregnancy Cat C
Antihistamines:
- drugs
- MOA
- dosage
- Adverse events
- pregnancy cat
- is this normally prescribed for insomnia?
Drugs: diphenhydramine (Benadryl)
MOA: unknown, acts as CNS depressant
Dosage: 25-50mg qhs
Adverse effects:
- excessive daytime drowsiness, impaired psychomotor function
- dry mouth, delerium
- anticholinergic effects
Pregnancy Cat B
Usually not recommended for insomnia, though people use it anyhow
Antidepressants
- drugs
- which one is the only one with FDA approval?
Drugs:
- Impiramine (Tofranil)
- Amitryptyline hydrochloride (Elavil)
- Nortryptyline (Pamelor)
New agents: used in pts who have anxiety or panic component to their insomnia.
- Nefazodone hydrochloride (Serzone)
- Venlafaxine (Effexor)
Silenor is the only one FDA approved for insomnia.
Doxepin (Silenor)
- MOA
- dosage
- Adverse events
- good for what type of insomnia?
- special instructions
MOA:
-increases synaptic concentrations of serotonin and NE in the CNS
Dosage; 3-6mg within 30mints of bedtime
Adverse Events:
- drowsiness
- dizziness
- constipation
- blurred vision
Good for sleep maintenance
Instructions:
-dont take within 3 hrs after eating
Doxepin (Silenor)
- CI
- BBW
- Preg cat
CI:
- glaucoma
- urinary retention
BBW:
-suicidal thoughts/behavior
Preg Cat C
Trazodone:
- MOA
- Dosage
- Onset and half life
- Caution in which pt population?
- adverse events
- CI
- Preg cat?
- BBW
MOA:
-inhibits reuptake of serotonin and causes adrenoreceptor subsensitivity
Dosage: 50-100mg before bed
Onset: 1-3hrs half life: 5-9hrs
Caution in obese pts, the half life can be longer.
Adverse events:
- dizziness, drowsiness
- blurred vision, confusion
CI:
- use of MAOI
- pts receiving linezolid or IV methylene blue
Preg Cat C
BBW: Suicidal thoughts
Amitriptyline (Elavil)
- MOA
- Dosage
- Adverse Events
- is this normally prescribed for insomnia?
- half life?
MOA:
-increases synaptic concentration of serotonin and NE in the CNS.
Dosage: 25-50mg at bedtime
Adverse effects:
-sedation, dizziness, HA, constipation, weight gain, confusion
Used off label for insomnia
Half life: 13-36hrs
Amitryptyline (Elavil)
- CI
- Preg Cat
- BBW
CI:
- history of MI
- MAOI
Preg Cat C
BBW: Suicidal thoughts
Melatonin Agonists:
- drugs
- MOA
- Dosage
- Adverse events
- good for what type of insomnia?
- onset and half life
- CI
- Preg category
DrugS:
-Ramelteon (Rozerem)
MOA: agonists of melatonin receptors
Dosage: 8mg daily within 30 min of bedtime
Adverse Events: somnolence, HA, fatigue, dizziness, nausea
Good for sleep onset insomnia
onset 30mins and halflife 1-2hrs
CI:
-Fluvoxamine (Luvox) (SSRI)
Preg Cat C
Belsomra (Suvorexant)
- drug class
- MOA
- dosage
- used for what type of insomnia?
- half life and onset
- special instructions
Drug class: orexin receptor antagonists
MOA: blocks binding of wake-promoting neuropeptide orexin A and B.
Dosage: 10mg once daily within 30mins of bedtime
Used for sleep onset and sleep maintenance.
half life is 12 hrs onset is 30minutes
special instructions: dont take immediately after a meal, this suppresses its absorption.
Belsomra (Suvorexant)
- Adverse events
- CI
- Pregnancy Cat
Adverse events:
-drowsiness, HA, abnormal dreams, cough
CI: Narcolepsy
Preg Cat C.
Narcolepsy
-which med is used first line? 2nd line?
first line: provigil (modafinil)
2nd line: Dextroamphetamine
Provigil (Modafinil)
- MOA
- dose
- Adverse Events
- CI
- Preg cat?
MOA: increases dopaminergic signaling
Dose; 100mg qAM, can titrate up to 300-400mg
Adverse events:
-HA, nausea, nervousness, dry mouth
CI: hypersensitivity
Preg Cat: C
Dextroamphetamine:
- MOA
- Dose
- SE
- Preg Cat
- BBW
- special instructions
MOA: stimulates CNS activity, blocks reuptake and increases release of NE and dopamine
Dose: 10mg daily (can go up to 60mg daily in divided doses)
SE: HTN, anorexia, addiction
Preg Cat C
BBW: high abuse potential, cardiac events
Special instructions: dont use late in evening for risk of insomnia
