Sleep Disorders Drugs Flashcards
Medications Known to Cause Insomnia: Antidepressants
- SSRIs
- SNRIs
- MAOIs
Medications Known to Cause Insomnia: Antihypertensives
-Lipophilic Beta-Blockers
Medications Known to Cause Insomnia: Bronchodilators
-Theophylline (similar to caffeine)
Medications Known to Cause Insomnia: Nasal Decongestants
- Pseudoephedrine
- Phenylpropanolamine
Medications Known to Cause Insomnia: Antiparkinsonian Drugs
-Levodopa
Medications Known to Cause Insomnia: Corticosteroids
-Prednisone (many ppl find this incredibly stimulating)
What do people take to try to improve their sleep?
- alcohol
- herbals
- dietary supplements
- homeopathic preparations
- melatonin
- OTC sleep aids
- sedating antidepressants
- sedative-hypnotics
Medications that block alerting neurotransmitters are sleep promoting
- antihistamines
- anticholinergics
- serotonin, dopamine, and norepi blockers
- orexin blockers - suvorexant approved 2014
- first orexin blocker
- approved 8/2014
- only clinical trial data available
- Schedule IV
- Warning for next day sedation
Suvorexant
Sedating Antidepressants
- all are H1 blockers (non-scheduled)
- Doxepin FDA approved for insomnia (H1 blocker)
- Trazodone, Sinequan (most sedative), Adapin (doxepin), amitriptyline HCl, and mirtazapine (Remeron)
- trazodone most commonly prescribed (never use for depression b/c can’t get up to the dose needed for depression without knocking them out)
BZs
- GABA
- facilitates GABA action on Cl- ion channel to hyperpolarize neurons
- multiple CNS effects include sedation, amnesia, anxiolysis, myorelaxation, and ataxia
- BZ hypnotic
- txt for insomnia
- short half-life (1.5-5.5 hrs)
Triazolom
- BZ hypnotic
- txt for insomnia
- t1/2 8.8 hrs
Temazepam
- BZ hypnotic
- txt for insomnia
- t1/2 10-24 hrs
Estazolam
- BZ hypnotic
- txt for insomnia
- t1/2 47-100 hrs
Flurazepam
- BZ hypnotic
- txt for insomnia
- t1/2 39-73 hrs
Quazepam
BZ Efficacy
- increased total sleep time
- decreased sleep latency, number of awakenings
BZ Adverse Events
- drowsniness, dizziness, coordination difficulties
- memory problems: anterograde amnesia
BZ Withdrawal
- same thing as alcohol withdrawal (acting on GABA)
- can occur with long-term use at high doses for all BZs
- evidence of rebound insomnia
- nonbenzodiazepine hypnotic
- not BZ chemically, but act on BZ receptors
Zaleplon (Sonata)
- nonbenzodiazepine hypnotic
- not BZ chemically, but act on BZ receptors
Zolpidem tartrate (immediate release)(Ambien)
- nonbenzodiazepine hypnotic
- not BZ chemically, but act on BZ receptors
Eszopiclone (Lunesta)
- nonbenzodiazepine hypnotic
- not BZ chemically, but act on BZ receptors
Zolpidem tartate extended release (Ambien CR)
