Sleep Disorders treatment Flashcards
1
Q
Goals of sleep disorder tx?
A
- promote pt’s ability to fall asleep, maintain sleep, and awaken refreshed
- use med for as short a time as possible
- use minimal dose with lease amt of side effects
2
Q
Benzos used for insomnia?
A
- alprazolam (Xanax)
- estazolam (Prosom)
- flurazepam (dalmane)
- lorazepam (ativan)
- quazepam (doral)
- temazepam (restoril)
- triazolam (Halcion)
3
Q
MOA of Benzos?
A
- selectively acts on polysynaptic neuronal pathways throughout the CNS
- enhance the effects of GABA in CNS
- insomnia: facilitate the effects of GABA in ascending reticular activating system
4
Q
Diff categories of benzos?
A
- short acting: triazolam (halcion)
- intermediate acting: temazepam (restoril), estazolam (proSom)
- long acting: flurazepam (dlamane), quazepam (doral)
5
Q
Adverse effects of Benzos?
A
- drowsiness
- impaired motor fxn
- prolonged use: physical dependency
6
Q
Interactions and CIs of Benzos?
A
- Interactions: caution with ETOH low dose contraceptives - CIs: acute narrow-angle glaucoma preg X lactation
7
Q
What are benzodiazepine receptor agonists (BRA)?
A
- developed to improve the safety profile of baribturate type compounds
- have short half life: 5 hrs
- has greater receptor specificity of the GABAa BZ complex
(don’t develop tolerance, can use for longer amt of time compared to benzos, safer thean benzos)
8
Q
Category of BRA’s?
A
- eszopiclone (lunesta)
- zolpidem (ambien)
- zaleplon (sonata)
9
Q
MOA and dosage of eszopiclone (Lunesta)?
A
- interacts with GABA receptors located near benzo receptors
- good for sleep maintenance
- dosage:
start at 2 mg immed b/f bed, can be started or increased to 3 mg to aid in sleep maintenance - elderly:
start 1 mg to help fall asleep
2 mg for sleep maintenance
10
Q
Adverse effects and CIs of eszopiclone (lunesta)?
A
- HA
- dry mouth
- dizziness
- CI: hypersensitivity to drug
- preg C
11
Q
MOA and dosage of zolpidem (ambien, ambien CR)?
A
- MOA: modulates the GABA receptors to suppress neurons
- dosage:
5-10 mg PO qhs
extended release: 6.25-12.5 mg PO qhs - give lower doses in women and elderly - don’t clear drug as quickly
12
Q
Adverse effects and CIs of zolpidem?
A
- adverse effects: morning drowsiness hangover HA - CIs: hypersensitivity - Preg C
13
Q
MOA and dosage, Adverse effects, and CIs of Zaleplon (Sonata)?
A
- MOA: interacts with GABA-BZ omega 1 receptor = leads to sedation, muscle relaxation, anti-convulsant
- dosage:
start 10 mg PO qhs
range 5-20 mg qhs - used 2nd line for pts who have hard time falling asleep behind ambien
- adverse effects: back or chest pain, migraine, constipation
- CIs: hypersensitivity
- Preg C
14
Q
Antihistamine use? Main drug used?
A
- most commonly used classes of OTC sleep inducing agents
- Diphenhydramine (benadryl)
MOA: unknown, acts as CNS depressant - dosage: 25-50 mg qhs
- adverse effects: excessive daytime drowsiness, impaired psychomotor fxn
- anticholinergic effects: dry mouth, caution in elderly, BPH
- category B: good to use in pregnancy
15
Q
Antidepressants used for insomnia?
A
- imipramine (tofranil)
- amitriptyline hydrochloride (elavil)
- nortriptyline (pamelor)
- newer agents: nefazodone hydrochloride (serzone)
venlafaxine (effexor) - used off label, only antidepressant approved for insomnia is silenor