Sleep/hypnotics

Question 1

Temazepam/Restoril

Answer 1

• Use: Short-term insomnia
• 7-10 days
  -Night time wakening
• start 15 mg, max 30 mg
• Capsules in 7.5, 15, 22.5mg
• Take 1-2 hours prior to bed

Side effects
- renal/haptic- 7.5 mg
- No glaucoma
Taper to prevent rebound

Question 2

Prazosin

Answer 2

Use: Nightmares, PTSD

• Start 1mg and increase
• 1-16mg dose range
  -Tabs in 1, 2, 5

Side effects:
- Taper to prevent rebound
- May dose daytime for hyper arousal

Question 3

Eszopiclone/Lunesta

Answer 3

Use: Insomnia
- Improve quality, sleep wake time, night time wakening
-May use long term

-Start 1mg at night, max 3mg
- Tabs in 1, 2, 3

Side effects:
- avoid administration w/high fat meal
- taper dose gradually to d/c if prolonged use
- Watch for sleep driving, cooking, calling
- Metallic tasting

Question 4

Ramelteon/Rozerem

Answer 4

Use: Insomnia
- difficult sleep onset, shift work
- Non-habit forming
- Promote circadian rhythm

8mg nightly
Tabs in 8mg

Side effects:
- avoid administration w/high fat meall
- adjust dose with liver disease

Question 5

Zolpidem/Ambien

Answer 5

Use: Insomnia (midnight wake/trouble returning to sleep)
- give >7 hrs before planned awakening
- More than 4 hours to sleep after midnight wake

IR: 5 mg, max 10mg
Tabs in 5, 10
XR: 6.25, max 12.5

Side effects:
- give on empty stomach
- taper dose gradually to d/c if prolonged use
- adjust dose for liver disease
- can make patients do weird things