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Neurologic & Psych > TRAT Insomnia Dr. Thomason > Flashcards

TRAT Insomnia Dr. Thomason Flashcards

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1
Q

What is the main action of benzodiazepines in treating insomnia?

A

Benzodiazepines (BZD) increase total sleep time:
-reduce sleep latency (the time needed to fall asleep)
-increase stage 2 sleep
-decrease delta sleep

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2
Q

Which nonbenzodiazepine medication is often used for middle-of-the-night dosing?

A

-Zaleplon
-Zolpidem (special formualtion)

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3
Q

Which sedating antidepressant is FDA-approved specifically for sleep maintenance insomnia?

A

Low dose Doxepin (3-6mg)

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4
Q

What is the mechanism of action for dual orexin receptor antagonists (DORAs) like suvorexant?

A

it turns off wakening signals

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5
Q

Which insomnia medication is classified as a melatonin receptor agonist?

A

Ramelteon

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6
Q

Name a commonly used antihistamine in over-the-counter sleep aids.

A

Diphenhydramine and doxylamine
patients quickly experience tolerance to the sedative effects

-they have anticholinergic side effects -> should be avoided in elderly

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7
Q

What side effect is particularly common with the nonbenzodiazepine eszopiclone?

A

-somnolence
-unpleasant taste !!!
-headache
-dry mouth

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8
Q

What is one reason benzodiazepines are not recommended for older adults with insomnia?

A

the half-life is prolonged in older patients -> increases the potential for medication accumulation -> side effects: prolonged sedation, cognitive and psychomotor impairment

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9
Q

Which class of insomnia medications is associated with less risk of tolerance and dependence?

A

nonbenzodiazepine hypnotics are associated with less withdrawal and tolerance and rebound insomnia

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10
Q

What are the main adverse effects of trazodone?

A

-carryover sedation
-alpha-adrenergic blockade
-orthostasis (dangerous in the elderly)
-priapism (prolonged erection, rare)

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11
Q

What is a potential serious side effect of dual orexin receptor antagonists (DORAs) that patients should be aware of?

A

-somnolence

rare:
-sleep paralysis
-cataplexy

caution use in patients with depression -> it can worsen mood and trigger thoughts of suicide (dose-dependent)

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12
Q

Which benzodiazepine receptor agonist has the shortest half-life, making it suitable for sleep onset insomnia?

A

Triazolam

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13
Q

Which benzo to pick to get through the night but has a longer onset?

A

Tamezapem (Restoril)

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14
Q

Name nonpharmacologic approaches that should be encouraged alongside insomnia medication.

A

-cognitive behavioral therapy
-stimulus control therapy
-sleep restriction
-relaxation therapy
-cognitive therapy
-paradoxical intention
-biofeedback
-education on sleep hygiene

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15
Q

What is a common adverse effect of antihistamine sleep aids, especially in older adults?

A

-tolerance to sedative effects
-anticholinergic side effects: drowsiness, dry mouth, constipation, urinary retention
->especially in elderly

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16
Q

Which sedating antidepressant has a risk of causing daytime sedation?

A

Mirtazapine

also causes weight gain

17
Q

What adverse effect is associated with higher doses of zolpidem in women?

A

-drowsiness
-dizziness
-headache
-amnesia
-gastrointestinal complaints
->dose related

18
Q

Which class of medications binds selectively to GABA receptors to induce sleep but lacks muscle relaxant properties?

A

newer nonbenzodiazepine GABA agonists only possess sedative properties

19
Q

Which herbal remedy is sometimes used for insomnia but lacks strong evidence for effectiveness?

A

Valerian

20
Q

What is the primary use of zolpidem in treating insomnia?

A

-reduces sleep latency
-nocturnal awakening
-increases total sleep time

-no significant side effect of next-day psychomotor performance

21
Q

What effect does food have on the absorption of zolpidem?

A

decreases the absorption
-should be taken on an empty stomach

22
Q

What is the recommended zolpidem dose for women due to differences in drug metabolism?

A

5 mg

10 mg for men

23
Q

Which zolpidem formulation is specifically used for middle-of-the-night awakenings?

A

reduced strength formulation
1.75 mg
3.5 mg

-SR: for the increase of total sleep time
-sublingual: to reduce sleep latency

24
Q

What unique behavior-related side effect is associated with zolpidem?

A

sleep eating (causes patients to eat while asleep)

25
Q

Why might zaleplon be preferred over other sleep aids for sleep onset insomnia?

A

-quick onset
-because of its short half-life? (1 hour)
-metabolized to an inactive metabolite (none of the non-benzodiazepine GABA agonists have significant metabolites)

26
Q

What is the typical half-life of zaleplon, making it effective for rapid sleep induction?

A

1 hour

27
Q

Which two adverse effects are commonly reported with zaleplon use?

A

-dizziness
-headache
-somnolence

28
Q

What drug interaction should be avoided with zaleplon due to increased plasma levels?

A

Cimetidine (CYP inhibitor)

(plasma level decreases with Rifampin use)

29
Q

What is a common withdrawal symptom associated with abrupt discontinuation of benzodiazepines?

A

rebound insomnia (increased wakefulness may last for a few nights)
->use lowest effective dose

30
Q

Which benzodiazepines have a long half-life, making it less suitable for elderly patients due to prolonged sedation?

A

flurazepam (Dalmane)
quazepam (Doral)

31
Q

What is the primary reason benzodiazepines are not recommended for patients with a history of substance use disorders?

A

potential for abuse, dependence and addiction

32
Q

Which specific cognitive side effect is commonly reported with benzodiazepines, especially at higher doses?

A

-daytime sedation
-psychomotor incoordination
-cognitive deficits

33
Q

What FDA-required warning is included in the labeling of benzodiazepines and benzodiazepine receptor agonists like zolpidem?

A

-anaphylaxis
-angioedema
-complex sleep behaviors (sleep driving, phone calls, sleep eating)

34
Q

Which class of medications, including zaleplon, is associated with less disruption of sleep architecture than traditional benzodiazepines?

A

nonbenzodiazepine GABA agonists

Zolpidem

35
Q

What is a key difference in the duration of action between zolpidem and zaleplon?

A

Zolpidem has a duration of action of 6-8h

Zaleplon’s duration of action is shorter (3-4h?)

36
Q

For what reason might zaleplon be used as a “rescue” sleep aid in the middle of the night?

A

-rapid-onset
-short half-life (1 hour)
-no effects on next-day psychomotor performance

Neurologic & Psych (37 decks)

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