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82 Cards in this Set
- Front
- Back
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time it takes to fall asleep
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sleep latency
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disturbance in maintaining sleep once achieved
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sleep maintenance
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ratio of total sleep time to time spent in bed
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sleep efficiency
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insonmia is difficulty --- ---, ---- --- or experiencing --- ----- sleep
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falling asleep
staying asleep non-restorative |
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antihistamines block histamin containing --- involved in ------
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neurons
wakefulness |
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sedation does no necessarily indicate ---- efficacy
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hypnotic
doesn't mean you're sleeping well |
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ae of antihistamines
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daytime drosiness
tolerance dizziness dry mouth constipation |
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antihistamines
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diphenhydramine 25-50 mg
doxylamine (unisom) |
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t/f
increasing dose of antihistamine will increase sedation |
f
does not increase sedation worsens ae . . .. paradoxical excitation |
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be careful w/ antihist w/ which population
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elderly
glaucoma bph |
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benzo bind to the ---- --- - inophore complex thereby opening Cl channels and increasing -----
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BDZ
GABA |
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ae of benzo
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drowsiness
dizziness fatigue impaired coordination daytime impairment |
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caution w/ benzos w/
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hx of substance abuse
pregnancy hepatic/renal impairment seizure disorders sleep apnea |
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advantaages of benzos
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efficacious
useful w/ concomittant anxiety inexpensive |
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disadvantages of bdz's
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no studies examining use over 12 weeks
controlled substances dependence withdrawal effects |
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disadvantages of bdzs
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no studies examing over 12 weeks
controlled substances dependence withdrawal effects (slowly taper off) |
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bdz approved for insomnia
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triazolam
temazepam estazolam flurazepam quazepam |
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short acting bdz
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triazolam
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intermediate acting bdz
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temazepam
estazolam |
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long acting bdz
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flurazepam
quazepam |
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whos prone to dependence w/ bdz
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older age
> mo onthe med etoh or hypnotic abus increased dose short acting benzo |
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advantages of triazolam
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short acting
light daytime sedation |
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disadvantages of triazolam
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bdz withdrawal
rebound insomna more common tolerance develops quickly |
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triazolam metabolized by
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cyp3a4
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when is triazolam reserved for
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short term use only
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t/f
hepatic metabolsim w/ temazepam |
f
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w/ temazepma there's no ------ thereby minimizing daytime ----
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accumulation
sedation |
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estazolam causes ---- in the elderly and in ----/----- impairment
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accumulation
hepatic/renal |
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estazolam may cause transient --- -----
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rebound insomnia
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estazolam ---/---- w/ chronic use is unknown
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efficacy/safety
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advantages of flurazepam
less --- --- less ----- |
rebound insomnia
tolerance |
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disadvantages of flurazepam
more ---- ---- due to long t 1/2 |
daytime sedation
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who should avoid flurazepam
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elderly:
risk of falls and fractures |
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quazepam t 1/2
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20-40 hrs
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t/f
quazepam causes daytime sedation |
t
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who do you avoid giving quazepam to
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elderly
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ae of bdz
---- --- in the elderly |
hip fractures
less w/ short/intermediate acting |
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ae of bdz --- cognitive impairemnt and sedation
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daytime
long acitng >short acting more common in elderly |
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ae of bdzs
--- behavior |
complex
ex: sleep driving |
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ae of bdz
--- --- w/ concommitant pulm disease |
resp depression
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how long will it take for zolpidem to begin to work
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30 min
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duration of zolpidem
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6-8 hrs
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which is better for sleep maintenance
ambien or ambien cr |
ambien cr
80% metabolized immediately 20% w/ in 3 hrs |
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t/f
ok ot take zolpidem in the middle of the night |
f
will have residual effects in the am duration: 6-8 hrs |
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ae of zolpidem
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n/d
drowsiness amnesia dizziness ha |
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zolpidem has little ----, --- ---- or --- ----- at recommened dose
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tolerance
rebound insomnia daytime impairment |
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t/f
zopidem has a high potential for abuse, dependence |
f
low |
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di w/ zoplidem
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protease inhibitor
etoh cns depressants |
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caution w/ zolpidem w/
pregnancy class --- --- impairement --- ---- |
B
hepatic copd depression |
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t/f
zolpidem limited to short term use |
f
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how long will it take for zaleplon o start working
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20 min
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how long will zaleplon work for
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4 hrs
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when's it ok to take zaleplon
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in the middle of the night
if more than 4 hrs to left to sleep |
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caution w/ zaleplon in
pregnancy class -- concomittant use w/ --- ----- ----- --- insufficiency severe ----- disease don't uses w/ --- --- allergy |
C
CNS depressant deprssion hepatic tartrazine dye |
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t/f
zaleplon associated w/ rebound insomnia, withdrawal symptoms, or daytime anxiety, sedation, or impairment |
f
not assocated |
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which has less psychomotor or memory impairment
bdz, zolpidem, zaleplon |
zaleplon
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eszopiclone will last for -
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hr
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1st hypnotic approved for longer use than 35 days
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eszopiclone
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ae of eszopilone
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bitter tase
dry mouth drowsiness dizziness |
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di w/ eszopiclone
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etoh
cns depressants |
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don't take eszopiclone w/ --- ---- meals
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high fat meals
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caution in eszopiclone in
pregnancy class ---, resp ----, ---- |
c
depression depression |
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moa of ramelteon: --- and --- receptor agonist
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MT1
MT2 |
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ramelteon only --- ---- substance approved for insomnia
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non-controlled
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how long does it take for remelteon to start working
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30 min
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t/f
ok to take ramelteon w/ high fat meals |
f
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ae of ramelteon
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somnolence
ha fatigue nausea dizziness |
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di w/ ramelteon
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fluvoxamine
cipro norflaxacin mexiletine |
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caution w/ ramelteon
preg class- --- --- diesea mild to mod ----- impairemnet --- disease --- disorder elderly |
c
neurologic hepatic endocrine seizure elderly |
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ci of ramelteon
------ mother kids severe --- impairment |
nursing mother
hepatic |
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ramelteon may need to monitor ----, --- conc
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prolactin
testosterone |
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ramelteon causes
decreased ---- ---- |
libido
amenorrhea |
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advantages of trazodone
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low cost
long term use little drug abuse potential |
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disadvantages of trazodone
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little efficacy data
tolerance ae di |
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tca used for insomnia
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doexpin
amitryptyline notriptyline mirtazapine nefazodone |
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save melatonin for --- -- probs
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circadian rhythm
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valerian may inhibit the enzyme which breaks down ---
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gaba
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avoid valerian in ---
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pregnancy
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di w/ valerian
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sedatives
antihistamines anti depressnats anxiolytics barbituates |
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what do you give for sleep meds
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triazolam
zolpidem cr zaleplon ramelteon |
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sleep maintence meds
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flurazepam
quazepam estazolam temazepam zoldpidem cr zaleplon eszopiclone |
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ae of melatonin
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depression
liver disease contraceptive effects vasoconstriction of coronary arteries higher doses: sleep disruption, daytime fatigue, ha, dizziness, irritability |
