www.pharmteacher.com INSOMNIA for PT
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| List some medications that cause insomnia: | CNS stimulants (such as caffeine, theophyline, nicotine, & decongestants) as well as corticosteroids, SSRIs, and Parkinson’s drugs
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| State the mechanism of action for the benzodiazepines: | GABA agonists
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| What effect does GABA have on the CNS? | GABA is an inhibitory neurotransmitter. It slows neuronal activity
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| How should sleep aids be used? | Ideally, sleep aids should be used/prescribed when non-drug therapy (sleep hygiene) has failed. Ideally they are used prn rather than scheduled and used no more than 2-3 times/week.
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| List the principles of good sleep hygiene: | establish routine sleep schedule; avoid naps and especially naps > 30 min; avoid CNS stimulants, alcohol, laxatives, & diuretics near bedtime; increase daytime activity & sunlight; wind down before bedtime; reserve bedroom for sleep only
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| Which sleep aids are available OTC? | doxylamine & diphenhydramine (Unisom, Benadryl, Tylenol PM, Advil PM)
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| Which sleep aids have anticholinergic side effects? | the OTC antihistamine sleep aids (diphenhydramine & doxylamine)
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| State the mechanism of action of ramelteon (Rozerem): | melatonin receptor agonist
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| This sleep aid is prescription only, but is not a controlled substance: | ramelteon (Rozerem)
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| Compare zolpidem (Ambien), zaleplon (Sonata) & eszopiclone (Lunesta) to the benzodiazepines: | similar in chemical structure and MOA but only used as hypnotics. They are not used for status epilepticus, anxiety, or general sedation
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| These sleep aids have a very short half-life & quick onset of action, & therefore should be taken right before bedtime: | zolpidem (Ambien), zaleplon (Sonata) & eszopiclone (Lunesta)
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| State the common ending for most benzodiazepines: | …pam or …lam
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| List the therapeutic uses of the benzodiazepines: | sedatives, treat acute anxiety and insomnia; some treat status epilepticus, alcohol withdrawal, and muscle spasms
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| Which benzodiazepines have skeletal muscle relaxant properties? | diazepam & clonazepam
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| List the common ADRs of the benzodiazepines: | CNS depression (drowsiness, dizziness, sedation), respiratory depression, anterograde amnesia (forgetfulness), sleep-walking, abuse potential, physical dependence
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| List benzodiazepine withdrawal symptoms: | opposite of what the drug does (anxiety, insomnia, panic, sweating, tremors, agitation, HTN, muscle twitching, status epilepticus)
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| What drugs might interact with benzodiazepines? | additive effects with other CNS depressants & respiratory depressants
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| List some CNS depressants that benzodiazepines might interact with: | alcohol, opioids, sleep aids, skeletal muscle relaxants, sedating antihistamines, seizure drugs
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| List some respiratory depressants that benzodiazepines might interact with: | alcohol, opioids
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| Discuss the link between benzodiazepines & falls in older adults: | Benzos, especially long-acting benzos, may increase the risk of falls in older adults due to their effects of dizziness, drowsiness, cognitive impairment, ataxia, etc.
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| ADRs include sleep walking, sleep eating, & other activities while not fully awake: | zolpidem, zaleplon, & escopiclone
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| List key elements of good sleep hygiene: | wake/sleep same time each day; get sunlight; exercise; no long naps; avoid heavy meals/alcohol/diuretics/CNS stimulants at bedtime; avoid non-sleep activity in bedroom; bedtime routine
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