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www.pharmteacher.com INSOMNIA for PT

List some medications that cause insomnia: CNS stimulants (such as caffeine, theophyline, nicotine, & decongestants) as well as corticosteroids, SSRIs, and Parkinson’s drugs
State the mechanism of action for the benzodiazepines: GABA agonists
What effect does GABA have on the CNS? GABA is an inhibitory neurotransmitter. It slows neuronal activity
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.
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
Which sleep aids are available OTC? doxylamine & diphenhydramine (Unisom, Benadryl, Tylenol PM, Advil PM)
Which sleep aids have anticholinergic side effects? the OTC antihistamine sleep aids (diphenhydramine & doxylamine)
State the mechanism of action of ramelteon (Rozerem): melatonin receptor agonist
This sleep aid is prescription only, but is not a controlled substance: ramelteon (Rozerem)
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
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)
State the common ending for most benzodiazepines: …pam or …lam
List the therapeutic uses of the benzodiazepines: sedatives, treat acute anxiety and insomnia; some treat status epilepticus, alcohol withdrawal, and muscle spasms
Which benzodiazepines have skeletal muscle relaxant properties? diazepam & clonazepam
List the common ADRs of the benzodiazepines: CNS depression (drowsiness, dizziness, sedation), respiratory depression, anterograde amnesia (forgetfulness), sleep-walking, abuse potential, physical dependence
List benzodiazepine withdrawal symptoms: opposite of what the drug does (anxiety, insomnia, panic, sweating, tremors, agitation, HTN, muscle twitching, status epilepticus)
What drugs might interact with benzodiazepines? additive effects with other CNS depressants & respiratory depressants
List some CNS depressants that benzodiazepines might interact with: alcohol, opioids, sleep aids, skeletal muscle relaxants, sedating antihistamines, seizure drugs
List some respiratory depressants that benzodiazepines might interact with: alcohol, opioids
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.
ADRs include sleep walking, sleep eating, & other activities while not fully awake: zolpidem, zaleplon, & escopiclone
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