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List some medications that cause insomnia:
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State the mechanism of action for the benzodiazepines:
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www.pharmteacher.com INSOMNIA for PT
| Question | Answer |
|---|---|
| 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 |
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