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Insomnia Drugs & Benzodiazepines
| 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) |
| State the mechanism of action of ramelteon: | melatonin receptor agonist |
| Compare zolpidem, zaleplon & eszopiclone 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, zaleplon) & eszopiclone |
| This sleep aid is prescription only, but is not a controlled substance: | ramelteon |
| Which sleep aids have anticholinergic side effects? | the OTC antihistamine sleep aids (diphenhydramine & doxylamine) |
| 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 |
| These benzos have skeletal muscle relaxant properties: | diazepam & clonazepam |
| These benzos are used to treat alcohol withdrawal symptoms: | lorazepam & oxazepam |
| These benzos cause the most anterograde amnesia: | midazolam & triazolam |
| This benzo is given IV prior to certain medical procedures: | midazolam |
| These benzos are given IV to treat status epilepticus: | diazepam & lorazepam |
| This benzo has one of the shortest half-lives: | alprazolam & also the less frequently prescribed, triazolam |
| List the benzos with the shorter half-lives: | LOTTA (lorazepam, oxazepam, triazolam, temazepam, alprazolam) |
| List the common ADRs of the benzodiazepines: | CNS depression (drowsiness, dizziness, sedation), respiratory depression, anterograde amnesia (forgetfulness), sleep-walking, abuse potential, physical dependence |
| List the 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. |
| How are benzos different from barbiturates? | barbiturates have a more narrow therapeutic window; higher abuse potential; more drug interactions, & no antidote |
| List the antidote for benzodiazepines: | flumazenil |
| Classify this drug: alprazolam | benzodiazepine |
| Classify this drug: chlordiazepoxide | benzodiazepine |
| Classify this drug: diazepam | benzodiazepine |
| Classify this drug: diphenhydramine | sedating OTC antihistamine |
| Classify this drug: doxylamine | sedating OTC antihistamine |
| Classify this drug: eszopiclone | non-benzo sleep aid |
| Classify this drug: lorazepam | benzodiazepine |
| Classify this drug: midazolam | benzodiazepine |
| Classify this drug: phenobarbital | barbiturate |
| Classify this drug: ramelteon | melatonin receptor agonist |
| Classify this drug: secobarbital | barbiturate |
| Classify this drug: temazepam | benzodiazepine |
| Classify this drug: zaleplon | non-benzo sleep aid |
| Classify this drug: zolpidem | non-benzo sleep aid |
| Tylenol PM and Advil PM contain: | diphenhydramine |
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