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Insomnia Drugs & Benzodiazepines

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