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