Science Medicine Psychiatry
Insomnia therapy
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Difficulty initiating sleep, difficulty maintaining sleep, or waking up too early, or sleep
Define insomnia that is nonrestorative and accompanied by daytime impairment-despite adequate
opportunity and circumstances for sleep
Transient: 2-3 nights
Types of insomnia? Short term: resolves in less than 3 weeks
Chronic: lasts greater than a month
What do 10-20% of patients usually self Alcohol or nonprescription products
medicate with for insomnia?
Psychophysiologic
Inadequate sleep hygiene
Contributing factors to insomnia?
Medical conditions: ex. respiratory illness or restless leg
Medications
*with opiods-> most patients experience it once
the meds are withdrawn
Common medication related causes of
insomnia?
*alpha and beta antagonists can mess with REM
sleep
*need at least 6-7 hours dedicated to sleep or else
What do you need to collect and assess for could have mental cognition issues
a patient with suspected insomnia?
What is the treatment pathway for
insomnia?
Educate on sleep hygiene
What are the three treatment principles? Eliminate unnecessary pharmacotherapy
Consider need for pharmacotherapy
, Retrains a persons thoughts and feelings toward
sleep
More intensive
What is CBT?
Apps that you can use for CBTI
CHRONIC INSOMNIA
These try and increase activity of GABA
Insomnia pharmacotherapy : sedative
hypnotics
Estazolam
Flurazepam
What are the BZDs with FDA insomnia
Quazepam
indication?
Temazepam (Restoril)
Triazolam (Halcion)
Latency and maintenance
What is Estazolams sedative-hypnotic
Best of the BZDs for latenence and maintenence
effect? Notes?
3A4 substrate
Latency and maintence
High risk of hangover due to long duration of action
What is Flurazepam sedative-hypnotic
Dont use in elderly
effect? Notes?
Not the best to use for regular adults also
3A4 substrate
Latency and maintenence
What is Quazepam sedative-hypnotic High risk of hangover effect
effect? Notes? Dont use in elderly / might not be great for adults also
3A4 substrate
Maintenence - > mnore of an intermediate onset
Not good for latency
What is temazepam sedative-hypnotic
effect? Notes?
Phase II metabolism
Dont ave to be concerned about 3A4 drug interaction
What is Triazolam sedative-hypnotic Latency only
effect? Notes? 3A4 substrate
*if patients rapidly stop benzos it can cause
What are the BZD non-sedative/hypnotic problems
effects? -insomnia again, anxiety
What are the precautions for BZDs?
Adverse effects for BZDs?
Eszopiclone (lunesta)
What are the non-benzodiazepine GABAA
Zaleplon
Agonists (Z drugs)
Zolpidem (Ambien; Ambien CR; Edluar SL)
Insomnia therapy
Save
Students also studied
Flashcard sets Study guides Practice tests
Gable Anxiety memory Psych MH Drugs Dr. Writer asked me this Clinica
8 terms 55 terms 7 terms 62 terms
amannddaa25 Preview ewood_0365 Preview PharmPhresh Preview sha
Difficulty initiating sleep, difficulty maintaining sleep, or waking up too early, or sleep
Define insomnia that is nonrestorative and accompanied by daytime impairment-despite adequate
opportunity and circumstances for sleep
Transient: 2-3 nights
Types of insomnia? Short term: resolves in less than 3 weeks
Chronic: lasts greater than a month
What do 10-20% of patients usually self Alcohol or nonprescription products
medicate with for insomnia?
Psychophysiologic
Inadequate sleep hygiene
Contributing factors to insomnia?
Medical conditions: ex. respiratory illness or restless leg
Medications
*with opiods-> most patients experience it once
the meds are withdrawn
Common medication related causes of
insomnia?
*alpha and beta antagonists can mess with REM
sleep
*need at least 6-7 hours dedicated to sleep or else
What do you need to collect and assess for could have mental cognition issues
a patient with suspected insomnia?
What is the treatment pathway for
insomnia?
Educate on sleep hygiene
What are the three treatment principles? Eliminate unnecessary pharmacotherapy
Consider need for pharmacotherapy
, Retrains a persons thoughts and feelings toward
sleep
More intensive
What is CBT?
Apps that you can use for CBTI
CHRONIC INSOMNIA
These try and increase activity of GABA
Insomnia pharmacotherapy : sedative
hypnotics
Estazolam
Flurazepam
What are the BZDs with FDA insomnia
Quazepam
indication?
Temazepam (Restoril)
Triazolam (Halcion)
Latency and maintenance
What is Estazolams sedative-hypnotic
Best of the BZDs for latenence and maintenence
effect? Notes?
3A4 substrate
Latency and maintence
High risk of hangover due to long duration of action
What is Flurazepam sedative-hypnotic
Dont use in elderly
effect? Notes?
Not the best to use for regular adults also
3A4 substrate
Latency and maintenence
What is Quazepam sedative-hypnotic High risk of hangover effect
effect? Notes? Dont use in elderly / might not be great for adults also
3A4 substrate
Maintenence - > mnore of an intermediate onset
Not good for latency
What is temazepam sedative-hypnotic
effect? Notes?
Phase II metabolism
Dont ave to be concerned about 3A4 drug interaction
What is Triazolam sedative-hypnotic Latency only
effect? Notes? 3A4 substrate
*if patients rapidly stop benzos it can cause
What are the BZD non-sedative/hypnotic problems
effects? -insomnia again, anxiety
What are the precautions for BZDs?
Adverse effects for BZDs?
Eszopiclone (lunesta)
What are the non-benzodiazepine GABAA
Zaleplon
Agonists (Z drugs)
Zolpidem (Ambien; Ambien CR; Edluar SL)
