CNS Depressants

Insomnia

What is the inability to fall asleep or stay asleep called?

CNS depressants

What drugs reduce activity in the central nervous system?

Sedative-hypnotics

What drugs are commonly used to treat sleep disorders?

Short-acting hypnotics

What type of hypnotic helps a person fall asleep and wears off sooner?

Intermediate-acting hypnotics

What type of hypnotic helps a person stay asleep longer?

Lowest dose

What general rule should be followed when taking a hypnotic?

Barbiturates

What class of CNS depressants includes phenobarbital butabarbital and secobarbital?

Benzodiazepines

What class of sedative-hypnotics includes lorazepam diazepam and triazolam?

Nonbenzodiazepines

What class includes zolpidem eszopiclone and zaleplon?

Melatonin agonists

What class of drugs acts on melatonin receptors to help regulate sleep?

Ramelteon

What melatonin agonist is used to treat insomnia?

Ramelteon

What drug may be used for chronic insomnia?

Ramelteon

What drug targets melatonin receptors and regulates circadian rhythms?

8 mg/day

What is the maximum daily dose of ramelteon listed in the notes?

30 minutes

How long before bedtime should ramelteon be taken?

1–2.6 hours

What is the half-life of ramelteon?

Phenobarbital

What is the long-acting barbiturate used to control seizures in epilepsy?

Butabarbital

What is the intermediate-acting barbiturate used to sustain sleep?

Secobarbital

What is the short-acting barbiturate used to produce sedation?

2 weeks or less

How long should barbiturates be restricted to short-term use?

Tolerance

What is the condition in which the body becomes accustomed to a drug and its effects may decrease?

Lorazepam

Which benzodiazepine can be used to alleviate anxiety?
→ mainly used for anxiety
→ intermediate-acting

Diazepam

Which benzodiazepine can be used to alleviate anxiety?

→ used for anxiety, and can also be used for muscle spasms and seizures
→ long-acting

Flumazenil

What is the benzodiazepine antagonist used for benzodiazepine overdose?

Stage 4 NREM

What stage of sleep can benzodiazepines suppress?

Vivid dreams

What may occur when stage 4 NREM sleep is suppressed?

REM sleep

What stage of sleep can benzodiazepines delay? Not NREM

Temazepam

Which benzodiazepine is the exception to the noted REM-sleep effect?

REM rebound

What can occur when REM sleep increases after being suppressed?

3–4 weeks

How long should benzodiazepines generally not be used for insomnia?

Triazolam

What is the short-acting benzodiazepine hypnotic?

2–5 hours

What is the half-life of triazolam?

Anterograde amnesia

What adverse effect means difficulty forming new memories?

Triazolam

Which benzodiazepine is more commonly associated with anterograde amnesia?

Alcohol and opioids

What substances can increase the risk of memory impairment with triazolam?

7–10 days

How long should triazolam generally not be used according to the notes?

Zolpidem

What nonbenzodiazepine is used for short-term treatment of insomnia?

6–8 hours

What is the duration of zolpidem?

1.4–8.4 hours

What is the half-life of zolpidem?

Less than 10 days

How long is zolpidem used for short-term insomnia according to the notes?

Older adults

In whom should the zolpidem dose be decreased?

Food

What decreases the absorption of zolpidem?

-Azole antifungals

What type of drugs can increase zolpidem levels?

Rifampin

What drug can decrease zolpidem levels?

Eszopiclone

What is another example of a nonbenzodiazepine?

Zaleplon

What is another example of a nonbenzodiazepine?
→ sleep medicine
→ mainly helps you fall asleep

Estazolam

What benzodiazepine is considered safer than barbiturates in older adults?

Temazepam

What benzodiazepine is considered safer than barbiturates in older adults?
→ exception regarding REM delay in your notes ⭐
→ intermediate-acting
→ helps maintain sleep

Triazolam

What benzodiazepine is considered safer than barbiturates in older adults?

→ short-acting
→ 2–5 hour half-life
→ anterograde amnesia is an important adverse effect

Flurazepam

What long-acting benzodiazepine should be avoided in older adults? (1)

Quazepam

What long-acting benzodiazepine should be avoided in older adults? (2)

Diazepam

What long-acting benzodiazepine should be avoided in older adults? (3)

Nonpharmacologic methods

What should be tried before prescription sleep medication in older adults?

Barbiturates

What drugs can increase CNS depression and confusion in older adults?

4 times a week

How often should a prescribed benzodiazepine be taken according to the notes to help avoid side effects and dependency?

Frequent nighttime awakening

What sleep problem may be caused by discomfort or pain?

Ibuprofen

What NSAID is mentioned as an occasional option for discomfort?

NSAIDs

What type of medication may occasionally alleviate discomfort or pain?