insomnia drugs

benzodiazepine receptor agonists
drugs?
MOA?

• escopiclone, zaleplon, zolpidem

• MOA - interacts with GABA receptors complexes

eszopiclone

• only one approved for long term use

• fast onset

• good for staying asleep bc it has a long half-life (6 hours)

zaleplon

• can use for 7-10 days max

• good for pts that wake up throughout night a lot

• half life of 3-4 hrs

zolpidem

• 7-10 days max

• half life of 6-8 hrs

• for those who need help falling asleep and staying asleep

• works rapidly

• 1st line

benzo receptor agonists side effects

• daytime drowsiness

• dizziness

• feeling drugged

• short term memory loss

benzo receptor agonists adverse effect

somnambulism (sleepwalking)

benzo receptor agonists nursing considerations

• don’t take alcohol or other CNS depressants

• give smaller doses for older adults

Benzodiazepines
drug?
MOA?
onset/length?

• temazepam

• MOA - depresses CNS through hypothalamic, thalamic, and limbic systems

• takes 30 mins to begin effects; lasts for long time; half life of 6-8 hrs

benzo side effects

• daytime drowsiness

• confusion

• impaired concentration

benzo adverse effects

potential addiction (possible overdose)

what is antidote for benzo overdose?

flumazenil

benzo pt teaching

• Teach PT about good sleep habits (turn lights down, turn phones off a couple of hours before you plan to go to sleep

• Avoid nicotine and caffeine

• Be careful with driving

• Teach that they could sleep-walk/do crazy things at night

• Assess that PT will have 8 hrs of sleep due to the half life
  

OTC antihistamines

• Diphenhydramine

• Dimenhydrinate

sedating antidepressants

• Trazodone

• Amitriptyline

• Doxepin

what is narcolepsy

• Sleep disorder: Uncontrollable urge to fall asleep

• Neurological disorder of brain being unable to regulate sleep and wake cycles. They hold onto CO2. They might wake up several times throughout the night.

narcolepsy symptoms

• cataplexy (loose muscle tone and reflexes; could be from stress or emotions)

• vivid hallucinations

• total paralysis (right before they go to sleep or right after they wake up for a few seconds)

drugs for narcolepsy

• stimulants: methylphenidate and modafinil

• sedatives: sodim oxybate

what does methylphenidate and modafinil do for the body

• help increase attention span

• give person more alertness during their wake hours

• prevent them from feeling tired - stay awake

stimulants side effects

• insomnia

• diarrhea

• tremors

sodium oxybate side effects

sleepwalking

stimulant adverse effects

• seizures

• abnormal heart rhythyms

• chest pain

narcolepsy med nursing considerations

• Assess PT for vitals

• Weigh daily (anorexia effects)

• Observe for seizures

• Avoid alcohol and caffeine

• Modafinil does not mix well with grapefruit juice

narcolepsy med pt teaching

• If you forget to take methylphenidate, teach PT to not take it before bedtime because it will keep them up.

• Teach PT to have family members to hang out with the PT while they sleep because you don’t want them to be harmed during this therapy (sleepwalking/crazy activities).