insomnia drugs

benzo receptor agonists

• escopiclone, zaleplon, zolpidem

• MOA - interacts with GABA receptors complexes

eszopiclone

• long term use

• good for staying asleep bc it has long half-life

zaleplon

• can use for 7-10 days

• good for pts that wake up throughout night

• do not take drug unless you have 4 hours before you have to get back up bc it has a half life of 3-4 hrs

zolpidem

• 7-10 days use

• half life of 6-8 hrs

• works rapidly

• 1st line

benzo receptor agonists side effects

• daytime drowsiness

• dizziness

• feeling drugged

• short term memory loss

benzo receptor agonists adverse effects

• somnambulism (sleepwalking)

benzo receptor agonists nursing considerations

• don’t take alcohol or other CNS depressants

• give smaller doses for older adults

Benzos

• temazepam

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

• works within 30 mins; 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)

• Teach about being careful with driving

• Teach that they could sleep-walk

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

OTC antihistamines

• Diphenhydramine

• Dimenhydrinate

sedating antidepressants

• Trazodone

• Amitriptyline

• Doxepin

narcolepsy

• Sleep disorder - Uncontrollable urge to fall asleep

• Neurologic Disorder - The brain is unable to regulate the sleep and wake cycle. 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 before they wake up for a few seconds)

drugs for narcolepsy

• stimulants methylphenidate and modafinil

• sodim oxybate (sedatives)

what will the methylphenidate and modafinil do for the body

• help increase attention span

• give person more alertness during their wake hours

• prevent them from feeling tired

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

• weight the PT daily because they could have anorexia effects

• Observe for seizures

• Avoid alcohol and caffeine.

• Modafinil does not mix well with grapefruit juice because it interferes with the action of the drug.

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 because you don’t want them to be harmed during this therapy.