All of the following are true about Trazadone (Desyrel, Olpetro) (select all that apply):
Blocks SERT
5HT2A antagonism
Is really a poor anti-depressant that is used off-label for insomnia
Has a rare but serious side effect of priapism
Requires a baseline CMP in all patients before initiating
Is recommended by the AASM for sleep onset or maintenance insomnia
Which Schedule IV medication is FDA approved for sleep onset and maintenance?
Doxepin (Silenor, Sinequan)
Suvorexant (Belsomra)
Quetiapine (Seroquel)
Trazadone (Desyrel, Olpetro)
Suvorexant (Belsomra) is an Orexin 1 and 2 antagonist agonist( antagonist, agonist ) and is not recommended if a patient is on a strong CYP3A4 CYP2D6( CYP3A4, CYP2D6 ) inhibitor inducer( inhibitor, inducer ) like nefazodone, suboxone, clarithromycin and certain HIV medications.
Which brand name of Doxepin is used for sleep?
Silenor
Sinequan
Doxepin (Silenor) is a selective and potent ❌ 1 antagonist, that is used for sleep ❌ insomnia, and is the only ❌ prescribed for sleep maintenance insomnia.
There is an increased risk for sedation with higher or lower doses of Doxepin (Silenor)?
Higher
Lower
T or F. Weight gain is unusual for low dose Sinequan (Doxepin).
The following are common and uncommon side effects for Doxepine (Silenor) (select all that apply):
Sweating
Fatigue
Paralytic illeus
EPS
QTc prolongation
Hair loss
Which medication can increase doxepin concentrations?
Depakote
ASA
Haldol
Lisinipril
❌ is also known as Restoril and is a ❌ that is FDA approved for the ❌-term treatment of insomnia. It has a BBW of increased CNS depressant effects with ❌.
T or F. Temazepam may be more effective for mid-nocturnal awakenings than sleep onset insomnia.
Temazepam or Restoril should be dosed how soon before bedtime?
1-2 hours
3-4 hours
5-7 hours
30 minutes to an hour
The following is correct about Temazepam (Restoril) (select all that apply):
Can cause withdrawal symptoms when stopped suddenly
Elderly patients need a lower dose
Does not require any baseline labs in patients with co-morbid illness
Can cause retrograde amnesia
Which benzodiazepine used for sleep is more likely to cause anterograde amnesia, unusual behaviors and hallucinations.
Temazepam (Restoril)
Trialzolam (Halcion)
Zolpidem (Ambien)
Clonazepam (Klonopin)
❌ or Halcion is FDA approved for short-term insomnia but can be used in ❌. The shorter half-life prevents ❌ and may minimize interactions with daytime meds. ❌ may increase concentrations.
T or F. With Triazolam the clearance is slightly faster with women than men.
The following is correct about Zaleplon (Sonata)
Is also a Hyundai car model
Is FDA approved for short-term insomnia
Is recommended by the AASM for sleep onset insomnia
May have more side effects due to the short half-life
A high-fat meal will delay absorption and decrease beneficial effects
May cause more dependence than some other sedative hypnotics-especially in those without a substance abuse history
This medication can reduce the effectiveness of Zaleplon (Sonata).
Carbamazepine (Tegretol)
Fluoxetine (Prozac)
Levofloxacin (Levaquin)
Acetiminophen
This is a uncommon side effect of Zaleplon (Sonata).
Angioedema
Sedation
Ataxia
Reduced Appetit
Zaleplon (Sonata) has not been shown to increase decrease( increase, decrease ) total sleep time or decrease the number of awakenings dreams( awakenings, dreams ).
T or F. Zaleplon can be used for mid-nocturnal awakenings with 4 hrs of sleep time remaining because evidence shows no residual sedation after 4 hours.
Jerry is a 38-year-old male who struggled with insomnia for several months. After trials of medication for short-term insomnia he wants to explore a medication that has efficacy for long term us and has a low potential for abuse. Based on this patient's wishes, which medication should the PMHNP prescribe?
Eszopiclone (Lunesta)
Trazadone (Desyeral)
Tamazepam (Restoril)
The following is true about Eszopiclone (Lunesta) (select all that apply):
AASM recommends for both sleep onset and maintenance insomnia
Can cause an unpleasant taste as a side effect
Should be taken with a high-fat meal
Titration is required
Rifampin decreases levels
Which baseline and routine labs are required with Eszopiclone (Lunesta)?
CMP, CBC. TSH
LFT, BUN, CrCl
None
ALT, AST, GGT
T or F. Sally has a history of a substance use disorder. She has been sober from drugs and alcohol for 5 years. She is now experiencing a period of insomnia. It is best practice for the PMHNP to prescribe Zolpidem (Ambien).
The FDA recommends avoiding this activity the whole day after taking Ambien CR.
Driving
Farming
Yoga
Trampoline Jumping
What formulation of Zolpidem can be used for nocturnal awakenings with difficulty falling back asleep, with at least 4 hours of bedtime remaining.
Edular
Intermezzo
Ambien CR
Zolpimist
Women and the elderly metabolize zolpidem more ❌ than men, making them more vulnerable to ❌ effects. As such the max dose for women and the elderly is ❌mg.
T or F. Ambien CR may allow enough agent to remain at receptors to improve sleep time and prevent early morning awakenings.
Zolpidem Sonata( Zolpidem, Sonata ) has been shown to increase total sleep wake( sleep, wake ) time and reduce increase( reduce, increase ) the number of mid-nocturnal awakenings.
Quetiapine (Seroquel) is used off-label for insomnia sleep maintenance( insomnia, sleep maintenance ) and is best for insomnia sleep maintenance( insomnia, sleep maintenance ) in patients with a co-occurring psychiatric illness. There are significant metabolic anti-cholinergic( metabolic, anti-cholinergic ) side effects and a risk for QTc prolongation Stevens-Johnson Syndrome( QTc prolongation, Stevens-Johnson Syndrome ).
