What is the definition of insomina?

difficult in falling asleep or staying asleep, or lack in refreshment from sleep.

What are causes of insomnia?

enviromental factors, stress, drugs, disease states (depression)

What are aspects of sleep hygeine?

avoid daytime nap;

regular arising time;

regular exercise (not before bed time);

avoid heavy meal before bedtime

avoid caffiene (warm milk before bed)

ensure compfortable/quiet enviro

stress management

What are the main drug classes of hypnotics?

Benzodiazepines - temazepam

Non-benzodiazepines - zopiclone

Antihistamines - promethazine

What factors should be considered when selecting a hypnotic?

duration of action

risk of adverse effects

costs

What are 2 common hypnotic drug regiemes for insomnia?

temazepam 10-20 mg po @ bedtime

zopiclone 3.75-7.5 mg po immediately after food

What is the definition of anxiety (symptoms)?

a feeling of apprehension PLUS;

palpitations, chest pains, SOB, dizziness, GIT disterbances, loss of libido, headache, tremor

What are possible precipitating factors of anxiety?

stress

CNS stimulants

withdrawal from CNS depressants

metabolic disturbances (hyperventilation)

What is generalised anxiety disorder?

anxiety and worry over a number of events for period 6 months or longer

What symptoms are particular to generalised anxiety disorder?

irritability,

difficulty concentrating

muscle tension

sleep disturbances

What is primary treatment of generalised anxiety disorder?

Non-pharmacological ->

Listening and counselling

Teaching relaxation techniques

What drugs classes are prescribed for generalised anxiety disorder (used as anxiolytics)?

BNZs

buspirone

BBs

TCAs

SSRIs

MAOIs

Generalised anxiety disorder - short term management?

diazepam

oxazepam

2 weeks, with gradual reduction to zero within 6 weeks

What drug may be given to treat tremor and palplitation of generalised anxiety disorder?`

propranolol 10-20 mg po

What are the contraindicaiton for benzodiazepines?

Myasthenia gravis

respiratory disorders

pregnancy - first trimester, late pregnanacy

What the side effects associated with benzodiazepines?

Excessive sedation

Fatigue, poor concentration

Falls in the elderly

Tolerance (to sedative effects)

What are the withdrawal symptoms of long term benzodiazepine use?

anxiety, insominia, hypersensitivity to sensory stimuli, muscle twitching, depression

psychosis and convulsion may occur in abrupt discontinuation

What drug is used for long term treatment (when non-pharm. fails) of generalised anxiety disorder and for how long?

Diazepam 2-5 mg day, OR

Diazepam 5-10 mg night, OR

Oxazepam 15-30 mg, 2-3 times daily

6-12months

In treating generalised anxiety disorder, when benzos are not desirable, what drug would be prescribed?

buspirone 5 mg 3/d, increasing up to 20 mg 3/d, and continuing for several weeks after symptoms subside

SSRIs or venlafaxine

What is the onset of action of buspirone?

2-4 weeks

What particular anxiety disorder are TCAs partiuarly good for?

panic disorder

What anxiety disorders are SSRIs and MAOIs particularly good for?

phobic states, and panic disorders