Medical Case Studies: Sleep Disorders and Medication
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Questions and Answers

What is the primary reason for switching to ramelteon in the 68-year-old man with hypertension and insomnia?

  • To improve the management of hypertension
  • To increase the dose of temazepam
  • To reduce the risk of daytime drowsiness and confusion (correct)
  • To reduce the risk of respiratory depression
  • Which medication is most likely to interact with sertraline and exacerbate insomnia?

  • Trazodone
  • Eszopiclone
  • Alprazolam (correct)
  • Zolpidem
  • Why is ramelteon considered the safest option for treating insomnia in the 60-year-old male patient with chronic kidney disease?

  • It is not metabolized by the kidneys (correct)
  • It has a shorter half-life compared to other sedative-hypnotics
  • It is not a controlled substance
  • It is a benzodiazepine receptor agonist
  • What is the primary reason for avoiding the use of temazepam in the 55-year-old female with breast cancer and chronic pain due to bone metastases?

    <p>It can increase the risk of respiratory depression</p> Signup and view all the answers

    Which of the following medications is most likely to cause daytime drowsiness and confusion in the 68-year-old man with hypertension and insomnia?

    <p>Temazepam</p> Signup and view all the answers

    What is a significant concern when prescribing zolpidem to elderly patients?

    <p>Increased risk of falls</p> Signup and view all the answers

    Which medication is least likely to be prescribed for insomnia in a patient with a history of substance use disorder?

    <p>Diazepam</p> Signup and view all the answers

    What is the primary mechanism of action of ramelteon?

    <p>Melatonin receptor agonist</p> Signup and view all the answers

    A patient taking a sedative-hypnotic medication presents with confusion, ataxia, and respiratory depression. Which medication is most likely responsible?

    <p>Lorazepam</p> Signup and view all the answers

    What is the primary reason to avoid prescribing diphenhydramine to elderly patients?

    <p>Anticholinergic side effects</p> Signup and view all the answers

    Study Notes

    Insomnia Management

    • A 68-year-old man with hypertension and insomnia taking temazepam for 6 months complains of daytime drowsiness and confusion; the most appropriate next step is to switch to ramelteon.
    • Temazepam is not suitable for long-term use due to its potential for causing daytime drowsiness and confusion.

    Medications for Insomnia

    • Trazodone is the most appropriate medication for a 40-year-old woman with major depressive disorder and generalized anxiety disorder, currently taking sertraline.
    • Ramelteon is the safest option for a 60-year-old male patient with chronic kidney disease and an eGFR of 25 mL/min/1.73 m².
    • Temazepam should be avoided in a 55-year-old female with breast cancer and chronic pain due to bone metastases, as it increases the risk of respiratory depression when combined with opioid therapy.

    Sedative-Hypnotics and Side Effects

    • Zolpidem can increase the risk of falls and worsen cognitive impairment in elderly patients; it's recommended to discontinue zolpidem and recommend sleep hygiene measures in such cases.
    • Ramelteon is the most appropriate medication for a 45-year-old man with a history of substance use disorder and insomnia, due to its lower risk of dependence.
    • Lorazepam can cause confusion, ataxia, and respiratory depression, especially when taken in higher doses than prescribed.

    Alternative Treatments

    • Ramelteon is a suitable alternative to diphenhydramine for a 65-year-old man with chronic insomnia, as it avoids the anticholinergic side effects of diphenhydramine.

    Medication Side Effects

    • Temazepam can cause increased agitation and confusion in elderly patients with dementia.
    • Flumazenil is the most appropriate initial management for a 55-year-old woman with a suspected overdose of benzodiazepines, who presents with a respiratory rate of 6 breaths per minute.

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    Description

    This quiz covers medical case studies related to sleep disorders, medications, and their management. It tests your knowledge of different treatment options and their effects on patients.

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