Podcast
Questions and Answers
What is the primary reason for switching to ramelteon in the 68-year-old man with hypertension and insomnia?
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?
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?
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?
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?
Which of the following medications is most likely to cause daytime drowsiness and confusion in the 68-year-old man with hypertension and insomnia?
Which of the following medications is most likely to cause daytime drowsiness and confusion in the 68-year-old man with hypertension and insomnia?
What is a significant concern when prescribing zolpidem to elderly patients?
What is a significant concern when prescribing zolpidem to elderly patients?
Which medication is least likely to be prescribed for insomnia in a patient with a history of substance use disorder?
Which medication is least likely to be prescribed for insomnia in a patient with a history of substance use disorder?
What is the primary mechanism of action of ramelteon?
What is the primary mechanism of action of ramelteon?
A patient taking a sedative-hypnotic medication presents with confusion, ataxia, and respiratory depression. Which medication is most likely responsible?
A patient taking a sedative-hypnotic medication presents with confusion, ataxia, and respiratory depression. Which medication is most likely responsible?
What is the primary reason to avoid prescribing diphenhydramine to elderly patients?
What is the primary reason to avoid prescribing diphenhydramine to elderly patients?
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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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