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Questions and Answers
What is the most likely reason for the 68-year-old man's daytime drowsiness and confusion?
What is the primary concern when prescribing sedative-hypnotics in patients with chronic kidney disease?
Which medication is most likely to be avoided in patients on opioid therapy due to the increased risk of respiratory depression?
What is the primary advantage of ramelteon over other sedative-hypnotics?
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Which medication is most likely to be prescribed for insomnia in a patient with a history of substance abuse?
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What is the primary concern when prescribing sedative-hypnotics in patients with a history of depression?
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A patient with a history of substance use disorder and insomnia is seeking treatment. Which medication is most appropriate?
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An elderly patient with dementia is prescribed a medication for insomnia, but the family reports increased agitation and confusion. Which medication is most likely causing these side effects?
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A patient is taking a sedative-hypnotic for insomnia and presents to the emergency department with confusion and ataxia. Which medication is most likely responsible for these symptoms?
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A patient is taking diphenhydramine nightly for insomnia and complains of dry mouth, constipation, and difficulty urinating. Which medication is a better alternative?
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A patient with a history of chronic insomnia is prescribed zolpidem. The caregiver reports that the patient has become increasingly forgetful and has experienced several falls since starting the medication. What is the most appropriate course of action?
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A patient with a history of chronic insomnia and severe anxiety is brought to the emergency department after a suspected overdose. What is the most appropriate initial management?
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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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Description
Test your knowledge of pharmacology with these questions on sleeping disorders, medications, and their effects. Identify the appropriate next steps in managing patient symptoms.
