This is Chapter Five Neuro, and in this video, we'll be talking about sedatives and hypnotics. Sedatives and hypnotics are basically the same thing.
Sedatives are just used at
lower doses, while hypnotics are used at higher doses. They aboth basically just mean sleeping pills.
Here are the medications we'll be going over in this video.
An over the counter option for sleep is
Tylenol PM, which contains acetaminophen, which is used for pain, and then
diphenhydramine, which is the sedative-hypnotic. Diphenhydramine is actually a first-generation
antihistamine, and we're not using it for stuffy noses or anything like that;
we're using it because of the side effect that it has which is causing drowsiness.
The next medication is melatonin receptor
agonist, that's the class, and the drug is ramelteon and the brand name is Rozerem. We remember that because 'roze-' rhymes
with doze, and you can think of -rem like REM sleep, which is the good kind of sleep. There are also two
benzodiazepine-like sedative/hypnotics that we'll talk about today. One is eszopiclone, which is Lunesta,
and one is zolpidem, which is Ambien or Ambien CR.
There's two different formulations of the
zolpidem - one is the Ambien which is short acting, and then the Ambien CR
is the extended release. It starts working in about the same amount of time as the zolpidem or Ambien but it just
lasts a little bit longer. That one can hep with sleep onset and sleep maintenance.
So let's go over some questions. This first one will look at the drug classes so the question is: 'A sedative/hypnotic
that also provides pain relief is?' A) is ramelteon
which is the melatonin receptor agonist, B) is the
benzodiazepine like medication which is eszopiclone, C) is the zlpidem, and D) is Tylenol PM .
The answer to that question is D)
Of all of these medications, the only one that provides pain relief and sedation is the Tylenol PM which contains the
acetamin for pain relief, which is a non-opioid analgesic, and the diphenhydramine, which provides sedation.
Now, we're going to go through these same answers in order but we're going to make each answer correct by changing the question.
To make A) correct,
'A sedative-hypnotic that mimics melatonin?' It works on melatonin receptors as an agonist
so B) Is incorrect and C)
Is incorrect, the eszopiclone and zolpidem because those are benzodiazepine like
medications, and then the Tylenol PM, as
we just alluded to, the acetaminophen/diphenhydramine is a non-narcotic analgesic with an antihistamine
Ramelteon is the one that mimics melatonin and we can remember also
that's the Rozerem, 'roz-' rhymes with doze and '-rem' reminds you of REM sleep.
To make B) correct, eszopiclone, 'A patient tells you they
were recently started on a benzodiazepine-like sedative that causes a metallic taste, which causes a mettalic taste?'
B) eszopiclone is the culprit. THis is one of the medications that can cause a metallic taste as kind of a funky
side effect
The ramelteon on does not cause it and is not a benzodiazepine like sedative, and neither is the acetaminophen/diphenhydramine,
so we can cross those out. The zolpidem is a benzodiazepine
like medication, but there is no side effect that deals with the metallic taste.
To make C) correct,
the question is 'A sedative hypnotic with multiple formulations that helps with sleep onset and sleep maintenance?'
A) is incorrect, the ramelteon because it's only used for sleep
onset. The acetaminophen/diphenhydramine is also only used for sleep onset, and so
we're down to the eszopiclone and zolpidem. The eszopiclone does help and with sleep onset and sleep maintenance, but there's only one
formulation that's longer acting, but as
we alluded to before, the zolpidem is available as Ambien which can help with sleep onset and then Ambien CR
which works for a little bit longer and that helps with sleep onset and sleep maintenance.