Home' Australian Pharmacist : Australian Pharmacist July 2013 Contents 70
Australian Pharmacist July 2013 I ©Pharmaceutical Society of Australia Ltd.
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1. Which of the following medical
conditions is NOT associated with
a) Chronic pain.
c) Breathing difficulties.
d) Urinary incontinence.
2. Which one of the following
statements is MOST accurate?
a) Zaleplon causes more sedation and
memory loss at therapeutic doses than
b) Zopiclone displays an absence of first
pass effect and therefore its dose
remains unchanged in people with
c) Zolpidem has a short elimination
half-life of two hours and is therefore
less likely to cause drowsiness the
d) Imidazopyridine agents all act with the
same affinity on GABAA receptors.
3. Which ONE of the following
statements is least accurate?
a) Melatonin production may diminish
with increased age, from 55 years of
age and over.
b) Slow release melatonin may be used
to assist benzodiazepine withdrawal
in benzodiazepine dependant elderly
c) Slow release melatonin works as
an alternative in all patients for
withdrawal of benzodiazepines.
d) A small study has shown small and
high doses of melatonin have similar
pharmacokinetics and effect on sleep.
4. Pharmacological therapy will
generate a state of consciousness
rather than sleep, which mimics
normal sleep patterns. True or false?
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2. Neubauer D. Insomnia. Prim Care: Clinics in office practice
3. Mayo Clinic. Insomnia. At: www.mayoclinic.com/health/
4. Therapeutic Guidelines. Psychotropic: Sleep disorders, Version
6. 2008. p. 87.
5. Mayo Clinic. Insomnia. At: www.mayoclinic.com/health/
6. Tiller J. Sleep disorders. Melbourne: Department of Psychiatry,
University of Melbourne; 2008.
7. University of Maryland Medical Center. Insomnia – treatment..
8. American Psychiatric Association. Diagnostic and statistical
manual of mental disorders. 4th ed. Washington, DC: American
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9. Juergens T, Barczi S. Sleep. In: Duthie. Practice of geriatrics. 4th
10. Benitez J, Allison L, Ternullo S. Sedative hypnotics. In: Haddad
& Winchester’s clinical management of poisoning and drug
overdose. 4th ed. WB Saunders; 2007.
11. LeGrand SB. Ch 134: Anxiolytics, sedatives & hypnotics – Non-
benzodiazepine sedatives, the Z-Drugs. In: Walsh TD. Pallative
medicine. WB Saunders; 2008.
12. Bootzin RR, Rider SP. Behavioral techniques and biofeedback
for insomnia. In: Pressman MR, Orr WC, eds. Understanding
sleep: the evaluation and treatment of sleep disorders.
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13. Therapeutic Guidelines. Psychotropic: Sleep disorders, Version
6. 2008. p. 91.
14. Gooneratne NS, Edwards A, Zhou C, et al. Melatonin
pharmacokinetics following two different oral surge-sustained
release doses in older adults. J Pineal Res 2012 May;52(4):437-
45. doi: 10.1111/j.1600-079X.2011.00958.x .
15. Kunz D, Bineau S, Maman K, et al. Benzodiazepine
discontinuation with prolonged-release melatonin:
hints from a German longitudinal prescription database.
Expert Opin Pharmacother. 2012;13(1):9–16. doi:
16. Huffam J, Theodore A. Side effects of psychotropic
medications. Anxiety and sleep agents. Mosby; 2008.
17. Ch .163: Sedative hypnotics: Zolpidem and zaleplon. In: Marx J,
Hockberger R, Walls R, eds. Rosen’s emergency medicine. 7th
edn. WB Saunders; 2009.
The use of benzodiazepines and
imidazopyridines in elderly people
is associated with numerous adverse
effects and are only recommended for
short term use. Melatonin is available
and maybe effective in reducing
side effects due to benzodiazepine
measures should always be discussed
with patients and behavioural
therapies such as sleep restrictions
and stimulus control will be efficacious
in the treatment of insomnia in
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