Family Nurse Practitioner Exam

What is the best pharmacologic agent for an elderly patient suffering from insomnia?

1. Diazepam (Valium)

2. Zolpidem (Ambien)

3. Temazepam (Restoril)

4. Diphenhydramine (Benadryl)

The correct answer is: Zolpidem (Ambien)

Zolpidem (Ambien) is often considered one of the most appropriate pharmacologic agents for managing insomnia in elderly patients. One key reason for this is that it is a non-benzodiazepine sedative, which has a specific mechanism of action targeting the GABA-A receptor. This selectivity allows it to effectively promote sleep while generally carrying a lower risk of adverse effects often associated with traditional benzodiazepines, such as prolonged sedation and cognitive impairment, which can be particularly concerning in older adults. Another important aspect is its relatively short half-life, which minimizes the likelihood of residual sedation the following day—a common issue with longer-acting hypnotics. This is vital for preventing falls and maintaining overall safety in elderly populations. Additionally, Zolpidem is typically well-tolerated and has a favorable side effect profile when used in appropriate doses for short-term treatment of insomnia. In contrast, options like Diazepam and Temazepam, while effective, can lead to increased sedation and a higher risk of dependency in older patients. Diphenhydramine, an antihistamine, can also cause anticholinergic side effects, which may lead to confusion and urinary retention, further complicating management in the elderly.