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* Olanzapine and Quetiapine 2nd gen antipsychotics used for sleep and delirium. Avoid in older patients with dementia (black box warning).
* Olanzapine and Quetiapine 2nd gen antipsychotics used for sleep and delirium. Avoid in older patients with dementia (black box warning).
=Melatonin=
=Melatonin=
* MOA: decreasing firing rate of neurons in SCN via MT1 receptor, but only when endogenous levels are low (daytime)
* MOA: chronohypnotic that decreases firing rate of neurons in SCN via MT1 receptor, but only when endogenous levels are low (daytime)
* In older adults, the amount of melatonin synthesized and the number and affinity of MT1 receptors all decrease. [35436355]
* In older adults, the amount of melatonin synthesized and the number and affinity of MT1 receptors all decrease. [35436355]
* does not make you feel drowsy. It enhances natural sleep wake cycle. Must be paired with good sleep hygiene. Only need very small amounts (1 mg). Give 1 hr before bedtime. [1|https://link.springer.com/article/10.1007/s00415-020-10381-w]
* Does not make you feel drowsy. It enhances natural sleep wake cycle. Must be paired with good sleep hygiene. Only need very small amounts (1 mg). Give 1 hr before bedtime. [1|https://link.springer.com/article/10.1007/s00415-020-10381-w]
* The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own.
* The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own.
* Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all.
* Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all.
* Refs: 15649737, 11600532, 24802882, 35436355
* Refs: 15649737, 11600532, 24802882, 35436355