眠りのメェ～探偵　睡眠薬の使い方がよくわかる

出版社： 金芳堂
著者：
発行日： 2024-01-01
分野： 臨床医学：内科  >  内科学一般
ISBN： 9784765319744
電子書籍版： 2024-01-01 （第1版第1刷）
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不眠症の薬物療法についていろいろな情報が飛び交うあまり、そうして結局いつも通りの処方としていませんか？
本書では、なんとなく処方している実情から脱却できるよう、実臨床で使える手法、治療選択における薬剤ごとの特徴などを羊の名探偵とともに解説しました。
本書を読んで、明日から自信をもって睡眠薬を処方してみませんか？

目次

  • はじめに

    Part1　眠れないから睡眠薬？
    睡眠薬の歴史
    どうしてテキトーな処方ではだめなのか？
    参考文献

    Part2　総論：睡眠障害の考え方
    睡眠障害≠不眠症
    不眠症の診断基準
    不眠の3Pモデル
    不眠症と紛らわしい！　概日リズム睡眠・覚醒障害
    若年者に多い睡眠・覚醒相後退障害
    高齢者に典型的な不眠のパターン
    参考文献

    Part3　処方の決め方
    寝付きを良くしたいのか、途中で起きてしまわないようにしたいのか
    「睡眠薬を処方しない」選択肢
    睡眠衛生指導
    解説のみかた

    1．オレキシン受容体拮抗薬
    －　スボレキサント（ベルソムラ®）
    －　レンボレキサント（デエビゴ®）

    2．GABAA受容体作動薬（ベンゾジアゼピン系および非ベンゾジアゼピン系睡眠薬）
    －　ゾルピデム（マイスリー®）
    ≫　column　睡眠関連摂食障害
    －　エスゾピクロン（ルネスタ®）
    －　ゾピクロン（アモバン®）
    －　ブロチゾラム（レンドルミン®）
    －　エチゾラム（デパス®）
    －　ロルメタゼパム（エバミール®、ロラメット®）
    －　リルマザホン（リスミー®）
    －　クアゼパム（ドラール®）
    －　トリアゾラム（ハルシオン®）
    －　ニトラゼパム（ベンザリン®）
    －　フルニトラゼパム（サイレース®）

    3．メラトニン受容体作動薬
    －　ラメルテオン（ロゼレム®）
    ≫　column　海外への渡航と睡眠薬
    －　メラトニン（メラトベル®）

    4．その他
    －　漢方薬
    －　ジフェンヒドラミン（ドリエル®など）
    参考文献

    Part4　睡眠薬処方の「型」
    睡眠薬処方の前に
    －　CASE 1　毎日のように寝付きが悪い
    －　CASE 2　寝ている途中で目が覚めてしまって再度眠れない
    －　CASE 3　“不眠時”頓服薬
    －　CASE 4　睡眠薬の使用が不安な方
    参考文献

    Part5　マニュアル編（Q&A）
    Q　長時間臥床が是正できない高齢者の不眠症状に対してはどうしたらいい？
    Q　勤労世代の不眠症状で注意すべきことは？
    Q　どの薬剤を使用しても「毎日3時間しか寝られないです」との訴えが続くときにはどうすべき？
    Q　睡眠薬を2剤もしくはそれ以上使うのはどうなの？
    Q　夜寝付けないと同時に、朝起きれない患者の対応はどうすべき？
    Q　閉塞性睡眠時無呼吸に不眠が併存した場合はどうする？
    Q　レストレスレッグス症候群の薬物療法は？
    Q　お酒が大好きでどうしてもやめられない人の不眠症状に対してどうすべき？
    Q　薬剤性（例：ステロイド、βブロッカー）の不眠症状に対してどうすべき？
    Q　認知症患者の不眠症状に対してどうすべき？
    Q　経口摂取が難しい患者に対する睡眠薬使用のコツは？
    Q　CYP3Aを強く阻害する薬剤を使用しているときにはどうすべき？
    参考文献

    Part6　睡眠薬をどうやめる？
    前提：睡眠薬を減量・中止できる状態にありますか？
    従来のスタンダードな中止法：漸減法と隔日法
    近年の睡眠薬は反跳性不眠が出にくい！
    参考文献

    Part7　オフレコ！　適応外処方を出した主治医が考えていそうなこと
    適応外処方のメリット・デメリット
    －　事例1　鎮静系抗うつ薬（トラゾドン・ミアンセリン）
    －　事例2　低用量のミルタザピン
    －　事例3　クエチアピン
    －　事例4　クロルプロマジン
    －　事例5　睡眠・覚醒相後退障害に対する低用量アリピプラゾール
    －　事例6　クロナゼパム
    －　事例7　プレガバリン
    －　事例8　ガバペンチン
    －　事例9　クロニジン

    おわりに：適応外処方全般に対する構え
    参考文献

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

Part 1 眠れないから睡眠薬 ?

P.6 掲載の参考文献
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Part 2 総論 : 睡眠障害の考え方

P.22 掲載の参考文献
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Part 3 処方の決め方

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Part 4 睡眠薬処方の「型」

P.98 掲載の参考文献
[1] 三島和夫. 睡眠薬の適正な使用と休薬のための診療ガイドライン. じほう, 2014.
 
[2] Sateia MJ, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults : An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017 ; 13 : 307-349.
PubMed
[3] Kishi T, et al. Lemborexant vs suvorexant for insomnia : A systematic review and network meta-analysis. J Psychiatr Res. 2020 ; 128 : 68-74.
PubMed
[4] Tom SE, et al. Nonbenzodiazepine sedative hypnotics and risk of fall-related injury. Sleep. 2016 ; 39 : 1009-1014.
PubMed
[5] Dolder CR, et al. Hypnosedative-induced complex behaviours : Incidence, mechanisms and management. CNS Drugs. 2008 ; 22 : 1021-1036.
PubMed
[6] Herring WJ, et al. Suvorexant in patients with insomnia : Pooled analyses of three-month data from phase-3 randomized controlled clinical trials. J Clin Sleep Med. 2016 ; 12 : 1215-1225.
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[7] De Crescenzo F, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults : a systematic review and network meta-analysis. Lancet. 2022 ; 400 : 170-184.
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Part 5 マニュアル編 ( Q & A )

P.120 掲載の参考文献
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Part 6 睡眠薬をどうやめる ?

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Part 7 オフレコ ! 適応外処方を出した主治医が考えていそうなこと

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