Sedatives and Hypnotics

A 72-year-old woman with a history of hypertension and type 2 diabetes mellitus is admitted to the hospital for acute pneumonia. She is on amlodipine, metformin, and lisinopril. On the second night of admission, she becomes confused and agitated, pulling at her IV lines and attempting to get out of bed. The nursing staff requests sedation. Her vital signs are: BP 145/92 mmHg, HR 98/min, RR 22/min, temperature 38.2°C, and oxygen saturation 91% on 2 L nasal cannula. Serum creatinine is 1.8 mg/dL (baseline 1.2 mg/dL), and she has mild hepatic impairment. Which of the following is the MOST APPROPRIATE initial sedative agent for this patient?

Which of the following benzodiazepines has the longest half-life and is therefore preferred for once-daily dosing in anxiety disorders?

A 58-year-old man with chronic insomnia and mild obstructive sleep apnea (OSA) presents to the sleep clinic. He has been using alcohol as a sleep aid for the past 3 years, consuming 2–3 pegs of whisky nightly. He complains of daytime somnolence, poor sleep quality, and morning headaches. His wife reports loud snoring and witnessed apneic episodes. On examination, BMI is 28 kg/m², BP 138/88 mmHg, and oxygen saturation 94% on room air. Polysomnography confirms moderate OSA (AHI 25/hour). The patient is counseled to avoid alcohol and is being considered for pharmacotherapy. Which of the following sedative-hypnotics would be MOST APPROPRIATE for this patient?