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NAPLEX 2024 > 68. Sleep Disorders > Flashcards

68. Sleep Disorders Flashcards

1
Q

A dx of chronic insomnia occurs when the patient has symptoms at least ____ for at least ____ despite adequate opportunity to sleep

A

3x per week for at least 3 months

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2
Q

Non-drug treatment for chronic insomnia

A

Cognitive behavioral therapy is preferred and includes changes to sleep hygiene that can reduce need for drugs
Important to treat any underlying medical conditions that may be contributed (e.g. pain, SOB d/t HF, bipolar disorder, depression, alcoholism) and d/c any meds that can worsen insomnia

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3
Q

Natural products used for insomnia

A

Melatonin or valerian
Kava not recommended d/t hepatotoxicity
Drink chamomile tea may help pts feel calmer and help with sleep

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4
Q

Drugs that worsen insomnia

A

ACEi (e.g. donepezil)
alcohol
antiretrovirals (e.g. emtricitabine, INSTIs)
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants (e.g. pseudoephedrine)
Diuretics (d/t nocturia)
Fluoxetine, if taken late in the day
Steroids
Stimulants (e.g. methylphenidate, phentermine)
Varenicline

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5
Q

Which medications help with falling asleep?

A

Eszopiclone
Zolpidem
Ramelteon
Zaleplon

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6
Q

Which medications help with staying asleep?

A

Eszopiclone
Zolpidem
Doxepin
Suvorexant

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7
Q

Which medications help with falling and staying asleep?

A

Eszopiclone
Zolpidem

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8
Q

If pts using rx drugs long-term for insomnia, which drugs are preferred?

A

Non-BZDs preferred over BZDs d/t decreased risk of physical dependence and fewer daytime cognitive effects

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9
Q

Pts may self-treat insomnia with OTC first-gen antihistamines, such as ___ or ___. While these can help short-term, should not be used long-term.

A

Diphenhydramine
Doxylamine

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10
Q

The American Academy of Sleep Medicine (AASM) guidelines state the following treatments are NOT recommended for chronic use:

A

Diphenhydramine, melatonin, tiagabine, trazodone, and valerian

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11
Q

What drugs used for insomnia are on Beers Criteria

A

BZDs, non-BZDs hypnotics (e.g. zolpidem), and first-gen antihistamines
If BZDs are used, use L-O-T drugs (lorazepam, oxazepam, temazepam)

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12
Q

Non-BZD hypnotics MOA (eszopiclone (Lunesta), zolpidem (Ambien, Edluar SL tabs))

A

act selectively at BZD receptors to increase GABA (inhibitor NT)&raquo_space; causes CNS depression

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13
Q

Non-BZD hypnotics (eszopiclone (Lunesta), zolpidem (Ambien, Edluar SL tabs) warnings

A

Increased risk of CNS depression and next-day impairment with <7-8 hrs of sleep (esp with higher doses or coadmin of CNS depressants or alcohol), abnormal thinking and behavioral changes (can worsen depression), respiratory depression, increased risk for hazardous sleep-related activities (e.g. sleep driving)

Potential for abuse/dependence (can cause withdrawal symptoms if used longer than 2 weeks)

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14
Q

Side effects of Non-BZD hypnotics (eszopiclone (Lunesta), zolpidem (Ambien, Edluar SL tabs)

A

somnolence, dizziness, ataxia, HA, can cause parasomnias (unusual actions while sleeping. which the pt may be unaware of), lightheadedness, “pins and needles” feeling on the skin

Eszopiclone= dysgeusia (altered sense of taste)

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15
Q

Non-BZD hypnotics (eszopiclone (Lunesta), zolpidem (Ambien, Edluar SL tabs) can cause additive effects when using with other sedating drugs including ___

A

most pain meds, muscle relaxants, anthistamines, mirtazapine (Remeron), trazodone, and alcohol

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16
Q

Orexin receptor antagonists MOA

A

Block orexin neuropeptide signaling system, resulting in drowsiness

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17
Q

Examples of orexin receptor antagonists

A

Daridorexant (Quviviq)
Lemborexant (DayVigo)
Suvorexant (Belsomra)

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18
Q

Side effects of orexin receptor antagonists

A

Somnolence

Others: HA, dizziness, abdnormal dreams

19
Q

How should orexin receptor antagonists be taken?

A

Empty stomach (food delays absorption)

20
Q

Examples of melatonin receptor agonists

A

Ramelteon (Rozerem)
Tasimelteon (Hetlioz, Heltizoz LQ)

21
Q

Side effects of melatonin receptor agonists

A

Somnolence, dizziness

22
Q

T/F: Ramelteon (Rozerem), Tasimelteon (Hetlioz) are C-IV meds

A

False - not controlled substance

23
Q

TCA (Doxepin (Silenor)) MOA

A

Inhibit NE and 5-HT reuptake, also block ACh and histamine receptors which contribute to side effects (e.g. somnolence)

24
Q

Contraindications of TCA

A

Requires 2 week washout for MAOi

25
Q

Silenor is a branded doexpin that is FDA-approved for insomnia. What other TCAs can be used off-label for sleep (but not recommended in guidelines)?

A

Generic doxepin, trazodone, mirtazapine

26
Q

Side effects of BZDs used in insomnia

A

Drowsiness, dizziness/increase fall risk, cognitive impairment

27
Q

Examples of antihistamines used in insomnia

A

Diphenhydramine (Benadryl)
Doxylamine (Unisom SleepTabs)

28
Q

Side effects for antihistamines used in insomnia (diphenhydramine, doxylamine)

A

Sedation (tolerance to sedative effects can develop after 10 days of use), confusion (can exacerbate memory/cognition difficulty)
Antihistamines may cause paradoxical excitation in younger children; do NOT use doxylamine in children <12 yo
Peripheral anticholinergic side effects: dry mouth, urinary retention (makes it very diff for males with BPH to urinate), dry/blurry vision, constipation

29
Q

It is best to avoid antihistamines for insomnia in pts with ___ and ___

A

BPH (can worsen symptoms)
Glaucoma (can worsen IOP)

30
Q

Define restless legs syndrome

A

Urge to move the lower legs, which is sometimes described as “creeping” sensation”
Worse at night and is relieved with movement
Thought to be d/t a dysfunction of dopamine in the brain’s basal ganglia circuits

31
Q

Primary treatment of restless leg syndrome includes ____

A

dopamine agonists and anticonvulsant gabapentin

32
Q

___ and ___ are dopamine agonists primarily used in longer-acting formulations for Parkinson disease. For RLS, the IR formulation is taken ____ before bedtime

A

Pramiprexole
Ropinirole
1-3 hrs before bed time

33
Q

____ is a dopamine agonist patch applied once daily (used for both Parkinson’s and RLS)

A

Rotigotine (Neupro)

34
Q

Doapmine agonist side effects

A

orthostasis, somnolence and nausea (dose-related)
Dose should be titrated up slowly

35
Q

What formulation of gabapentin is approved for postherpetic neuralgia (PHN) and RLS?

A

Gabapentin enacarbil (Horizant) - ER form of gabapentin
Taken with food and must be swallowed whole
Note: IR gabapentin is used off-label as less expensive alt

36
Q

Define narcolepsy

A

Excessive daytime sleepiness with cataplexy (sudden loss of muscle tone) and sleep paralysis

37
Q

Narcolepsy is treated with ____ such as _____
Several stimulants used for ADHD have indication for narcolepsy including ______

A

Stimulants such as modafinil or armodafinil or with sodium oxybate (Xyrem) or calcium, magnesium, potassium, and sodium oxybate (Xywav) - both of which are derived from inhibitor NT GABA

Several stimulants used for ADHD have indication for narcolepsy including dextramphetamine (Dexedrine, ProCentra, Zenzedi), dextroamphetamine/amphetamine (Adderall), and methylphenidate (e.g. Methylin and Ritalin)

38
Q

Side effects for Modafinil (Provigil), Armodafinil (Nuvigil)

A

Severe rash, can be life-threatening (SJS), HA, insomnia, anxiety, nausea

39
Q

T/F: Modafinil (Provigil) and armodafinil (Nuvigil) are C-IV

A

True

40
Q

Armodafinil is the __-isomer of modafinil

A

R-isomer

41
Q

Sodium oxybate (Xyrem) and calcium, magnesium, potassium and sodium oxybates (Xywav) boxed warnings

A

Strong CNS depressant; respiratory depression, coma and death can result; risk increased when taken with other CNS depressants

Active moiety of oxynbate salts is the sedative GHB (illicitly used to facilitate sexual assault) - REMS program required for pts with narcolepsy with cataplexy

42
Q

T/F: Sodium oxybate (Xyrem) and calcium, magnesium, potassium and sodium oxybates (Xywav) are C-IV when used for narcolepsy

A

False - C-III (narcolepsy), C-I (illicit use)

43
Q

Pitolisant (Wakix) MOA

A

Histamine-3 (H3) receptor antagonist/inverse agonist

44
Q

Solriamfetol (Sunosi) MOA

A

Dopamine and NE reuptake inhibitor (DNRI)

NAPLEX 2024 (74 decks)

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