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NAPLEX 2023 > Chapter 68: Sleep Disorders - Insomnia, RLS & Narcolepsy > Flashcards

Chapter 68: Sleep Disorders - Insomnia, RLS & Narcolepsy Flashcards

1
Q

A diagnosis of chronic insomnia occurs when:

A

The patient has symptoms at least 3 times per week for at least 3 months

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2
Q

Key drugs that can worsen insomnia

A 
Acetylcholinesterase inhibitors (e.g., donepezil)
Alcohol
Antiretrovirals
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants
Diuretics
Fluoxetine, if taken late in the day
Steroids
Stimulants
Varenicline
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3
Q

What are some natural products used for insomnia

A
  • Melatonin (note: it is a 1A2 substrate and if taken with inhibitors like cipro or fluvoxamine, can cause prolonged effects)
  • Valerian
  • Chamomile tea
  • Kava not recommended d/t hepatotoxicity
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4
Q

What is first-line treatment for insomnia

A

Non-drug treatment like cognitive behavioral therapy (CBT), keep bedroom dark, regular sleep schedule, avoid daytime naps, etc. (sleep hygeine)

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5
Q

What drugs can be used if a patient complains of not being able to fall asleep

A

Eszopiclone
Zolpidem
Ramelteon
Zaleplon

EZZR (easier) way to fall asleep

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6
Q

What drugs can be used for a patient who needs help staying asleep

A

Eszopiclone
Zolpidem
Doxepin
Suvorexant

SEDZ (sedated)

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7
Q

What drugs can be used in a patient who needs help falling and staying asleep

A

Eszopiclone
Zolpidem

EZ tip for excellent ZZZZ (sleep) -> E and Z are in all treatment groups

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8
Q

Patients may self-treat insomnia short-term with which OTC products

A

antihistamines like Benadryl or doxylamine

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9
Q

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

A

Benadryl, melatonin, tiagabine, trazadone, and valerian

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10
Q

MOA of hypnotics

A

The non-BZDs act selectively at BZD receptors to increase GABA, an inhibitory NT which causes CNS depression

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11
Q

Eszopiclone brand name

A

Lunesta

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12
Q

Zolpidem brand name

A

Ambien, Ambien CR, Edluar

Intermezzo (SL tabs)

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13
Q

What drug schedule are hypnotics (eszopiclone, zolpidem, zaleplon)

A

Schedule IV

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14
Q

Dosing for Ambien, Edular, Zolpimist

A

Female/Elderly: 5 mg PO/SL/spray QHS
Male: 5-10 mg PO/SL/spray QHS

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15
Q

T/F: Hypnotics do not have potential for abuse and dependance

A

False

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16
Q

SE of hypnotics

A

Somnolence, dizziness, ataxia, can cause parasomnias (unusual actions while sleeping, which the pt may be unaware of)

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17
Q

MOA for orexin receptor antagonists

A

Block the orexin neuropeptide signaling system, which normally promotes wakefulness, leading to drowsiness

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18
Q

Which drug is an orexin receptor antagonist

A

lemborexant (DayVigo)
Suvorexant (Belsomra)

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19
Q

What schedule of drugs is orexin receptor antagonists

A

C-IV

20
Q

Side effect of orexin antagonists (lemborexant, suvorexant)

A

Somnolence

21
Q

Which drugs are melatonin receptor agonists

A

Ramelteon and tasimelteon

has the word MEL for melatonin

22
Q

What DEA class is ramelteon and tasimelteon?

A

not controlled

only melatonin agonist

23
Q

MOA of TCAs

A

inhibit NE and 5HT reuptake. Also block ACh and histamine receptors, which contributes to side effects

24
Q

Which TCA is used for insomnia

A

Doxepin (Silenor)

25
Q

CI for doxepin

A

Requires a 2 week washout period for MAOi

26
Q

Restoril generic name

A

temazepam

27
Q

Unisom SleepTabs generic name

A

Doxylamine (OTC)

28
Q

With which disease states should Doxylamine be avoided in

A

BPH and glaucoma

29
Q

What are the primary treatments of RLS

A

Dopamine agonists (pramipexole and ropinirole) and gabapentin

30
Q

Brand name for pramipexole

A

Mirapex

31
Q

drug class used for RLS

A

dopamine agonists

and gabapentin

32
Q

Generic for Requip

A

ropinirole

33
Q

For RLS, the IR formulation of pramipexole and ropinirole is taken ___ hours before bedtime

A

1-3

34
Q

Which dopamine agonist comes as a patch

A

Rotigotine (Neupro)

once daily

35
Q

SE of dopamine agonists

A

orthostasis, somnolence, and nausea

monitor for pyschiatric SEs

36
Q

Gabapentin (Horizant) used for RLS should be taken at what time

A

~5 PM

37
Q

What is narcolepsy

A

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

38
Q

How is narcolepsy treated

A

Stimulants, such as modafinil or armodafinil
or with sodium oxybate (Xyrem), Ca Mg K and Na oxybate (Xywav), dextro/amphetamines, methylphenidate

39
Q

What schedule of drugs are stimulants used for wakefulness (modafinil, armodafinil)

A

C-IV

40
Q

Side effects of stimulants used for wakefulness

A

Severe rash that can be lifethreatening

41
Q

Sodium Oxybate is derived from

A

GABA

42
Q

What schedule of drug is sodium oxybate for narcolepsy

A

C-III

43
Q

sodium oxybate brand name

A

Xyrem

44
Q

Sodium oxybate is a C-I when used as an illicit drug, also known as

A

“date rape” drug

45
Q

Which drug used for narcolepsy requires a REMS program

A

sodium oxybate (Xyrem)
Ca Mg K and Na oxybate (Xywav)

46
Q

Other oral medications for narcolepsy include:
1. pitolisant
2. solriamfetol

what are the drug classes?

A
  1. histamine-3 receptor antagonist/inverse agonist
  2. DA and NE reuptake inhibitor (DNRI)

NAPLEX 2023 (88 decks)

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