Circadian Rhythm disorders

Question 1

Types of Circadian rhythm disorders

Answer 1

Jetlag

Non-24

Shift-work sleep disorder

Restless leg
syndrome

Question 2

Non-24

Answer 2

Related to blindness

Question 3

Shift-work disorder treatment

Answer 3

Treat with bright light therapy + melatonin agent

Modafinil/armodifinil may be used to assist in staying awake if needed

Question 4

Modafinil/armodifinil

Answer 4

used to treat shift work disorder/ narcolepsy

Question 5

Restless leg syndrome treatment

Answer 5

(Seen in elderly, iron deficiency anemia, pregnancy)

1st line treatment: Dopamine agonists + Iron studies
NOT levodopa

-Ropinirole (Requip)
-Pramipexole (Mirapex)
-Rotigotine (Neupro)

2nd line: Gabapentin/pregabalin
*Clonazepam and opiates not first line treatment either

Question 6

___________ is not suggested for first line tx of RLS and why

Answer 6

Levodopa is a dopamine agent but NOT suggested for first line treatment for RLS due to RLS augmentation (worsen condition)

Question 7

AE of dopamine agents (to treat RLS)

Answer 7

Impulse control issues (gambling shopping, hyper sexual, binge eating), hallucinations, orthostatic hypotension, somnolence, nausea/vomiting

Question 8

RLS augmentation

Answer 8

When treating with dopamine agent, symptoms worsen after treatment (usually in first 6 months). NOT natural progression of disease. Due to high dose of dopamine agonists.

Question 9

Narcolepsy causes

Answer 9

Dysregulation of hypocretin-orexin system

Question 10

Narcolepsy treatment + AE

Answer 10

Treat daytime sleepiness: Modafanils or stimulants

AE: HA, nervousness, anxiety, insomnia

Meds to treat Cataplexy:
-TCAs
-Venlafaxine (SSRI)
-Fluoxetine (SSRI)
-Sodium oxubate (RESTRICTED PROGRAM)

Question 11

How to rate narcolepsy

Answer 11

Epworth Sleepiness Scale