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PHM701 > Exam 2 - Sleep Disorders > Flashcards

Exam 2 - Sleep Disorders Flashcards

1
Q

What medications can cause/worsen insomnia? (17)

A

alcohol, caffeine, nicotine, anticholinergics, SSRIs/SNRIs, alpha blockers, beta blockers, ACEi/ARBs, cholinesterase inhibitors, bronchodilators, CNS stimulants, corticosteroids, decongestants, diuretics, H2RAs, statins, opioids

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2
Q

What is first-line for long-term insomnia treatment?

A

CBT

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3
Q

What is the treatment for sleep-onset insomnia for those avoiding BZDRAs and morning sedation?

A

ramelteon

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4
Q

What is the treatment for sleep-onset insomnia for those avoiding BZDRAs and who can tolerate morning sedation? (2)

A

DORAs, ramelteon

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5
Q

What is the treatment for sleep-onset insomnia for those who can tolerate BZDRAs and are avoiding morning sedation? (2)

A

ramelteon, z-drugs

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6
Q

What is the treatment for sleep-onset insomnia for those who can tolerate BZDRAs and morning sedation? (3)

A

DORAs, ramelteon, z-drugs

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7
Q

What is the treatment for sleep-maintenance for those avoiding BZDRAs? (2)

A

DORAs, doxepin

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8
Q

What is the treatment for sleep-maintenance for those who can tolerate BZDRAs? (3)

A

DORAs, doxepin, z-drugs

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9
Q

What is the MOA of BZDRAs?

A

GABA receptor agonist

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10
Q

What are boxed warnings for BZDRAs? (3)

A

concomitant depressant effects, risk of abuse, risk of dependence and withdrawal

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11
Q

What is a boxed warning for z-drugs?

A

parasomnias and complex sleep behaviors

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12
Q

Which BZDRA has the longest and shortest half-life, respectively?

A

longest = quazepam, shortest = zaleplon

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13
Q

Which BZDRAs have clinically-active metabolites? (2)

A

flurazepam, quazepam

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14
Q

What is the indication for eszopiclone (Lunesta)?

A

sleep-onset and sleep-maintenance

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15
Q

What are important PKPD characteristics of eszopiclone (Lunesta)? (2)

A

duration 6-9 hours, CYP3A4 substrate

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16
Q

What are adverse effects of eszopiclone (Lunesta)?

A

HA, dysgeusia, anxiety, xerostomia, infection

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17
Q

What is the indication for zaleplon (Sonata)?

A

short-term insomnia

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18
Q

What does zaleplon (Sonata) not help with?

A

nighttime awakening

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19
Q

What are important PKPD characteristics of zaleplon (Sonata)? (2)

A

duration 3-4 hours, CYP3A4 substrate

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20
Q

What is the indication for zolpidem?

A

sleep-onset and sleep-maintenance

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21
Q

What is the dosing for sleep-onset zolpidem (Intermezzo)?

A

take if more than 4 hours remain before waking and trouble returning to sleep

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22
Q

What is the dosing for sleep-maintenance zolpidem (Edluar)?

A

take immediately before bedtime with 7-8 hours of planned sleep before waking

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23
Q

Which Ambien formulation is for sleep-onset only?

A

Ambien IR (NOT CR)

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24
Q

What is the indication for DORAs?

A

sleep-onset and sleep-maintenance

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25
Q

In what medical condition are DORAs contraindicated?

A

narcolepsy

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26
Q

What are important PKPD characteristics of suvorexant (Belsomra)? (3)

A

onset < 30 minutes, t1/2 = 12 hrs, CYP3A4 interactions

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27
Q

What are adverse effects of suvorexant (Belsomra)? (3)

A

sleep paralysis, abnormal dreams, HA

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28
Q

What are important PKPD characteristics of lemborexant (DayVigo)? (4)

A

onset < 30 minutes, t1/2 = 17-19 hrs, CYP3A4 interactions, CNS depression may persist several days after discontinuation

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29
Q

What are adverse effects of lemborexant (DayVigo)? (3)

A

complex sleep behaviors, abnormal dreams, HA

30
Q

What are important PKPD characteristics of daridorexant (Quviviq)? (4)

A

onset < 30 minutes, t1/2 = 8 hrs, CYP3A4 interactions, onset delayed if taken with food

31
Q

What is the MOA of ramelteon (Rozerem)?

A

melatonin receptor agonist

32
Q

What is the indication for ramelteon (Rozerem)?

A

sleep-onset only

33
Q

What are contraindications for ramelteon (Rozerem)? (1)

A

fluvoxamine use

34
Q

What are two interesting points about ramelteon (Rozerem)?

A

not as effective in patients with BZDRAs, not controlled

35
Q

What is the MOA of doxepin?

A

TCA

36
Q

What is the indication for doxepin?

A

sleep-maintenance only

37
Q

What is the dosing for doxepin?

A

3-6 mg/d

38
Q

What is an important counseling point for doxepin?

A

Do not take within 3 hours of a meal

39
Q

When should melatonin be avoided? (2)

A

patients with autoimmune conditions or Alzheimer’s disease

40
Q

What are important points regarding first-generation antihistamines? (3)

A

avoid in older adults, tolerance develops quickly, anticholinergic side effects

41
Q

What is an off-label treatment for patients with a history of substance abuse?

A

trazodone

42
Q

What are other off-label insomnia therapies? (3)

A

amitryptiline, mirtazapine, gabapentin

43
Q

What medications can elderly use? (4)

A

ramelteon, doxepin, eszopiclone, zolpidem

44
Q

What medications can pregnant women use? (3)

A

diphenhydramine, doxylamine, doxepin

45
Q

What are the treatments for obstructive sleep apnea? (4)

A

behavior modifications, PAP, avoid CNS depressants, medications

46
Q

What are contraindications for modafinil (Provigil) and armodafinil (Nuvigil)? (2)

A

pregnancy, cardiovascular disease

47
Q

What are adverse effects of modafinil (Provigil) and armodafinil (Nuvigil)? (4)

A

HA, mania, cardiovascular symptoms, SJS

48
Q

What is the MOA of modafinil (Provigil)?

A

unknown

49
Q

What is the MOA of armodafinil (Nuvigil)?

A

unknown

50
Q

What is the MOA of solriamfetol (Sunosi)?

A

DA and NE reuptake inhibitor

51
Q

What are contraindications for solriamfetol (Sunosi)? (2)

A

use of MAOI, cardiovascular disease

52
Q

What is the MOA for pitolisant (Wakix)?

A

histamine-3 receptor antagonist

53
Q

What are adverse effects of pitolisant (Wakix)? (2)

A

HA, QTc prolongation

54
Q

What obstructive sleep apnea medications must be administered in the morning? (4)

A

armodafinil, modafinil, pitolisant, solriamfetol

55
Q

What are the treatments for narcolepsy? (3)

A

behavior modifications, avoid CND depressants, medications

56
Q

What is the indication for sodium oxybate (Xyrem)?

A

cataplexy and excessive daytime sleepiness

57
Q

What are BBWs for sodium oxybate (Xyrem)? (3)

A

CNS depression, abuse (REMS), restricted access

58
Q

How is sodium oxybate (Xyrem) dosed?

A

at bedtime on empty stomach, then again 2.5-4 hours later

59
Q

How is sodium oxybate (Lumryz) different?

A

single dose suspension

60
Q

How is sodium oxybate (Xywav) different?

A

contains other cation salts

61
Q

What are REM-suppressing drugs used for cataplexy? (4)

A

venlafaxine, fluoxetine, duloxetine, clomipramine

62
Q

What can abrupt withdrawal of REM-suppressing drugs cause?

A

status cataplecticus

63
Q

What are medications that treat both cataplexy and excessive daytime sleepiness? (2)

A

pitolisant and sodium oxybate

64
Q

What are treatments for jet lag disorder? (3)

A

melatonin, ramelteon, z-drugs

65
Q

What are non-pharm treatments for shift work disorder? (3)

A

sleep hygiene, exposure to bright lights at night and darkness during day, CBT-I

66
Q

What are pharm treatments for shift work disorder? (5)

A

melatonin, ramelteon, suvorexant, z-drugs, modafinil/armodafinil

67
Q

What are non-pharm causes of RLS? (4)

A

nutrition (iron, vitamin B, folate, caffeine, alcohol, weight loss), smoking, exercise, sleep

68
Q

What are medications that can cause RLS? (4)

A

centrally-acting (1st gen) antihistamines, antidepressants (NOT BUPROPION), antipsychotics, anti-nausea drugs that block dopamine

69
Q

What are treatments for intermittent symptoms of RLS? (2)

A

caribodopa-levodopa, BZDRAs (clonazepam)

70
Q

What are treatments for chronic and persistent symptoms of RLS? (2)

A

alpha-2-delta calcium channel ligands (pregabalin, gabapentin encarbil (Horizant)), dopamine agonists (pramipexole, ropinirole, rotigotine)

PHM701 (14 decks)

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