Final Exam (Sleep)

Question 1

Which of the following statements is/are FALSE:

A. Decrease in DA promotes sleep
B. Decreases in 5-HT reduces sleep
C. Sleep disorders can be diagnosed after one overnight session at a sleep lab
D. GABA is one NT that mediates NREM sleep
E. Concomitant psychiatric disorders are common in patients with insomnia disorder

Answer 1

C. Requires a minimum of 1 month before a sleep disorder can be diagnosed

Question 2

Which of the following statements is TRUE:

I. REM sleep is turned on by cholinergic stimulation
II. Acetylcholine promotes wakefulness
III. NE promotes wakefulness

A. I only
B. I & II
C. III only
D. I, II, & III

Answer 2

D. I, II, & III are all true

Question 3

All of the following are approved for insomnia Tx, EXCEPT:

A. Restoril®
B. Sonata®
C. Provigil®
D. Zolpidem
E. Benadryl®

Answer 3

C. Modafinil (Provigil®) is the DOC for excessive daytime sleepiness from narcolepsy. It is a CNS stimulant and NOT indicated for insomnia

temazepam (Restoril®)
zaleplon (Sonata®)
zolpidem (Ambien®)

Question 4

All of the following are characteristics of temazepam, EXCEPT:

A. Will have carry over sedation based on its long T1/2
B. Tell patients to avoid EtOH
C. Can cause anterograde amnesia
D. May cause priapism
E. C & D

Answer 4

D. temazepam is NOT known to cause priapism. However, this is a SE of trazodone.

temazepam (Restoril®) has a T1/2 of 15 hrs and will have some carry over sedation

Question 5

Restoril® should be avoided in which of the following:

I. pregnancy
II. narrow-angle glaucoma
III. Hx of substance abuse

A. I only
B. I & II
C. III only
D. I, II, & III

Answer 5

D. I, II, and II are correct

Question 6

List the brand name for each generic:

1. eszopiclone
2. zaleplon
3. zolpidem

Answer 6

1. eszopiclone (Lunesta®)
2. zaleplon (Sonata®)
3. zolpidem (Ambien®, Intermezzo®)

Question 7

What is the DOC for excessive daytime sleepiness from narcolepsy?

Answer 7

Modafinil (Provigil®)

Question 8

What are the most effective therapies for cataplexy?

Answer 8

TCAs, venlafaxine, and fluoxetine

Question 9

What is the only drug that treats the entire tetrad of Sx associated with narcolepsy?

Answer 9

Sodium oxybate (Xyrem®)

Question 10

What is the DOC for treating obstructive sleep apnea?

Answer 10

Trick question, there are no drugs used to treat obstructive sleep apnea…just avoidance of certain drugs that worsen sleep.

Question 11

What class of drugs is 1st line treatment for restless leg syndrome?

Answer 11

DA-agonists

Pramipexole, Ropinerole, Rotigotine (least incidence of augmentation i.e. worsening RLS)

Question 12

What is Horizant® used for?

Answer 12

Horizant® is a different form of Gabapentin and used as 2nd line treatment for RLS.