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Clinical Pharmacology > Hypnotics/ADHD > Flashcards

Hypnotics/ADHD Flashcards

1
Q

FDA approved sleep aid medication, takes forever to work and lasts forever (like Slak). It should be avoided in elderly patients.

A

Diphenhydramine

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2
Q

What are the major ADRs associated w/diphenhydramine?

A
  • anticholinergic effects
  • next day impairment
  • large doses = hallucinogenic effect
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3
Q

What medication is beneficial for sleep maintenance but must be avoided in pt w/CVD?

A

Doxepin (TCA)

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4
Q

When should you consider BZDs for sleep? Which has the quickest onset?

A

Last resort!

Quickest onset: Triazolam

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5
Q

Anterograde amnesia and complex sleep related behaviors are an adverse drug reaction from what class of meds?

A

BZDs and NBRAs

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6
Q

Which class of medications is approved for short term use for both sleep onset and sleep maintenance, but has minimal efficacy?

A

NBRAs

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7
Q

List the 3 NBRAs

A

Zaleplon
Zolpidem
Eszopiclone

“z drugs”

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8
Q

Which class of meds require a lower dose for the elderly and women and are also on the Beer’s list?

A

NBRAs

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9
Q

Which NBRA commonly has a metallic aftertaste?

A

Eszopiclone

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10
Q

What is the benefit of NBRAs over BZDs?

A

less tolerance, dependence, withdrawal, abuse

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11
Q

Melatonin is best for treating which type of sleep issues?

A

Sleep latency (falling asleep)

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12
Q

Which medication is used for the treatment of non-24hr sleep wake disorder?

A

Tasimelteon

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13
Q

What are the 2 orexin receptor antagonists used to treat sleep latency +/- sleep maintenance?

A
  • suvorexant

- lemborexant

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14
Q

In general, ADs, 2nd gen antipsychotics, and AEDs/neuropathic analgesics should only be used to treat insomnia if _____.

A

they are already being taken to treat an underlying comorbid disease

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15
Q

What is the 1st and 2nd step for treatment of insomnia?

A
  1. Nonpharm (CBT)
  2. Pharm - if necessary.
    - start low and go slow
    - 4-5x higher mortality in pt on rx drug for sleep
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16
Q

Ritalin generic

A

Methylphenidate

17
Q

Adderall generic

A

Amphetamine-dextroamphetamine

18
Q

Vyvanse generic

A

Lisdexamphetamine

19
Q

Which 3 drugs do stimulants typically interact with?

A
  1. anti-HTN meds
  2. MAOI, linezolid
  3. sympathomimetics, caffeine
20
Q

You recently started your patient on methylphenidate for their ADHD. What do you need to warn the patient/family about regarding potential ADRs?

A
  • **anorexia, wt loss, appetite disturbance
  • sleep disturbance
  • feeling zombie-like, less spontaneous
21
Q

The methylphenidate you prescribed is causing too many issues for your patient and you want to take them off. What do you do?

A

TAPER - important with all stimulants

22
Q

What monitoring is important for patients who are on stimulants?

A

BP/Pulse
Growth rate in children

Also

  • s/s of depression, aggression, hostility
  • signs of CNS stimulation
23
Q

Your patient has been diagnosed with ADHD and while doing a thorough family hx, they mention a Fhx of Tourettes. What meds should you avoid?

A

Stimulants

24
Q

What are 3 non stimulants for ADHD?

A
  1. Atomoxetine (SNRI)
  2. Guanfacine
  3. Clonidine
25
Q

What drugs should you avoid for patients with atomoxetine?

A

MAOI

Linezolid

26
Q

Which ADHD med has a BBW?

A

Atomoxetine (SNRI) - suicidal ideation

27
Q

Which 2 meds for ADHD have interactions with anti-HTN & vasodilators AND additive sedations w/other CNS depressants?

A

Guanfacine

Clonidine

28
Q

What is the major side effect of Guanfacine?

A

somnolence

hypotension

29
Q

What is the major side effect of clonidine?

A

sedation

other: irritability, emotional flattening, depression, insomnia, nightmares, withdrawal syndrome

30
Q

Which non stimulants must be tapered over 1-2wk?

A

Guanfacine

Clonidine

31
Q

What are the short acting simulants?

A
  1. Methylphenidate - Ritalin
  2. Dexmethylphenidate - Focalin
  3. Dextroamphetamine - Dexadrine
  4. Amphetamine-Dextroamphetamine - Adderall
32
Q

What are the intermediate acting stimulants?

A
  1. Methylphenidate - Ritalin (swallow whole)

2. Dextroamphetamine - Dexedrine Spansule

33
Q

What are the long acting stimulants?

A
  1. Methylphenidate - Ritalin or Concerta
  2. Dexmethylphenidate - Focalin
  3. Amphetamine-Dextroamphetamine - Adderall
  4. Lisdexamphetamine - Vyvanse
34
Q

Used for difficulty falling asleep

Consider when abuse or dependence is a concern, for elderly pt prone to falls or CNS effects, for travelers, or for pt with chronic insomnia

A

Ramelteon

Clinical Pharmacology (54 decks)

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