L? Sleep disorders Ott Flashcards
diagnostic criteria of insomnia:
how often?
how long?
at least 3 nights per week for 3 months
what is the only benzo that ott says is used even though they all “can be”
temazepam
first line tx of insomnia disorders
sleep hygiene principles
Most commonly used sleep meds?
z-hypnotics
(zolpidem, eszopiclone, zaleplon)
What is the initial dose of zolpidem in women and elderly?
5 mg (lower)
which z-hypno is FDA approved for long term use
eszopiclone
which z-hypno leaves pts complaining of metallic taste
eszopiclone
T or F: all 3 z-hypnos are CYP2D6 substrates
false, 3A4
4 side effects of z-hypnos
somnolence
dizziness
ataxia
headaches
what is a warning on all z-hypnos?
parasomnias - unusual actions while someone is sleeping
T or F: All but 1 of the z-hypnos is a control
false, they all are
Contraindicated with fluvoxamine
A. Ramelteon
B. Tasimelteon
A. Ramelteon
GI upset, next day somnolence, hyperprolactinemia, prolactinemia
A. Ramelteon
B. Tasimelteon
A. Ramelteon
FDA approved for non-24 sleep-wake disorder in adults
A. Ramelteon
B. Tasimelteon
B. Tasimelteon
1A2 substrate: watch for 1A2 inducers and inhibitors
A. Ramelteon
B. Tasimelteon
both
what do the 3 orexin receptor antagonists end with
- orexant
aim for at least 7 hours of sleep after taking
A. Suvorexant
B. Lemborexant
C. Daridorexant
all
contraindicated in narcolepsy bc of narcolepsy-like side effects
A. Suvorexant
B. Lemborexant
C. Daridorexant
all
3A4 substrate
A. Suvorexant
B. Lemborexant
C. Daridorexant
all
TCA - low doses exert effects through H1 antagonism
A. Doxepin
B. Trazodone
A. Doxepin
Anticholinergic side effects
A. Doxepin
B. Trazodone
A. Doxepin
Not FDA-approved for insomnia
A. Doxepin
B. Trazodone
B. Trazodone
Long half-life, may see daytime hangover
A. Doxepin
B. Trazodone
B. Trazodone
used as sleep agent especially in pts w/ depression
A. Mirtazapine
B. Quetiapine
A. Mirtazapine
low dose not recommended in insomnia unless there is a co-morbid psych disorder
A. Mirtazapine
B. Quetiapine
B. Quetiapine
Not recommended by AASM
A. bendaryl/doxylamine
B. Melatonin
C. Valerian
D. Chamomile
A
Anticholinergic side effects
A. bendaryl/doxylamine
B. Melatonin
C. Valerian
D. Chamomile
A
Can be considered in jet lag
A. bendaryl/doxylamine
B. Melatonin
C. Valerian
D. Chamomile
B
1A2 substrate
A. bendaryl/doxylamine
B. Melatonin
C. Valerian
D. Chamomile
B
contains a BZD-like compound
A. bendaryl/doxylamine
B. Melatonin
C. Valerian
D. Chamomile
D
allergic reactions in pts w/ daisy or ragweed allergies
A. bendaryl/doxylamine
B. Melatonin
C. Valerian
D. Chamomile
D
AASM 1st line therapy
CBT and behavioral therapies
diagnostic criteria of obstructive sleep apnea
at least 5 obstructive apneas per hour of sleep confirmed by polysomnography
T or F: clinically, there is greater recognition that many pts have apnea and insomnia
true
T or F: if a pt has apnea and insomnia, treat insomnia first
false, apnea first
at least 1 of 6 things needs to be present for use of a polysomnography in obstructive sleep apnea, what are they?
- cardiorespiratory disease
- muscle weakness due to neuro-muscular condition
- sleep-related hypoventilation
- chronic opioid use
- stroke
- severe insomnia
What is the first non-pharm option you should consider in the tx of sleep apnea?
weight loss
T or F: Sleeping on stomach rather than back will help sleep apneas
False, sleep on side
what tf is CPAP?
continuous positive airway pressure
what two drugs can treat excessive daytime sleepiness in sleep apnea (maybe others too idk)
modafinil and armodafinil
what 3 things are included in the narcolepsy triad?
EDS
hallucinations
Sleep paralysis
100% of pts
A. EDS
B. Cataplexy
C. Hallucinations
D. Sleep paralysis
E. All four sxs
A
75% of pts
A. EDS
B. Cataplexy
C. Hallucinations
D. Sleep paralysis
E. All four sxs
B
30-60% of pts
A. EDS
B. Cataplexy
C. Hallucinations
D. Sleep paralysis
E. All four sxs
C
25-50% of pts
A. EDS
B. Cataplexy
C. Hallucinations
D. Sleep paralysis
E. All four sxs
D
10-33% of pts
A. EDS
B. Cataplexy
C. Hallucinations
D. Sleep paralysis
E. All four sxs
E
what do the following drugs treat? Sodium oxybate, Xywav, Lumryz
cataplexy in narcolepsy
What do the following drugs treat?
Modafinil/armodafinil, sodium oxybate, pitolisant, solfriamfetol
EDS in narcolepsy
For adults and children >7
A. Xywav
B. Lumryz
A
for adults only
A. Xywav
B. Lumryz
B
Approved for idiopathic hypersomnia in adults
A. Xywav
B. Lumryz
A
ER dosage form, once nightly dosing
A. Xywav
B. Lumryz
B
High sodium content
A. Xywav
B. Lumryz
C. Sodium oxybate
B and C
low sodium content
A. Xywav
B. Lumryz
C. Sodium oxybate
A
Associated with possible life-threatening rash
A. Xywav
B. Lumryz
C. Sodium Oxybate
D. Modafinil
E. Armodafinil
D and E
Avoid use with centrally-acting H1 receptor antagonists (OTC antihistamines)
A. Pitolisant
B. Sodium Oxybate
C. Solriamfetol
D. Modafinil
A
Contraindicated in severe hepatic impairment
A. Pitolisant
B. Sodium Oxybate
C. Solriamfetol
D. Modafinil
A
H3 receptor antagonist/ inverse agonist
A. Pitolisant
B. Sodium Oxybate
C. Solriamfetol
D. Modafinil
A
go look more at the solriamfetol and pitolisant slides
okay
Drugs of choice for shift work sleep disorder
modafinil and armodafinil
when should you take modafinil and armodafinil for shift work sleep disorder?
1 hour before the. work period starts during “wake time”
drug of choice for restless leg syndrome
gabapentin enacarbil (prodrug of gabapentin)
What kind of supplementation may be considered in restless leg syndrome
iron
which two IR formulation dopamine agonists can be used in restless leg syndrome
pramipexole or ropinirole
