NERVOUS SYSTEM - SLEEP DISORDERS + SUBSTANCE DEPENDENCE

Question 1

What is insomnia?

Answer 1

Sleeping problem

Question 2

List 4 symptoms of insomina?

Answer 2

difficulty sleeping

difficulty staying asleep

early morning awaking

poor sleep quality

Question 3

What is transient insomnia caused by?

Answer 3

Environmental factors (use 1-2 doses of short-acting hypnotic - midazolam)

e.g. jet lag

Question 4

What is short-term insomnia caused by?

Answer 4

Emotional or serious illness

Question 5

How to treat short-term insomnia?

Answer 5

Use short-term hypnotic intermittent (use for <3 weeks)

Question 6

What is chronic insomnia caused by?

Answer 6

Psychiatric or physical illness- treat the underlying cause.

Question 7

List the 3 types of insomnia?

Answer 7

Transient

Short-term

Chronic

Question 8

What 2 classes of drugs are given for insomnia?

Answer 8

Z drugs

Benzodiazepines

Question 9

List 2 Z drugs used in insomnia?

Answer 9

Zopiclone

Zolpidem

Question 10

What drug schedule are Z drugs?

Answer 10

CD4 part 1

Question 11

List Benzos used in insomnia? (8)

Answer 11

Nitrazepam

Flurazepam

Diazepam

Temazepam

Lorazepam

Loprazolam

Lormetazepam

Oxazepam

Question 12

Are zopiclone + zolpidem short or long acting?

Answer 12

Short acting

Question 13

What Z drug causes taste disturbances

Answer 13

Zopiclone

Question 14

What Z drug causes GI disturbances?

Answer 14

Zolpidem

Question 15

What is 1 counselling point to tell the patient regarding zolpidem and driving?

Answer 15

Drowsiness may still persist the next day - leave 8 hours before driving.

Question 16

What Benzo is commonly used in dental procedures + preferred?

Answer 16

Diazepam

Lorazepam

Temazepam - preferred

Question 17

What 2 benzos help with insomnia linked to anxiety?

Answer 17

Lorazepam

Oxazepam

Question 18

What 2 Z drugs are short-acting?

Answer 18

Zopiclone + Zolpidem

Question 19

Who should benzos + Z drugs be avoided in?

Answer 19

Elderly - risk of falls

Question 20

What is MOA of Z drugs?

Answer 20

Acts on benzodiazepine sites on GABA receptors + increases GABA binding.

Question 21

What is indication of Z drugs?

Answer 21

Severe insomnia -SHORT TERM

Question 22

What 3 benzos are long acting?

Answer 22

Diazepam

Flurazepam

Nitrazepam

Question 23

What 5 benzos are SHORT acting?

Answer 23

Temazepam

Lorazepam

Loprazolam

Lormetazepam

Oxazepam

Question 24

What effect is more prominent in long-acting benzodiazepines?

Answer 24

Hangover effect

Anxiolytic effect during day (diazepam single dose at night).

Question 25

What are 3 SEs of Z -drugs?

Answer 25

Daytime sleepiness Respiratory depression Dependence + tolerance

Question 26

What does label say for Z-drugs?

Answer 26

this medicine makes you feel sleepy. If you still feel sleepy the next day, do not drive or use tools/ machines. Do not drink alcohol.

Question 27

What can happen if a benzo is given with opioid?

Answer 27

CNS depression effect- monitor when starting, new dose

Question 28

If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, when to monitor methadone?

Answer 28

2 weeks of initiation as CNS depression effect delayed

Question 29

What other patient counselling should be given regarding respiratory depression?

Answer 29

Report signs of slow and shallow breathing, sedation + blue lips

Question 30

What are some cautions surrounding dependence on Z drugs?

Answer 30

Substance misuse + MH disorder

Question 31

What class drugs can interact with Z drugs + increase CNS depression / sedation?

Answer 31

-Alcohol, opioids, sedating antihistamines, Antipsychotics, Benzos, (CNS depressant) -Azole antifungals, Macrolides, Diltiazem + verapamil (enzyme inhibitors)

Question 32

What drug types/enzyme ---- can interact with Z drugs to increase CNS depression?

Answer 32

CNS depressants Enzyme inhibitors - increase toxicity of Z drug = sedation

Question 33

What is narcolepsy?

Answer 33

Excessive sleepiness in the daytime + may also suddenly fall asleep during any activity.

Question 34

What is 1st line management of narcolepsy?

Answer 34

Modafinil

Question 35

What is alcoholism?

Answer 35

Strong, uncontrollable desire to drink.

Question 36

What are 2 1st line drug treatments for alcohol withdrawal symptoms?

Answer 36

Chlordiazepoxide OR Diazepam

Question 37

What drug can help alcohol with-drawal patient with seizures?

Answer 37

Lorazepam

Question 38

What drug can help alcohol withdrawal patient with delirium tremens?

Answer 38

Oral lorazepam

Question 39

What drug can help alcohol with-drawal patient with persistant delirium tremens OR if declines?

Answer 39

Parenteral Lorazepam OR Haloperidol

Question 40

What is 1st line treatment for alcohol dependence?

Answer 40

Acamprostate OR naltexone + psychological therapy

Question 41

What drug is used to reduce the alcohol consumption in patient with alcohol dependence with high risk of drinking ?

Answer 41

Nalmefene

Question 42

What drug is used to help treat Wernicke's Encephalopathy?

Answer 42

Thiamine

Question 43

What is nicotine dependence?

Answer 43

Nicotine which is present in tobacco is addictive and smoking causes lung cancer + COPD.

Question 44

What is the most effective approach in stopping smoking?

Answer 44

Abrupt quiting Cessation aids + behavioural support

Question 45

What are 2 drug treatments to help stop smoking?

Answer 45

Varenicline Long + short acting NRT.

Question 46

What are examples of short acting NRT?

Answer 46

Gum, Lozenge, Nasal + oral spray, sublingual tablet, inhalator. (helps with urge to smoke + prevent cravings).

Question 47

What are examples of long acting NRT?

Answer 47

patch - for strong cravings on waking

Question 48

What are 2 durations of the patch?

Answer 48

16 hours 24 hours

Question 49

What is an SNRI drug which is also used for smoking cessation?

Answer 49

Bupropion

Question 50

What is an MHRA warning regarding the use of bupropion and serotonergic drugs?

Answer 50

Increased risk of serotonin syndrome

Question 51

What patient counselling can be given to the SNRI Bupropion?

Answer 51

Report any worsening of depression, suicidal behaviour.

Question 52

What 2 drugs are given for opioid dependence?

Answer 52

Methadone Buprenorphine

Question 53

What is frequency of dose for opioid dependence drugs?

Answer 53

OD

Question 54

What is a SE of methadone?

Answer 54

QT prolongation

Question 55

What is a SE of buprenorphine?

Answer 55

Precipitates withdrawal - take 1st dose on withdrawal signs.

Question 56

describe half life of methadone?

Answer 56

Long half life

Question 57

What is more sedating; methadone or buprenoprhine?

Answer 57

Methadone

Question 58

What to do if they miss 3 days of methadone?

Answer 58

Cannot give- overdose risk

Question 59

What to do if they miss 5 days of methadone?

Answer 59

risk of misuse - cannot give.

Question 60

Which opioid dependence drug has a lower risk of overdose?

Answer 60

Buprenorphine

Question 61

What 3 conditions to avoid varenicline in ?

Answer 61

CVD Epilepsy Psychiatric illness

Question 62

What 3 conditions to avoid bupropion in?

Answer 62

Eating disorders seizures psychiatric illness

Question 63

What NRT to use if pregnant?

Answer 63

16 hour patch if pregnant or nightmares + short term reliever - e.g. gum, lozenges

Question 64

What is max supply for opioid dependance treatment?

Answer 64

14 days - FP10MDA FORM

Question 65

How many missed does of methadone means refer back?

Answer 65

3 or more missed doses

Question 66

Can treatment for opioid dependence carry on when pregnant?

Answer 66

YES