Neuro/MH

Question 1

Five most
common
medications likely
to disrupt sleep

Answer 1

1. Levodopa
2. Prednisone
3. Venlafaxine
4. Fluvoxamine
5. Rotigotine

Question 2

Initial treatment for chronic insomnia

Answer 2

CBT-I is recommended as the initial treatment for chronic insomnia2,3,4,5

Question 3

Benzodiazipines in elderly. Which are safe for insomnia?

Answer 3

Avoid in the elderly due to risk of cognitive and behavioural adverse effects, falls and fractures
Flurazepam, oxazepam, triazolam are indicated for primary insomnia, but are not recommended2

Question 4

Treatment of insomnia duration with pharmacotherapy

Answer 4

1-2 weeks

Question 5

Evidence suggests that
pharmacotherapy should be used no
longer than _____ due to the risk of
dependence and tolerance

Answer 5

1 month

Question 6

Doxepin SE

Answer 6

• A/E: anticholinergic side effects with higher doses• A/E: anticholinergic side effects with higher doses

Question 7

Safest and best studied medication for insomnia for older adults and dosing

Answer 7

Doxepin 3-6 mg

Question 8

Sedative hypnotics can increase total

sleep time by ______

Answer 8

25 minutes

Question 9

Average adult > 60 years only requires ___ hours of sleep

Answer 9

6

Question 10

Sedative hypnotics can decrease sleep

latency by _____

Answer 10

10 minutes

Question 11

General approach to tapering, follow up interval

Answer 11

1-4 weeks

Question 12

Avoid benzodiazipines and Z drugs in older adult for which common adverse effects (BEERS)

Answer 12

Falls, fractures, change in cognition, delirium, MVC (increased hospitalizations with Z drugs)

Question 13

Which 4 classes of medications should be avoided in dementia/cognitive impairment? (BEERS)

Answer 13

Antipsychotics
Anticholinergics
Benzos
Z drugs

Question 14

Which class of medications is associated with higher risk of CVA and mortality with persons with dementia?

Answer 14

Antipsychotics

Question 15

What duration of therapy should be ordered for cyclobenzaprine for appropriate head/neck pain?

Answer 15

No longer than 2 weeks

Question 16

First line treatment for migraine

Answer 16

NSAID

Question 17

1st line prophylactic medication for migraine

Answer 17

BB

TCA

Question 18

1st line prophylaxis for TTH

Answer 18

TCA

Question 19

1st line prophylactic for cluster headache

Answer 19

Verapamil/CCB

Question 20

1st line treatment for acute cluster headache

Answer 20

Sumatriptan or 02

Question 21

Must be off opioids for >/ ___ days before starting naltrexone

Answer 21

7 days

Question 22

Monitoring for naltrexone

Answer 22

LFT 1, 3, 6 months

Question 23

SE of naltrexone

Answer 23

dizziness, nausea, headache, vomiting

Question 24

Starting dose naltrexone

Answer 24

12.5mg BID x 3 days then increase to 50 mg

Question 25

Do you need to abstain from drinking before starting naltrexone?

Answer 25

No

Question 26

Duration of naltrexone use?

Answer 26

12 week up to 6 months

Question 27

PAWSS threshold for inpatient managmenet

Answer 27

PAWSS Scores ≥4 were 93.1% sensitive and 99.5% specific for development of complicated AWS in prospective validation

Question 28

Acamprosate class and indication for use

Answer 28

NMDA antagonist, most effective for abstinence maintenance