Pharmacotherapy of Sleep disorders

Question 1

Sleep onset only

Answer 1

zolpidem, zaleplon, eszopiclone
Ramelteon
Triazolam

Question 2

Sleep maintenance only

Answer 2

zolpidem, eszopiclone
doxepin
suvorexant

Question 3

Sleep onset and maintenance

Answer 3

zolpidem, eszopiclone
temazepam

Question 4

Narcolepsy tetrad symptoms

Answer 4

1. EDS
2. cataplexy
3. hallucinations
4. sleep paralysis

Question 5

Cataplexy treatment

Answer 5

1. Sodium Oxybate, GHB (Xyrem)–> high sodium content
2. Xywav–>low sodium content
   - adults/children 7 years or older narcolepsy and idiopathic hypersomnia
3. Lumyrz–> high sodium content
   -adult narcolepsy
   -once daily dosing at night ER dosage form
   -Boxed warning: respiratory depression/misuse

Question 6

EDS

Answer 6

Solriamfetol

MOA: blocks NET and DAT

Moderate renal impairment: start 37.5 mg increase to 75 mg after 7 days

Severe renal impairment: start/max 37.5 mg

Warnings: BP and HR increase, avoid unstable CV and arrhythmias, caution in bipolar and psychosis, caution with dopaminergic agents