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Behavioral Health > Sleep Disorder Treatment > Flashcards

Sleep Disorder Treatment Flashcards

1
Q

Goals of Therapy

A

Promote patient’s ability to fall sleep, maintain sleep, & awaken refreshed
Meds as short a time as possible
Use minimal dose with least amount of SE

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2
Q

Types of Benzodiazepines

A 
Alprazolam (Xanax)
Estazolam (ProSom)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)
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3
Q

MOA of Benzodiazepines

A

Facilitate the effects of GABA in the ascending reticular activating system

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4
Q

Examples of Short Acting Benzodiazepines

A

Triazolam (Halcion)

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5
Q

What are short acting benzodiazepines used for?

A

Difficulty falling asleep

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6
Q

Examples of Intermediate Acting Benzodiazepines

A

Temazepam (Restoril)

Estazolam (ProSom)

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7
Q

What are intermediate acting benzodiazepines used for?

A

Trouble maintaining or staying asleep

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8
Q

Examples of Long Acting Benzodiazepines

A

Flurazepam (Dalmane)

Quazepam (Doral)

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9
Q

What are long acting benzodiazepines used for?

A

Trouble falling asleep

Maintaining sleep

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10
Q

Benzodiazepine SE

A 
Drowsiness
Impaired motor function
Prolonged use can lead to physical dependency
Confusion
Shakiness
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11
Q

Interactions with Benzodiazepines

A

Alcohol

Low-dose contraceptives: benzo’s not cleared as quickly

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12
Q

Contraindications of Benzodiazepines

A

Acute narrow-angle glaucoma
Pregnancy
Lactation

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13
Q

What were benzodiazepine receptor agonists developed for?

A

Improve the safety profile of barbiturate-type compounds

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14
Q

Half-life of Benzodiazepine Receptor Agonists

A

5 hours

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15
Q

Examples of Benzodiazepine Receptor Agonists

A

Eszopiclone (Lunesta)
Zolpidem (Ambien)
Zaleplon (Sonata)

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16
Q

MOA of Eszopiclone (Lunesta)

A

Interacts with GABA receptors located near benzodiazepine receptors

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17
Q

What affects the absorption of eszopiclone (Lunesta)?

A

High fat meals

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18
Q

When does eszopiclone (Lunesta) peak?

A

Within 1 hour

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19
Q

What is the half-life of eszopiclone (Lunesta)?

A

5-7 hours

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20
Q

Eszopiclone (Lunesta) SE

A

Headache
Dry mouth
Dizziness
Unpleasant taste in mouth

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21
Q

Contraindications for Eszopiclone (Lunesta)

A

Hypersensitivity

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22
Q

Pregnancy Category of Eszopiclone (Lunesta)

A

Pregnancy C

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23
Q

MOA of Zolpidem (Ambien, Ambien CR)

A

Modulates the GABA receptors to suppress neurons

Sedation & relaxation

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24
Q

Who needs a decreased dose of zolpidem (Ambien, Ambien CR)?

A

Elderly

Women

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25
Q

Half-life of Zolpidem (Ambien, Ambien CR)

A

2.5 hours

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26
Q

Onset of Zolpidem (Ambien, Ambien CR)

A

30 minutes

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27
Q

Duration of Zolpidem (Ambien, Ambien CR)

A

6-8 hours

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28
Q

Zolpidem (Ambien, Ambien CR) SE

A 
Morning drowsiness
Hangover effect
Headache
Dizziness
Nausea
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29
Q

Contraindications of Zolpidem (Ambien, Ambien CR)

A

Hypersensitivity

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30
Q

Pregnancy Category of Zolpidem (Ambien, Ambien CR)

A

Pregnancy C

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31
Q

MOA of Zaleplon (Sonata)

A

Interacts with GABA-BZ omega 1 receptor
Sedation
Relaxation
Anti-convulsant activity

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32
Q

What is the 2nd line for falling asleep?

A

Zaleplon (Sonata)

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33
Q

Duration of Zaleplon (Sonata)

A

5 hours

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34
Q

Onset of Zleplon (Sonata)

A

Within 1 hour

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35
Q

Half-life of Zaleplon (Sonata)

A

1 hour

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36
Q

Zaleplon (Sonata) SE

A 
Back or chest pain
Migraine
Constipation
Dry mouth
Nervousness
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37
Q

Contraindications of Zaleplon (Sonata)

A

Hypersensitivity

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38
Q

Pregnancy Category of Zaleplon (Sonata)

A

Pregnancy C

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39
Q

MOA of Diphenhydramine (Benadryl)

A

Acts as CNS depressant

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40
Q

Contraindications of Diphenhydramine (Benadryl)

A

Hypersensitivity

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41
Q

Pregnancy Category of Diphenhydramine (Benadryl)

A

Pregnancy B

42
Q

Diphenhydramine (Benadryl) SE

A 
Excessive daytime drowsiness
Impaired psychomotor function
Dry mouth
Delirium
Anti-cholinergic effect
Constipation
Urinary retention
43
Q

Examples of Antidepressants Used for Insomnia

A

Imipramine (Tofranil)
Amitriptyline hydrochloride (Elavil)
Nortriptyline (Pamelor)

44
Q

Newer Antidepressant Agents

A 
Neazodone hydrochloride (Serzone)
Venlafaxine (Effexor)
45
Q

MOA of Doxepin (Silenor)

A

Antagonizes histamine receptor

Increases synaptic concentrations of serotonin & norepinephrine in the CNS

46
Q

Doxepin (Silenor) SE

A

Drowsiness
Dizziness
Constipation
Blurred vision

47
Q

How long after eating does one need to wait to take doxepin (Silenor)?

A

3 hours

48
Q

Contraindications of Doxepin (Silenor)

A

Glaucoma
Urinary retention
Constipation

49
Q

Black Box Warning of Doxepin (Silenor)

A

Suicide thinking/behavior

50
Q

Pregnancy Category of Doxepin (Silenor)

A

Pregnancy C

51
Q

MOA of Trazodone

A

Inhibits repute of serotonin
Causes adrenoreceptor subsensitivity
Induces change in 5-HT presynaptic receptor adrenoreceptors
Block histamine receptors

52
Q

Onset of Trazodone

A

1-3 hours

53
Q

Half-life of Trazodone

A

7-9 hours

Longer in obese patients

54
Q

Trazodone SE

A

Dizziness
Drowsiness
Blurred vision
Confusion

55
Q

Contraindications of Trazodone

A

Use of MAOI’s

Patients receiving linezolid or IV methylene blue

56
Q

Pregnancy Category of Trazodone

A

Pregnancy C

57
Q

Black Box Warning for Trazodone

A

Suicidal thoughts

58
Q

MOA Amitriptyline (Elavil)

A

Increases synaptic concentration of serotonin and/or norepinephrine in CNS

59
Q

Half-life of Amitriptyline (Elavil)

A

13-36 hours

60
Q

Amitriptyline (Elavil) SE

A 
Sedation
Dizziness
Headache
Weight gain
Sexual SE
61
Q

Contraindications of Amitriptyline (Elavil)

A

Hx of MI

MAOI’s

62
Q

Pregnancy Category of Amitriptyline (Elavil)

A

Pregnancy C

63
Q

Black Box Warning for Amitriptyline (Elavil)

A

Suicidal thoughts

64
Q

MOA of Ramelteon (Rozerem)

A

Potent, selective agonist of melatonin receptors MT1 & MT2 within the suprachiasmic nucleus of the hypothalamus

65
Q

Half-life of Ramelteon (Rozerem)

A

1-2 hours

66
Q

Ramelteon (Rozerem) SE

A 
Somnolence
Headache
Fatigue
Dizziness
Nausea
67
Q

Contraindications for Ramelteon (Rozerem)

A

Fluvoxamine (Luvox)

68
Q

Pregnancy Category of Ramelteon (Rozerem)

A

Pregnancy C

69
Q

Melatonin Agonist

A

Ramelteon (Rozerem)

70
Q

Orexin Receptor Antagonist

A

Suvorexant (Belsomra)

71
Q

MOA of Suvorexant (Belsomra)

A

Blocks binding of wake-promoting neuropeptides orexin A & orexin B to receptors OZ1R & OX2R
AKA: Blocks wakening of the patient

72
Q

Duration of Suvorexant (Belsomra)

A

7 hours

73
Q

When can you not take Suvorexant (Belsomra)?

A

Immediately after a meal

74
Q

Half-life of Suvorexant (Belsomra)

A

12 hours

75
Q

Onset of Suvorexant (Belsomra)

A

30 minutes

76
Q

Suvorexant (Belsomra) SE

A 
Drowsiness
Headache
Abnormal dreams
Lower extremity weakness
Cough
77
Q

Contraindications of Suvorexant (Belsomra)

A

Narcolepsy

78
Q

Pregnancy Category of Suvorexant (Belsomra)

A

Pregnancy C

79
Q

Medications for Insomnia

A 
Alprazolam (Xanax)
Estazolam (ProSom)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)
Eszopiclone (Lunesta)
Zolpidem (Ambien)
Zaleplon (Sonata)
Imipramine (Tofranil)
Amitriptyline hydrochloride (Elavil)
Nortriptyline (Pamelor)
Nefazodone hydrochloride (Serzone)
Venlafaxine (Effexor)
Doxepin (Silenor)
Trazodone
Ramelteon (Rozerem)
Suvorexant (Belsomra)
80
Q

First Line Narcolepsy Medication

A

Modafinil (Provigil)/Armodafinil (Nuvigil)

81
Q

MOA of Modafinil (Provigil)/Armodafinil (Nuvigil)

A

Not well understood

May increase dopaminergic signaling

82
Q

Modafinil (Provigil)/Armodafinil (Nuvigil) SE

A

Headache
Nausea
Nervousness
Dry mouth

83
Q

Contraindications of Modafinil (Provigil)/Armodafinil (Nuvigil)

A

Hypersensitivity

84
Q

Pregnancy Category Modafinil (Provigil)/Armodafinil (Nuvigil)

A

Pregnancy C

85
Q

Second Line Narcolepsy Medication

A

Dextroamphetamine

86
Q

MOA of Dextroamphetamine

A

Not well understood
Stimulates CNS activity
Blocks reuptake & increases release of norepinephrine & dopamine in extra neuronal space

87
Q

Dextroamphetamine SE

A

HTN
Anorexia
Addiction

88
Q

Pregnancy Category of Dextroamphetamine

A

Pregnancy C

89
Q

Black Box of Dextroamphetamine

A

High abuse potential

Cardiac events

90
Q

Medication for REM Sleep Behavior Disorder

A

Melatonin

91
Q

MOA of Melatonin

A

Prepares the body for sleep

92
Q

Melatonin SE

A

Abnormal heartbeat
Dizziness
Fatigue

93
Q

Medications for Movement Disorders

A 
Carbidopa-levadopa (Sinemet)
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
Gabapentin (Neurontin)
94
Q

Carbidopa-levodopa (Sinemet) SE

A

Sleepiness

GI problems

95
Q

Examples of Dopamine Agonists for Movement Disorders

A

Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)

96
Q

MOA of Dopamine Agonists

A

Stimulating of postsynaptic dopamine D2-type receptors within the caudate putamen in the brain

97
Q

Dopamine Agonist SE

A 
Nausea
Lightheadedness
Stuffiness
Edema
Daytime sleepiness
98
Q

Pregnancy Category of Dopamine Agonists

A

Pregnancy C

99
Q

MOA of Gabapentin (Neurontin)

A

Thought to reduce presynaptic GABA release

100
Q

Gabapentin (Neurontin) SE

A

Fatigue
Dizziness
Blurred vision

101
Q

Pregnancy Category for Gabapentin (Neurontin)

A

Pregnancy C

Behavioral Health (25 decks)

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