Sleep Disorders Flashcards
BH is a 46 y/o female who’s been using eszopiclone for sleep. Her spouse complains that she’s eaten all of his leftover birthday cake. She doesn’t recall doing so, although a plate with cake crumbs was found in the kitchen a few mornings in a row. What side effect of eszopiclone is BH experiencing?
a. Increased appetite
b. Somnolence
c. Paresthesia
d. Anxiety
e. Parasomnia
e
Which of the following meds can be used for narcolepsy?
a. Methylphenidate
b. Gabapentin
c. Pramipexole
d. Zaleplon
e. Mirtazapine
a
ADHD meds that have indications for narcolepsy:
-Dextroamphetamine (Dexedrine, ProCentra, Zenzedi)
-Dextroamphetamine/amphetamine (Adderall)
-Methylphenidate (Methylin and Ritalin)
Which of the following drug/s increase GABA leading to an inhibitory effect by binding to BZD receptor-subtypes specific for sedation?
a. Ramelteon
b. Zolpidem
c. Eszopiclone
d. Zaleplon
e. Trazodone
f. Suvorexant
b, c, d
This drug class is called hypnotics.
RA is a 44 y/o female that complains of difficulty falling asleep. She says she has tried appropriate sleep hygiene, OTC drugs, and natural products, but they aren’t working. She reports this problem persisting for the past 2 months. Once she falls asleep, she can stay asleep. What is the best drug for RA’s sleep problem?
a. Temazepam
b. Suvorexant
c. Eszopiclone
d. Doxepin
e. Modafanil
c
Eszopiclone and zolpidem can be used to help fall asleep, stay asleep, or both.
Armodafinal (Nuvigil) and modafinil (Provigil) require a MedGuide and careful pharmacist counseling d/t this risk:
a. Severe rash that can be life-threatening
b. Demyelinating disorder, causing nerve paralysis
c. Progressive Multifocal Leukoencephalopathy (PML)
d. Severe abdominal pain with risk of pancreatitis
e. Neuroleptic Malignant Syndrome (NMS)
a
HG is a 61 y/o male pt who’s come in for his routine annual physical. He reports that he’s developed an urge to move his legs when he tries to sleep at night, and the only way to stop it is to get up and move. If he stops moving, the feeling comes back. HG states that this has occurred during the day a few times (when he’s resting in his easy-chair), but it almost always happens when he first goes to bed. He describes it as “unpleasant, uncomfortable, and creepy.” Which condition is most likely causing HG’s symptoms?
a. Non-24 hr Sleep-Wake Disorder
b. Insomnia
c. Cataplexy
d. Restless Legs Syndrome
e. Narcolepsy
d
Select the correct mechanism for modafinil:
a. Tricyclic antidepressant
b. Dopamine agonist
c. BZD receptor agonist
d. Melatonin receptor agonist
e. Stimulant
e
Modafinil is a stimulant used to promote wakefulness in people with narcolepsy.
GR, a 33 y/o male, is seen in the clinic for upper respiratory symptoms and mentions he would like something to help him fall asleep. His PMH includes allergies, ADHD, and depression. He currently takes atomoxetine, fluoxetine, Claritin, and Sudafed. He reports 4-5 cups of coffee during the day to stay awake and 3-4 beers each evening to help him fall asleep. Which of the following may be contributing to GR’s sleep problem?
a. Atomoxetine
b. Alcohol
c. Fluoxetine
d. Caffeine
e. Claritin
f. Sudafed
a, b, c, d, f
Drugs that can worsen insomnia:
-Acetylcholinesterase inhibitors (e.g., donepezil)
-Alcohol
-Antiretrovirals (e.g., emtricitabine, INSTIs)
-Aripiprazole
-Atomoxetine
-Bupropion
-Caffeine
-Decongestants (e.g., pseudoephedrine)
-Diuretics (d/t nocturia)
-Fluoxetine (if taken late in the day)
-Steroids
-Stimulants
-Varenicline
JF wishes to purchase OTC diphenhydramine for sleep. The pharmacist notes his PMH includes T2DM, arthritis, glaucoma, HTN, and occasional diarrhea. Which of JF’s medical problems could be exacerbated by diphenhydramine?
a. T2DM
b. Arthritis
c. Glaucoma
d. HTN
e. Diarrhea
c
Anticholinergic effects are present with the centrally acting antihistamines, including diphenhydramine. They cause sedation, confusion, dry mouth, urinary retention, dry/blurry vision, and constipation. They may increase IOP in pts with glaucoma.
A pharmacist will instruct a medical resident about writing an Rx for zolpidem. Which of the following are correct formulations for zolpidem?
a. IR and CR tablet
b. Oral spray
c. SL tablet
d. Nasal spray
e. Subcutaneous injection
a, b, c
Select the drug class used most commonly to treat restless leg syndrome (RLS).
a. Stimulants
b. Melatonin receptor agonists
c. Dopamine agonists
d. Dopamine antagonists
e. Benzodiazepines
c
A pt arrives at the pharmacy with an Rx for pramipexole for new-onset restless leg syndrome (RLS). How should the pt be counseled to take this med?
a. Take 1-3 hrs before bedtime
b. Take TID
c. Take 1st thing in the morning
d. Take once weekly
e. Take PRN for symptoms in the middle of the night
a
For RLS, pramipexole and ropinirole should be taken in the IR form 1-3 hrs before bedtime.
EC is a 55 y/o female who has been prescribed Ambien for sleep. She has 1 or 2 glasses of wine at dinner almost daily, and she currently takes lisinopril, ibuprofen, and a calcium/vit D supplement daily. Using Ambien with alcohol increases EC’s risk of which side effect?
a. Life-threatening rash
b. Hypercalcemia
c. CNS depression
d. Glaucoma
e. Urinary retention
c
Zolpidem (and other hypnotics) can cause CNS depression, somnolence, dizziness, and ataxia, which can be exacerbated by alcohol or other CNS depressants. Alcohol should be avoided.
