Sleep Disorders

Question 1

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Question 2

Insomnia is the most common sleep condition and is characterized by difficulty falling asleep (sleep initiation or sleep latency), reduced sleep duration and/or poor sleep quality.

Question 3

A diagnosis of chronic insomnia occurs when the patient has symptoms at least ________ for at least _____________, despite adequate opportunity to sleep.

Answer 3

3 times per week

3 months

Question 4

________________ for insomnia is preferred and includes changes to sleep hygiene that can reduce the need for drugs.

Answer 4

(CBT) cognitive behavioral therapy

Question 5

It is important to treat any underlying medical condition that may be contributing and discontinue medications that can worsen insomnia.

Question 6

Natural products used for sleep:

Answer 6

melatonin
valerian
Kava - Not recommended due to risk of hepatotoxicity.
chamomile tea - drinking in the evening can help to feel calmer.

Question 7

The American Academy of Sleep Medicine (AASM) guidelines state that the following treatments are NOT recommended for chronic use:

Answer 7

diphenhydramine
melatonin
tiagabine
trazodone
valerian

Question 8

Key Drugs that can worsen insomnia:

Answer 8

• acetylcholinesterase inhibitors
• alcohol
• antiretrovirals
• aripiprazole
• atomoxetine (stimulant)
• bupropion (activating)
• caffeine
• decongestants
• diuretics (due to nocturia)
  -fluoxetine (activating)
• steroids
• stimulants
• varenicline

Question 9

Insomnia
- difficulty with sleep
Sleep initiation/latency: falling asleep
Sleep duration: staying asleep
Sleep quality: awakening after sleep onset

Question 10

Non-drug treatments first:

CBT
Treat other conditions
Stop medications worsening insomnia
Try natural products

Answer 10

• keep the bedroom dark, comfortable, and quiet
• keep to a regular sleep schedule
• avoid daytime naps, even after a poor night of sleep, or limit to 30 mins
• reserve the bedroom for sleep and other appropriate activities (no TV)
• turn the face of the clock aside to minimize anxiety about falling asleep
• Do not eat heavy meals right before bedtime
• do not take caffeine in the afternoon

Question 11

Need Help Falling asleep (Initiation):

Z-drugs or ramelteon
eszopiclone
zolpidem
zaleplon

Answer 11

Need help staying asleep (Duration):

eszopiclone
zolpidem
suvorexant
doxepin

Question 12

EZ TIP for excellent Zzzzzzzzz (sleep): For help falling asleep (Initiation) and staying asleep (Duration):

E
Z

Answer 12

Eszopiclone
Zolpidem

Question 13

Non-benzodiazepines preferred.
Can consider benzodiazepines for short term treatment.
OTC drugs sometimes used.

Question 14

Beers Criteria, benzodiazepines, non-benzodiazepine hypnotics and first-generation antihistamines are considered potentially inappropriate in patients aged 65 years old and older. If benzodiazepines are used (LOT) drugs are preferred in elderly due to the lower risk of adverse reactions.

Answer 14

Lorazepam

Oxazepam

Temazepam

Question 15

Lunesta

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 15

eszopiclone C-IV

Class: Hypnotics

Indications: insomnia

MOA: increase GABA (inhibitory neurotransmitter) at the benzodiazepine receptor. This causes CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
History of complex sleep behavior

Warnings:
Increase risk of CNS depression and next day impairment with < 7-8 hours of sleep (especially with higher doses or coadministration of CNS depressants or alcohol).

Potential for abuse and dependance (can cause withdrawal symptoms if used longer than 2 weeks)

Side Effects:
Somnolence, dizziness, ataxia, headache,
Parasomnias (unusual actions while you are sleeping, which the patient may be unaware of).

Monitoring:

Pearls/Notes:
C-IV
Preferred over benzodiazepines for first line treatment due to decrease abuse, dependence and tolerance.

Do not take with fatty food, a heavy meal or alcohol.

Drug-Drug/Food interactions:

Question 16

Ambien

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 16

zolpidem

Class: Hypnotics

Indications: insomnia

MOA: increase GABA (inhibitory neurotransmitter) at the benzodiazepine receptor. This causes CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
History of complex sleep behavior

Warnings:
Increase risk of CNS depression and next day impairment with < 7-8 hours of sleep (especially with higher doses or coadministration of CNS depressants or alcohol).

Potential for abuse and dependance (can cause withdrawal symptoms if used longer than 2 weeks)

Side Effects:
Somnolence, dizziness, ataxia, headache,
Parasomnias (unusual actions while you are sleeping, which the patient may be unaware of).

Monitoring:

Pearls/Notes:
C-IV
Preferred over benzodiazepines for first line treatment due to decrease abuse, dependence and tolerance.

Do not take with fatty food, a heavy meal or alcohol.

Drug-Drug/Food interactions:

Question 17

Edluar

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 17

zolpidem

Class: Hypnotics

Indications: insomnia

MOA: increase GABA (inhibitory neurotransmitter) at the benzodiazepine receptor. This causes CNS depression.

Dosage forms: Sublingual tablet

Dosing:

Max dose:

Contraindications:
History of complex sleep behavior

Warnings:
Increase risk of CNS depression and next day impairment with < 7-8 hours of sleep (especially with higher doses or coadministration of CNS depressants or alcohol).

Potential for abuse and dependance (can cause withdrawal symptoms if used longer than 2 weeks)

Side Effects:
Somnolence, dizziness, ataxia, headache,
Parasomnias (unusual actions while you are sleeping, which the patient may be unaware of).

Monitoring:

Pearls/Notes:
C-IV
Preferred over benzodiazepines for first line treatment due to decrease abuse, dependence and tolerance.

Do not take with fatty food, a heavy meal or alcohol.

Drug-Drug/Food interactions:

Question 18

Zolpimist

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 18

zolpidem

Class: Hypnotics

Indications: insomnia

MOA: increase GABA (inhibitory neurotransmitter) at the benzodiazepine receptor. This causes CNS depression.

Dosage forms: oral spray

Dosing:

Max dose:

Contraindications:
History of complex sleep behavior

Warnings:
Increase risk of CNS depression and next day impairment with < 7-8 hours of sleep (especially with higher doses or coadministration of CNS depressants or alcohol).

Potential for abuse and dependance (can cause withdrawal symptoms if used longer than 2 weeks)

Side Effects:
Somnolence, dizziness, ataxia, headache,
Parasomnias (unusual actions while you are sleeping, which the patient may be unaware of).

Monitoring:

Pearls/Notes:
C-IV
Preferred over benzodiazepines for first line treatment due to decrease abuse, dependence and tolerance.

Do not take with fatty food, a heavy meal or alcohol.

Drug-Drug/Food interactions:

Question 19

Sonata

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 19

zaleplon

Class: Hypnotics

Indications: insomnia

MOA: increase GABA (inhibitory neurotransmitter) at the benzodiazepine receptor. This causes CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
History of complex sleep behavior

Warnings:
Increase risk of CNS depression and next day impairment with < 7-8 hours of sleep (especially with higher doses or coadministration of CNS depressants or alcohol).

Potential for abuse and dependance (can cause withdrawal symptoms if used longer than 2 weeks)

Side Effects:
Somnolence, dizziness, ataxia, headache,
Parasomnias (unusual actions while you are sleeping, which the patient may be unaware of).

Monitoring:

Pearls/Notes:
C-IV
Preferred over benzodiazepines for first line treatment due to decrease abuse, dependence and tolerance.

Do not take with fatty food, a heavy meal or alcohol.

Drug-Drug/Food interactions:

Use caution in combination with potent CYP3A4 inhibitors.

Question 21

DayVigo

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 21

lemborexant

Class: orexin receptor antagonist

Indications:

MOA: The orexin neuropeptide signaling system promotes wakefulness. Orexin receptor antagonists block the orexin neuropeptide signaling system, resulting in drowsiness.

Dosage forms:

Dosing:

Max dose:

Contraindications:
Narcolepsy

Warnings:
Worsening depression/suicidal ideation, sleep paralysis, hallucinations, cataplexy-like symptoms (sudden loss of muscle tone), increased risk for complex sleep behavior, daytime impairment (risk increased with other CNS depressants).

Side Effects:
somnolence, headache, dizziness, abnormal dreams

Monitoring:

Pearls/Notes:
Should be taken on an empty stomach (food delays absorption)
Not recommended in patients with severe hepatic impairment.

Drug-Drug/Food interactions:

Question 22

Belsomra

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 22

suvorexant

Class:

Indications:

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

Question 24

Rozerem

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 24

ramelteon

Class: melatonin receptor agonists

Indications:

MOA: drug acts at the melatonin receptors, MT1 and MT2. This promotes sleepiness and regulates the circadian rhythm to coordinate the sleep-wake cycle.

Dosage forms:

Dosing:

Max dose:

Contraindications:
contraindicated with fluvoxamine (increases serum concentrations of ramelteon)

Warnings:

Side Effects:
somnolence, dizziness

Monitoring:

Pearls/Notes:

Not limited to short use
Not controlled
Good for helping fall asleep.

Drug-Drug/Food interactions:

Question 25

Hetliaz

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 25

tasimelteon

Class: melatonin receptor agonists

Indications:

MOA: drug acts at the melatonin receptors, MT1 and MT2. This promotes sleepiness and regulates the circadian rhythm to coordinate the sleep-wake cycle.

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
Not limited to short use
Not controlled
tasimelteon - for non-24-hour sleep wake disorder

Drug-Drug/Food interactions:

Question 27

Silenor

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 27

doxepin

Class: tricyclic antidepressant

Indications: insomnia

MOA: inhibits NE and 5-HT reuptake. They also block acetylcholine and histamine receptors which contribute to side effects (somnolence).

Dosage forms:

Dosing: 3-6mg PO QDHS

3mg if > or = to 65 years old.

Max dose:

Boxed Warnings:
increase in suicidal thoughts or actions in some children, teenagers or young adults within the first few months of treatment or when the dose is changed.

Contraindications:
Requires a w-week washout period for MAO inhibitors.

Warnings:

Side Effects:
somnolence, possibility of anticholinergic side effects.

Monitoring:

Pearls/Notes:
Doxepin ER (Silenor) the brand name is FDA-approved for sleep.
Good for staying asleep

Drug-Drug/Food interactions:

Question 29

Restoril

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 29

temazepam

Class: benzodiazepine

Indications:

MOA: drug enhances GABA, an inhibitory neurotransmitter, causing CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
pregnancy due to observed teratogenicity*

Warnings:
complex sleep behaviors (e.g. sleep-driving) have been noted.
-drowsiness, dizziness, ataxia, lightheadedness
-anterograde amnesia (some of the events that occur after taking BZD cannot be stored as memories - forgetting what happens)

Side Effects:
Drowsiness, dizziness/ increased fall risk, cognitive impairment

Monitoring:

Pearls/Notes:
C-IV drugs; there is a risk of physical (physiological) dependence, abuse (addiction) and tolerance.
- Increased risk of falls, use with caution in those at high risk
- cross the placenta
- For Short Term use only, 1-2 weeks.
- Slow taper required if used long term.

Drug-Drug/Food interactions:

Question 30

estazolam

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 30

Class: benzodiazepine

Indications:

MOA: drug enhances GABA, an inhibitory neurotransmitter, causing CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
pregnancy due to observed teratogenicity*

Warnings:
complex sleep behaviors (e.g. sleep-driving) have been noted.
-drowsiness, dizziness, ataxia, lightheadedness
-anterograde amnesia (some of the events that occur after taking BZD cannot be stored as memories - forgetting what happens)

Side Effects:
Drowsiness, dizziness/ increased fall risk, cognitive impairment

Monitoring:

Pearls/Notes:
C-IV drugs; there is a risk of physical (physiological) dependence, abuse (addiction) and tolerance.
- Increased risk of falls, use with caution in those at high risk
- cross the placenta
- For Short Term use only, 1-2 weeks.
- Slow taper required if used long term.

• *Estazolam do not use with potent CYP3A4 inhibitors (e.g ketoconazole, itraconazole)

Drug-Drug/Food interactions:

Question 31

Doral

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 31

quazepam

Class: benzodiazepine

Indications:

MOA: drug enhances GABA, an inhibitory neurotransmitter, causing CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
pregnancy due to observed teratogenicity*

Warnings:
complex sleep behaviors (e.g. sleep-driving) have been noted.
-drowsiness, dizziness, ataxia, lightheadedness
-anterograde amnesia (some of the events that occur after taking BZD cannot be stored as memories - forgetting what happens)

Side Effects:
Drowsiness, dizziness/ increased fall risk, cognitive impairment

Monitoring:

Pearls/Notes:
C-IV drugs; there is a risk of physical (physiological) dependence, abuse (addiction) and tolerance.
- Increased risk of falls, use with caution in those at high risk
- cross the placenta
- For Short Term use only, 1-2 weeks.
- Slow taper required if used long term.

Drug-Drug/Food interactions:

Question 32

flurazepam

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 32

Class: benzodiazepine

Indications:

MOA: drug enhances GABA, an inhibitory neurotransmitter, causing CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
pregnancy due to observed teratogenicity*

Warnings:
complex sleep behaviors (e.g. sleep-driving) have been noted.
-drowsiness, dizziness, ataxia, lightheadedness
-anterograde amnesia (some of the events that occur after taking BZD cannot be stored as memories - forgetting what happens)

Side Effects:
Drowsiness, dizziness/ increased fall risk, cognitive impairment

Monitoring:

Pearls/Notes:
C-IV drugs; there is a risk of physical (physiological) dependence, abuse (addiction) and tolerance.
- Increased risk of falls, use with caution in those at high risk
- cross the placenta
- For Short Term use only, 1-2 weeks.
- Slow taper required if used long term.

Drug-Drug/Food interactions:

Question 33

Halcion

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 33

triazolam

Class: benzodiazepine

Indications:

MOA: drug enhances GABA, an inhibitory neurotransmitter, causing CNS depression.

Dosage forms:

Dosing:

Max dose:

Contraindications:
pregnancy due to observed teratogenicity*

Warnings:
complex sleep behaviors (e.g. sleep-driving) have been noted.
-drowsiness, dizziness, ataxia, lightheadedness
-anterograde amnesia (some of the events that occur after taking BZD cannot be stored as memories - forgetting what happens)

Side Effects:
Drowsiness, dizziness/ increased fall risk, cognitive impairment

Monitoring:

Pearls/Notes:
C-IV drugs; there is a risk of physical (physiological) dependence, abuse (addiction) and tolerance.
- Increased risk of falls, use with caution in those at high risk
- cross the placenta
-** triazolam: associated with higher rebound insomnia and daytime anxiety; contraindicated with azole antifungals, protease inhibitors and other CYP3A4 inhibitors
- For Short Term use only, 1-2 weeks.
- Slow taper required if used long term.

Drug-Drug/Food interactions:

Question 34

L-O-T:

Answer 34

Lorazepam
Oxazepam
Temazepam
- these benzo’s are thought to be safer in liver disease
- considered safer for patient’s 65 years and older since these medications do not have active metabolites.

Question 35

Bendryl

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 35

diphenhydramine

Class: antihistamine

Indications:

MOA: drug competes with and blocks histamine H1 receptors

Dosage forms:

Dosing: 50mg PO QDHS

Max dose:

Contraindications:

Warnings:

Side Effects: sedation (tolerance to sedative effects can develop after 10 days of use), confusion (can exacerbate memory/cognition difficulty)

Antihistamines may cause paradoxical excitation in young children; DO NOT USE doxylamine in children < 12 years old.

Peripheral anticholinergic side effects: dry mouth, urinary retention (makes it very difficult for males with BPH to urinate), dry/blurry vision, constipation

Best to avoid in BPH (can worsen symptoms) and glaucoma (can elevate IOP)

Monitoring:

Pearls/Notes:
BEERS Criteria - (Anticholinergic Effects)

Drug-Drug/Food interactions:

Question 36

Unisom

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 36

doxylamine

Class: antihistamine

Indications:

MOA: drug competes with and blocks histamine H1 receptors

Dosage forms:

Dosing: 25mg PO QDHS

Max dose:

Contraindications:

Warnings:

Side Effects: sedation (tolerance to sedative effects can develop after 10 days of use), confusion (can exacerbate memory/cognition difficulty)

Antihistamines may cause paradoxical excitation in young children; DO NOT USE doxylamine in children < 12 years old.

Peripheral anticholinergic side effects: dry mouth, urinary retention (makes it very difficult for males with BPH to urinate), dry/blurry vision, constipation

Best to avoid in BPH (can worsen symptoms) and glaucoma (can elevate IOP)

Monitoring:

Pearls/Notes:
BEERS Criteria - (Anticholinergic Effects)

Drug-Drug/Food interactions:

Question 37

(RLS) Restless Leg Syndrome:

Answer 37

Urge to move lower legs.
- worse at night
- relieved with movement

Question 38

Drug treatment for RLS: increase (DA) dopamine

“usually used in PD for movement disorder”

Answer 38

dopamine agonists
- (Mirapex) pramipexole
- (Requip) ropinirole
- (Neupro) rotigotine - patch
- (Horizant) gabapentin enacarbil - approved for RLS and postherpetic neuralgia. (Take with food, swallow whole)

Question 39

For RLS, the immediate release (IR) formulation is taken 1-3 hours before bedtime.**

Answer 39

(Neupro) rotigotine is a dopamine agonist that comes in a patch formulation (used for both PD and RLS). The patch is applied once daily, and patients must be counseled on appropriate use. (e.g. do not apply a heat source over the patch, remove the patch before an MRI procedure, rotate sites to avoid skin irritation.

Question 40

Dopamine agonists cause:

Answer 40

orthostasis, somnolence and nausea that is dose related.

Question 42

Narcolepsy:

Answer 42

is excessive daytime sleepiness with cataplexy (sudden loss of muscle tone) and sleep paralysis.
- sudden and uncontrollable sleep attacks with cataplexy (sudden loss of muscle tone)
- poor control of normal sleep-wake cycle
- excessive sleepiness

Question 43

Drug Treatment for Narcolepsy:

Stimulants
- modafinil (Provigil)
- armodafinil (Nuvigil)

Sodium oxybate (Xyrem)

calcium, magnesium, potassium and sodium oxybate (Xywav)

Several of the ADHD stimulants also have an indication for Narcolepsy:
- dextroamphetamine
- dextroamphetamine/amphetamine
- methylphenidate

Question 45

Provigil

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 45

modafinil

Class: stimulant for wakefulness

Indications: narcolepsy, obstructive sleep apnea (to help with daytime sleepiness) and shift work disorder.

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:
Avoid with pre-existing cardiac conditions, caution with hepatic or renal dysfunction, psychiatric disorders and Tourette’s syndrome.

Side Effects:
*Severe rash, can be life threatening (SJS), headache, insomnia, anxiety, nausea

Monitoring:

Pearls/Notes:
C-IV

Drug-Drug/Food interactions:

Question 46

Nuvigil

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 46

armodafinil

Class: stimulant for wakefulness

Indications: narcolepsy, obstructive sleep apnea (to help with daytime sleepiness) and shift work disorder.

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:
Avoid with pre-existing cardiac conditions, caution with hepatic or renal dysfunction, psychiatric disorders and Tourette’s syndrome.

Side Effects:
*Severe rash, can be life threatening (SJS), headache, insomnia, anxiety, nausea

Monitoring:

Pearls/Notes:
C-IV

Drug-Drug/Food interactions:

Question 47

Xyrem

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 47

sodium oxybate

Class:

Indications: narcolepsy with cataplexy (sudden loss of muscle tone)

MOA:

Dosage forms:

Dosing:

Max dose:

Boxed warning:
Strong CNS depressant: respiratory depression, coma and death can result; risk is increased when taken with other CNS depressants.

Contraindications:
Use with sedative hypnotics or alcohol

Warnings:
depression, suicide, psychosis, anxiety, sleepwalking

Side Effects:
dizziness, confusion, nausea

Monitoring:

Pearls/Notes:
-derived from GABA
C-III
- **Restricted access through Xyrem REMS program - “date rape” drug
- drug helps with sleep at night and are generally used with daytime stimulants.
- High sodium content; limiting dietary sodium intake may be required

Drug-Drug/Food interactions:

Question 48

Xywav

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 48

calcium, magnesium, potassium and sodium oxybates (Xywav)

Class:

Indications: narcolepsy with cataplexy (sudden loss of muscle tone)

MOA:

Dosage forms:

Dosing:

Max dose:

Boxed warning:
Strong CNS depressant: respiratory depression, coma and death can result; risk is increased when taken with other CNS depressants.

Contraindications:
Use with sedative hypnotics or alcohol

Warnings:
depression, suicide, psychosis, anxiety, sleepwalking

Side Effects:
dizziness, confusion, nausea

Monitoring:

Pearls/Notes:
-derived from GABA
C-III
- **Restricted access through Xyrem REMS program - “date rape” drug
- drug helps with sleep at night and are generally used with daytime stimulants.
- High sodium content; limiting dietary sodium intake may be required

Drug-Drug/Food interactions:

Question 50

Wakix

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 50

pitolisant

Question 51

Sunosi

Class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 51

solriamfetol