Sleep disorders

Question 1

most common sleep disorder

Answer 1

insomnia

Question 2

natural products used for insomnia

Answer 2

Chamomile tea
melatonin
valerian

Question 3

Drugs that can worsen insomnia

Answer 3

alcohol
bupropion
caffeine
fluoxetine
steroids
stimulants

Question 4

Drugs recommended for sleep onset insomnia (trouble falling asleep) 6 drugs

Answer 4

eszopiclone
ramelteon
temazepam
triazolam
zaleplon
zolpidem

Question 5

Drugs recommended for sleep maintenance insomnia

5 drugs

Answer 5

doxepin
temazepam
eszopiclone
suvorexant
zolpidem

Question 6

Which class is preferred for long-term insomnia treatment?

Answer 6

non-benzo sedatives (zolpidem, etc)

less incidence of dependence

Question 7

Nono-benzo sedative side effects

Answer 7

somnolence
dizziness
ataxia
parasomnias - sleep walking, sleep-driving, etc

Question 8

zolpimist

Answer 8

zolpidem oral spray (5mg/spray)

Question 9

Edluar

Intermezzo

Answer 9

zolpidem SL tab

Question 10

Max dose of zolpidem in elderly and females

Answer 10

IR: 5 mg HS
CR: 6.25 mg Hs

Question 11

Sonata

Answer 11

Zaleplon

Question 12

Belsomra

Answer 12

suvorexant

Question 13

Belsomra MOA

Answer 13

Orexin receptor antagonist

Question 14

Belsomra dosing

Answer 14

10 mg HS
Max: 20 mg
5 mg w/ moderate CYP3A4 iinhibitor

Question 15

Rozerem

Answer 15

ramelteon

Question 16

Rozerem MOA

Answer 16

melatonin receptor agonist

Question 17

Hetiloz

Answer 17

Tasimelteon

Question 18

Hetiloz use

Answer 18

non-24 hr sleep-wake disorder

Question 19

Silenor

Answer 19

doxepin

Question 20

Silenor dosing

Answer 20

6 mg HS

3 mg if 65 or older

Question 21

Withdrawal is possible after taking sedatives frequently after…..

Answer 21

2 or more weeks

Question 22

BZDs used for insomnia (6 drugs)

Answer 22

Lorazepam
temazepam
estazolam
quazepam
Flurazepam
Triazolam

Question 23

Halcion

Answer 23

Triazolam

Question 24

BZDs with long t1/2 and not recommended in the elderly

Answer 24

quazepam

flurazepam

Question 25

Triazolam clinical pearls

Answer 25

associated with rebound insomnia and daytime anxiety

contraindicated with several CYP3a4 inhibitors

Question 26

Restless leg syndrome

Answer 26

Urge to move the lower legs

“creeping sensation”

Question 27

Treatment options for restless leg syndrome

Answer 27

dopamine agonist
gabapentin enacarbil (Horizant)

Question 28

Dosing for dopamine agonist in RLS

Answer 28

1-3 hours before bedtime (mirapex/requip IR)

Neupro patch: 1 patch daily

Question 29

Horizant administration

Answer 29

take around 5 PM

Question 30

Narcolepsy

Answer 30

excessive daytime sleepiness with sudden loss of muscle tone and sleep paralysis

Question 31

Provigil

Answer 31

modafinil 200 mg daily

stimulant used for narcolepsy

Question 32

Nuvigil

Answer 32

armodafinil 150-250 mg daily

stimulant used for narcolepsy

Question 33

Provigil/nuvigil side effects

Answer 33

HA
dizziness
anxiety
agitation
rash (requires MedGuide- can be life-threatening)

Question 34

Sodium oxybate

Answer 34

agent derived from GABA

indicated for narcolepsy with cataplexy (sudden loss of muscle strength)

Question 35

Sodium oxybate brand

Answer 35

Xyrem

Question 36

Sodium oxybate clinical pearls

Answer 36

REMS program
same compound as “date rape” drug
start 2.25 grams HS
usually take 6-9 grams HS