Sleep Disorders & ADHD

Question 1

What are the 3 types of insomnia?

Answer 1

Transient Insomnia
Short-Term Insomnia
Chronic Insomnia

Question 2

What is Transient insomnia and the treatment?

Answer 2

Sleep affected by external factors such as jet lag, shift work or noise.
1/2 doses of a rapidly eliminated hypnotic should be chosen. Ideally started with OTC Nytol

Question 3

What is Short-Term Insomnia and the treatment?

Answer 3

Emotional problem or serious medical illness.
Hypnotic can be useful but should not be given for longer than 3 weeks due to dependence.

Question 4

What is Chronic Insomnia and the treatment?

Answer 4

Caused by anxiety, depression and alcohol/drug abuse
Underlying psychiatric complaint should be treated

Question 5

What are 3 types of Long-Acting Benzodiazepines?

Answer 5

Nitrazepam, Diazepam and Flurazepam
Higher hangover effect on the following day compared to short-acting.
Used for sleep maintenance

Question 6

What are 3 types of short-acting Benzodiazepines?

Answer 6

Loprazolam, Lormetazepam and Temazepam
Little or no hangover effect
Used for sleep onset
Higher chance of withdrawal symptoms

Question 7

Which type of Benzodiazepines are used for sleep onset and sleep maintenance?

Answer 7

Sleep onset - short-acting
Sleep maintenance - long-acting

Question 8

What are 2 examples of Z-Hypnotics and their MOA?

Answer 8

Zolpidem and Zopiclone
Increases GABA = CNS depression

Question 9

After how many days does dependency occur with Z-Hypnotics and what is the maximum length of time it should be used?

Answer 9

Dependency occurs within 3-14 days of use
Should be used for 4 weeks max

Question 10

Why should Z-Hypnotics and Benzodiazepines be avoided in elderly patients?

Answer 10

Risk of falls and injury / Drowsiness

Question 11

What type of side effects can occur with Z-Hypnotics?

Answer 11

Paradoxical Side Effects

Question 12

What is the 1st line treatment for ADHD in children aged 5 years and over?

Answer 12

Methylphenidate

Question 13

How long should a trial of methylphenidate at the maximum dose be used with no reduction in symptoms for ADHD before switching medication? What medication should it be switched to?

Answer 13

6 week trial of methylphenidate at max tolerated dose
if no symptom improvement switch to Lisdexamfetamine

Dexamfetamine if patient cannot tolerate longer duration of Lisdexamfetamine

Question 14

For children who are intolerant of both Methylphenidate and Lisdexamfetamine what should be used for the treatment of ADHD?

Answer 14

Atomoxetine or Guanfacine

Question 15

What is the 1st and 2nd line treatment for adults with ADHD?

Answer 15

1. Methylphenidate or Lisdexamfetamine/ Dexamfetamine
2. Atomoxetine

Question 16

What are 3 serious side effects of Atomoxetine?

Answer 16

QT Prolongation
Hepatoxicity
Suicidal Ideation

Question 17

What are side effects of Methylphenidate?

Answer 17

High BP
Tachycardia
Arrhythmias
Behaviour/Mood Change
Drowsiness and Sleep Disorders

Question 18

What side effects especially need to be monitored in children who are taking Methylphenidate?

Answer 18

Decreased Appetite
Growth Retardation
Weight Loss

Question 19

What are the monitoring requirements for Methylphenidate?

Answer 19

Monitor pulse, BP, psychiatric symptoms, appetite, weight and height at initiation, following dose adjustments, then 6 monthly.

Question 20

How can an overdose of lisdexamfetamine/ dexamfetamine be detected?

Answer 20

Patient experiences high then crash
High - walefulness, excessive activity, paranoia, hallucinations and hypertension
Crash - exhaustion, convulsions, hyperthermia and coma