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Behavioral Health > Sleep Disorders Treatment > Flashcards

Sleep Disorders Treatment Flashcards

1
Q

Goals of therapy

3

A
  1. Promote patient’s ability to fall asleep, maintain sleep, and awaken refreshed
  2. Use med for as short a time as possible
  3. Use minimal dose with least amount of side-effects
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2
Q

Benzodiazepines

7

A
  1. Alprazolam (Xanax)
  2. Estazolam (ProSom)
  3. Flurazepam (Dalmane)
  4. Lorazepam (Ativan)
  5. Quazepam (Doral)
  6. Temazepam (Restoril)
  7. Triazolam (Halcion)
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3
Q

Benzodiazepines MOA?

3

A

MOA
1. Selectively acts on polysynaptic neuronal pathways throughout the CNS

  1. Enhance the effects of GABA (an inhibitory neurotransmitter) in the CNS
  2. Insomnia
    - -Facilitate the effects of GABA in the ascending reticular activating system
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4
Q

Benzos are divided into which three categories?

A
  1. Short acting
  2. Intermediate acting
  3. Long acting
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5
Q

Which drugs are in each category:
1. Short acting 1

  1. Intermediate acting 2
  2. Long acting 2
A
  1. Triazolam (Halcion)
    • Temazepam (Restoril)
    • Estazolam (ProSom)
    • Flurazepam (Dalmane)
    • Quazepam (Doral)
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6
Q

Benzo Adverse events

3

A
  1. Drowsiness
  2. Impaired motor function
  3. Prolonged use
    - Physical dependency
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7
Q

Benzos

  1. Drug interactions? 2
  2. Contraindications? 3
A
  1. Interactions
    - Caution with alcohol
    - Low-dose contraceptives
  2. Contraindications
    - Acute narrow-angle glaucoma
    - Preg X
    - Lactation
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8
Q

Benzodiazepine Receptor Agonists (BRA)

  1. Developed why?
  2. Half life?
  3. Has greater receptor specificity of the what?
A
  1. to improve the safety profile of barbiturate-type compounds
  2. Have short half-life
    5 hours
  3. GABAa BZ complex
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9
Q

Benzodiazepine Receptor Agonists (BRA): Drugs in this category?
3

A

Drugs

  1. Eszopiclone (Lunesta)
  2. Zolpidem (Ambien)
  3. Zaleplon (Sonata)
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10
Q

Eszopiclone (Lunesta)

MOA?

A

Interacts with GABA receptors located near benzodiazepine receptors

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11
Q

BRAs: Dosage

  1. Start with?
  2. Can be started or increased to?
  3. Elderly dosing?
A
  1. Start at 2mg immediately before bed
  2. Can be started or increased to 3mg to aid in sleep maintenance
  3. Elderly
    Start 1mg to help fall asleep
    2mg for sleep maintenance
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12
Q

Eszopiclone (Lunesta)

  1. Adverse affects? 3
  2. Contraindications? 1
  3. Preg cat?
A
  1. Adverse events
    - HA
    - Dry mouth
    - Dizziness
  2. Contraindications
    - Hypersensitivity
  3. Preg C
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13
Q

Zolpidem (Ambien, Ambien CR)

  1. MOA?
  2. Dosage? 2
A
  1. MOA
    Modulates the GABA receptors to suppress neurons
  2. Dosage
    - 5-10mg PO qhs
    - Extended release
  3. 25-12.5mg PO qhs
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14
Q

Zolpidem

  1. Adverse affects? 3
  2. Contraindications? 1
  3. Preg?
A
  1. Adverse events
    - Morning drowsiness
    - Hangover
    - HA
  2. Contraindications
    - Hypersensitivity
  3. Preg C
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15
Q

Zaleplon (Sonata)

  1. MOA?
  2. Dosage?
    - Start at?
    - Range from?
A
  1. MOA
    Interacts with GABA-BZ omega 1 receptor
  2. Dosage
    Start: 10mg PO qhs
    Range 5-20mg qhs
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16
Q

Zaleplon

  1. Adverse affects? 3
  2. Contraindications? 1
  3. Preg?
A
  1. Adverse Events
    - Back or chest pain
    - Migraine
    - Constipation
  2. Contraindications
    - Hypersensitivity
  3. Preg C
17
Q

Most commonly used classes of OTC sleep-inducing agents?

Specific agent?

A

Antihistamines

Diphenhydramine (Benadryl)

18
Q 
Antihistamines:
Diphenhydramine (Benadryl)
1. MOA?
2. Dosage?
3. Adverse affects? 2
A
  1. MOA
    Unknown, but acts as a CNS depressant
  2. Dosage
    - 25-50mg qhs
  3. Adverse Events
    - Excessive daytime drowsiness
    - Impaired psychomotor function
19
Q

Antidepressants
3

Newer agents? 2

A
  1. Imipramine (Tofranil)
  2. Amitriptyline hydrochloride (Elavil)
  3. Nortriptyline (Pamelor)

Newer agents

  1. Nefazodone hydrochloride (Serzone)
  2. Venlafaxine (Effexor)
20
Q

Doxepin (Silenor)

  1. MOA?
  2. Dosage?
  3. Adverse effects? 4
A
  1. MOA
    Increases synaptic concentrations of serotonin and norepinephrine in the CNS
  2. Dosage
    - 3-6mg within 30 min of bedtime
  3. Adverse Events
    - Drowsiness
    - Dizziness
    - Constipation
    - Blurred vision
21
Q

Doxepin (Silenor)

  1. Contraindications? 2
  2. BBW?
  3. Preg cat?
A
  1. Contraindications
    - Glaucoma
    - Urinary retention
  2. Black Box Warning
    - Suicide thinking/behavior
  3. Preg C
22
Q

Trazodone
MOA? 3

Dosage?

A

MOA

  1. Inhibits reuptake of serotonin
  2. Causes adrenoreceptor subsensitivity
  3. Induces change in 5-HT presynaptic receptor adrenoreceptors

Dosage
50-100mg before bedtime

23
Q

Trazodone

  1. Adverse affects?
  2. Contraindications? 2
  3. Preg cat?
  4. BBW?
A
  1. Adverse Events
    - Dizziness
    - drowsiness
  2. Contraindications
    - Use of MAO inhibitors
    - Patients receiving linezolid or IV methylene blue
  3. Preg C
  4. Black box warning
    Suicidal thoughts
24
Q

Amitriptyline (Elavil)

  1. MOA?
  2. Dosage?
  3. Adverse affects? 3
A

MOA
1. Increases synaptic concentration of serotonin and/or norepinephrine in CNS

  1. Dosage
    25-50mg at bedtime
  2. Adverse Events
    - Sedation
    - Dizziness
    - HA
25
Q

Amitriptyline

  1. Contraindications? 2
  2. Preg cat?
  3. BBW?
A
  1. Contraindications
    - History of MI
    - MAOIs
  2. Preg C
  3. Black box warning
    Suicidal thoughts
26
Q

Melatonin Agonist? 1

A

Ramelteon (Rozerem)

27
Q

Ramelteon (Rozerem)

  1. MOA?
  2. Dosage?
  3. Adverse effects? 3
  4. Contraindications? 1
  5. Preg cat?
A
  1. MOA
    Potent, selective agonist of melatonin receptors MT1 and MT2 within the suprachiasmic nucleus of the hypothalamus
  2. Dosage
    8mg daily within 30 min of bedtime
  3. Adverse Events
    - Somnolence
    - HA
    - Fatigue
  4. Contraindications
    Fluvoxamine (Luvox)
  5. Preg C
28
Q

Orexin Receptor Antagonist?

A

Suvorexant (Belsomra)

29
Q

Suvorexant (Belsomra)

  1. MOA?
  2. Dosage?
A
  1. MOA
    Blocks binding of wake-promoting neuropeptides orexin A and orexin B to receptors OZ1R and OX2R
  2. Dosage
    10mg once daily within 30min of bedtime (max 20mg)
30
Q

Suvorexant

  1. Adverse effects? 3
  2. Contraindications? 1
  3. Preg cat?
A
  1. Adverse Events
    - Drowsiness
    - HA
    - Abnormal dreams
  2. Contraindications
    Narcolepsy
  3. Preg C
31
Q
  1. First line for narcopelsy?
  2. MOA?
  3. Adverse affects? 3
  4. Preg cat?
A
  1. Modafinil (Provigil)/Armodafinil (Nuvigil)
  2. MOA: not well understood, but may increase dopaminergic signaling
  3. Adverse Events
    - HA
    - Nausea
    - Nervousness
    - Dry mouth
  4. Preg C
32
Q
  1. Narcolepsy second line?
  2. MOA?
  3. Common side effects?
  4. Preg cat?
  5. BBW? 2
A
  1. Dextroamphetamine
  2. MOA: not well understood, but stimulates CNS activity; blocks reuptake and increases release of norepinephrine and dopamine in extraneuronal space (sympathomimetic)
    Dose: 10mg daily
  3. Side-effects common
    - HTN
    - Anorexia
    - Addiction
  4. Preg C
    Black Box
    -High abuse potential
    -Cardiac events
33
Q

REM Sleep Behavior Disorder

  1. First line therapy?
  2. MOA?
  3. SE? 3
A
  1. Melatonin (First-line therapy)
  2. MOA: Prepares the body for sleep
    Doses: 0.5-10mg PO qhs
  3. Side-effects
    - Abnormal heartbeat
    - Dizziness
    - fatigue
34
Q

Movement Disorder
Dopaminergic agents? 3

MOA?

A
  1. Pramipexole (Mirapex)
  2. Ropinirole (Requip)
  3. Rotigotine (Neupro)

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

35
Q
  1. Dopaminergic agents SE? 2

2. Preg cat?

A
  1. Adverse Events
    - Nausea
    - Lightheadedness
  2. Preg C
36
Q 
Movement disorder
Anticonvulsants
1. Which drug?
2. MOA?
3. Adverse effects? 3
4. Preg cat?
A
  1. Gabapentin (Neurontin)
  2. MOA
    Thought to reduce presynaptic GABA release
    –Dosage
    Initial: 300mg daily 2 hours before bed
  3. Adverse Events
    - Fatigue
    - Dizziness
    - Blurred vision
  4. Preg C

Behavioral Health (20 decks)

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