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Sleep Disorders treatment Flashcards

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1
Q

Goals of sleep disorder tx?

A
  • promote pt’s ability to fall asleep, maintain sleep, and awaken refreshed
  • use med for as short a time as possible
  • use minimal dose with lease amt of side effects
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2
Q

Benzos used for insomnia?

A
  • alprazolam (Xanax)
  • estazolam (Prosom)
  • flurazepam (dalmane)
  • lorazepam (ativan)
  • quazepam (doral)
  • temazepam (restoril)
  • triazolam (Halcion)
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3
Q

MOA of Benzos?

A
  • selectively acts on polysynaptic neuronal pathways throughout the CNS
  • enhance the effects of GABA in CNS
  • insomnia: facilitate the effects of GABA in ascending reticular activating system
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4
Q

Diff categories of benzos?

A
  • short acting: triazolam (halcion)
  • intermediate acting: temazepam (restoril), estazolam (proSom)
  • long acting: flurazepam (dlamane), quazepam (doral)
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5
Q

Adverse effects of Benzos?

A
  • drowsiness
  • impaired motor fxn
  • prolonged use: physical dependency
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6
Q

Interactions and CIs of Benzos?

A 
- Interactions: 
caution with ETOH
low dose contraceptives
- CIs:
acute narrow-angle glaucoma
preg X
lactation
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7
Q

What are benzodiazepine receptor agonists (BRA)?

A
  • developed to improve the safety profile of baribturate type compounds
  • have short half life: 5 hrs
  • has greater receptor specificity of the GABAa BZ complex

(don’t develop tolerance, can use for longer amt of time compared to benzos, safer thean benzos)

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8
Q

Category of BRA’s?

A
  • eszopiclone (lunesta)
  • zolpidem (ambien)
  • zaleplon (sonata)
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9
Q

MOA and dosage of eszopiclone (Lunesta)?

A
  • interacts with GABA receptors located near benzo receptors
  • good for sleep maintenance
  • dosage:
    start at 2 mg immed b/f bed, can be started or increased to 3 mg to aid in sleep maintenance
  • elderly:
    start 1 mg to help fall asleep
    2 mg for sleep maintenance
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10
Q

Adverse effects and CIs of eszopiclone (lunesta)?

A
  • HA
  • dry mouth
  • dizziness
  • CI: hypersensitivity to drug
  • preg C
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11
Q

MOA and dosage of zolpidem (ambien, ambien CR)?

A
  • MOA: modulates the GABA receptors to suppress neurons
  • dosage:
    5-10 mg PO qhs
    extended release: 6.25-12.5 mg PO qhs
  • give lower doses in women and elderly - don’t clear drug as quickly
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12
Q

Adverse effects and CIs of zolpidem?

A 
- adverse effects:
morning drowsiness
hangover
HA
- CIs:
hypersensitivity
- Preg C
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13
Q

MOA and dosage, Adverse effects, and CIs of Zaleplon (Sonata)?

A
  • MOA: interacts with GABA-BZ omega 1 receptor = leads to sedation, muscle relaxation, anti-convulsant
  • dosage:
    start 10 mg PO qhs
    range 5-20 mg qhs
  • used 2nd line for pts who have hard time falling asleep behind ambien
  • adverse effects: back or chest pain, migraine, constipation
  • CIs: hypersensitivity
  • Preg C
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14
Q

Antihistamine use? Main drug used?

A
  • most commonly used classes of OTC sleep inducing agents
  • Diphenhydramine (benadryl)
    MOA: unknown, acts as CNS depressant
  • dosage: 25-50 mg qhs
  • adverse effects: excessive daytime drowsiness, impaired psychomotor fxn
  • anticholinergic effects: dry mouth, caution in elderly, BPH
  • category B: good to use in pregnancy
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15
Q

Antidepressants used for insomnia?

A
  • imipramine (tofranil)
  • amitriptyline hydrochloride (elavil)
  • nortriptyline (pamelor)
  • newer agents: nefazodone hydrochloride (serzone)
    venlafaxine (effexor)
  • used off label, only antidepressant approved for insomnia is silenor
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16
Q

MOA, dosage, adverse effects and CI of doxepin (silenor)?

A
  • MOA: increases synaptic concentrations of serotonin and NE in CNS
  • dosage: 3-6 mg w/in 30 min of bedtime
  • adverse effects: drowsiness, dizziness, constipation, blurred vision
  • CI: glaucoma, urinary retention, constipation
  • preg C
17
Q

BBW of Doxepin (silenor)?

A
  • Suicide thinking/behavior
18
Q

MOA, dosage, adverse effects, CI of trazodone? BBW?

A
  • SARI: inhibits reuptake of serotonin, causes adrenoreceptor subsensitivity, induces change in 5-HT pressynaptic receptor adrenoreceptorys
  • dosage: 5-100 mg b/f bedtime
  • adverse effects: dizziness, drowsiness
  • CI: use of MAOIs, pts receiving linezolid or IV methylene blue
  • preg C
  • BBW: suicidal thoughts
19
Q

MOA, dosage, adverse effects, CI of amitriptyline ?

A
  • MOA: increases synaptic concentration of serotonin and or NE in CNS
  • dosage: 25-50 mg at bedtime
  • adverse effects: sedation, dizziness, HA, constipation, wt gain
  • half life: 13-36 hrs
  • CI: hx of MI, MAOIs
  • preg C
  • BBW: suicidal thoughts
20
Q

MOA, dosage, adverse effects, CI, preg of Ramelteon (rozerem)?

A
  • MOA: potent, selective agonist of melatonin receptors MT1, and MT2 within the suprachiasmic nucleus of the hypothalamus
  • dosage: 8 mg daily w/in 30 min of bedtime
  • adverse effects: somnolence. HA, fatigue, nausea
  • CI: fluvoxamine (luvox) SSRI
  • preg C
21
Q

What is suvorexant (belsomra)? MOA, dosage, adverse effects, CIs, preg?

A
  • orexin receptor antagonist
  • MOA: blocks binding of wake promoting neuropeptides orexin A and B to receptors OZ1R and OX2R - suppresses wake drive
  • dosage: 10 mg once daily w/in 30 min of bedtime (max 20 mg)
  • don’t take immed after meal, need 7 hrs of planned sleep
  • adverse effects: drowsiness, HA, abnormal dreams
  • CI: narcolepsy
  • preg C
22
Q

First line tx for narcolepsy? MOA, dose, adverse effects, preg?

A
  • modafinil (Provigil)/armodafinil (nuvigil):
    MOA: not well understood, but may increase dopaminergic signaling
  • dose: modafinil - 100mg qAM, can titrate up to 300-400 mg
    armodafinil: 150 mg q AM, titrate up to 250 mg
  • adverse effects: HA, nausea, nervousness, dry mouth
  • preg C
23
Q

2nd line tx for narcolepsy? MOA, dose, side effects, preg, BBW?

A
  • dextroamphetamine
  • MOA: not well understood, but stimulates CNS activity, blocks reuptake and icnreases release of NE and dopamine in extraneuronal space (sympathomimetic)
  • dose: 10 mg daily
  • SE: HTN, anorexia, addiction
  • preg C
  • BBW: high abuse potential, cardiac events
  • don’t take in evening - insomnia
24
Q

First line therapy for REM sleep behavior disorder?

A
  • melatonin
  • MOA: prepares body for sleep
  • doses: 0.5 - 10 mg PO qhs
  • SEs:
    abnormal heartbeat, dizziness, fatigue
25
Q

Movement disorders?

A
  • RLS

- periodic limb movement disorders

26
Q

Dopaminergic agent used in movement disorders?

A
  • carbidopa-levodpa (sinemet)
  • dosage: carbidopa 25 mg/levodopa 100mg (0.5-1 tab)
  • adverse effects:
    sleepiness, GI probs
27
Q

Dopamine agonists used in movement disorders? MOA?

A
  • pramipexole (mirapex)
  • ropinirole (requip)
  • rotigotine (neupro)
  • MOA: stimulation of postsynaptic dopamine D2 type receptors within caudate putamen in the brain
28
Q

Dosage of dopamine agonists in movement disorders? Adverse effects, preg?

A
  • pramipexole: initial 0.125 mg once daily 2-3 hrs b/f bef
  • ropinirole (requip): inital 0.25 mg daily 1-3 hrs b/f bed
  • rotigotine: apply 1 mg pathc daily
  • adverse effects: Nausea, lightheadedness
  • preg C
29
Q

Anticonvulsants used in movement disorders?

A
  • gabapentin (neurontin)
  • MOA: thought to reduce presynaptic GABA release
  • dosage: initial 300 mg daily 2 hrs b/f bed
  • adverse events:
    fatigue, dizziness, blurred vision
  • preg C
  • used off label for RLS

Psych (20 decks)

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