Sleep- Narcolepsy

Question 1

Narcolepsy definition

Answer 1

Impairment of both onset and offset of REM and NREM

Question 2

Narcolepsy tetrad

Answer 2

EDS, cataplexy, hallucinations, sleep paralysis

Question 3

Narcolepsy patho

Answer 3

Loss of normal function of hypocretin-orexin neurotransmitter system

Question 4

Narcolepsy nonpharm treatment

Answer 4

Sleep hygiene, scheduled daytime naps, avoid drugs that can worsen daytime sleepiness (BZDs, opiates, APS, alcohol)

Question 5

Standard pharm treatment for narcolepsy

Answer 5

Modafinil, armodafinil

Question 6

Medications used in cataplexy in insomnia

Answer 6

Fluoxetine, venlafaxine, atomoxetine, clomipramine, imipramine, nortriptyline

Question 7

Medications used in cataplexy

Answer 7

TCAs, SNRIs, SSRIs

Question 8

Meds used in EDS treatment in narcolepsy

Answer 8

Modafinil, armodafnil, solriamfetrol, pitolisam, amphetamine, methylphenidate, sodium oxybate

Question 9

Meds used in cataplexy for insomnia treatment

Answer 9

Fluoxetine, venlafaxine, atomoxetine, clomipramine, imipramine, nortriptyline

Question 10

Modafinil ADEs

Answer 10

HA, nausea, anxiety/nervousness, dizziness, dyspepsia, xerostomia, back pain, rhinitis

Question 11

Armodafinil ADEs

Answer 11

HA, insomnia, dizziness, nausea, xerostomia

Question 12

What patient population should you avoid modafinil and armodafinil in?

Answer 12

Pregnancy

Question 13

What disease state should you use modafinil and armodafnil with caution in?

Answer 13

CVD

Question 14

Modafinil, armodafnil DDIs

Answer 14

May decrease contraceptive effectiveness

Question 15

Solriamfetol MoA

Answer 15

Dopamine and NE reuptake inhibitor

Question 16

Solriamfetol ADEs

Answer 16

HA, anxiety, insomnia, decreased appetite, nausea

Question 17

Solriamfetol CI

Answer 17

MAOI use within 14 days

Question 18

Avoid using solriamfetol in what disease state?

Answer 18

Unstable CVS, arrhythmias, etc.

Question 19

Pitolisant MoA

Answer 19

Antagonist at histamine-3 receptors

Question 20

Pitolisant is a major substrate of what CYP enzymes?

Answer 20

2D6, 3A4

Question 21

Pitolisant ADEs

Answer 21

HA, anxiety, musculoskeletal pain

Question 22

Pitolisant CI

Answer 22

Severe hepatic impairment

Question 23

You have to lower the dose of pitolisant in what patients?

Answer 23

Poor 2D6 metabolizers

Question 24

Modafinil, armodafnil, and solriamfetol are controlled substances. What Schedule are they?

Answer 24

CIV

Question 25

Sodium oxybate is a controlled substance. What Schedule is it?

Answer 25

CIII

Question 26

Sodium oxybate BBWs

Answer 26

CNS depression, abuse/misuse, restricted access (REMS!)

Question 27

What’s unique about sodium oxybate dosing?

Answer 27

You take the first dose at bedtime after the patient is in bed, then you take the second dose 2.5-4 hours later

Question 28

Sodium oxybate MoA

Answer 28

CNS depressant

Question 29

Active moiety of sodium oxybate

Answer 29

GHB

Question 30

Sodium oxybate ADEs

Answer 30

Confusion, HA, dizziness, weight loss/decreased appetite, urinary incontinence, drowsiness, depression, somnambulism, anxiety

Question 31

What other drugs can you use for EDS?

Answer 31

Amphetamines, methylphenidate