Sleep OTT Flashcards
disease states associated with insomnia
anxiety, mood disorders
medications associated with insomnia
caffeine, modafanil, amphetamines, beta agonists, beta blockers, nicotine, bupropion, decongestants, methyphenidate
insomnia disorder is classified as
difficulty with sleep initation, maintenance, or early awakening
at least 3 nights per week
for at least 3 months
first line therapy for sleep
sleep hygine principles
most common sleep meds
z hypnotics - zolpidem, eszopiclone, zaleplon
initial dose of zolpidem for women/elderly
5 mg (lower)
which med has metallic taste
eszopiclone
z hypnotics are _____ substrates
3A4
z hypnotics side effects
somnolence, dizzy, ataxia, headache
best benzo for sleeep
temazepam
side effects benzos
drowsiness, dizzy, cognitive impairment, fall risk
all medications approved FDA for sleep have what
sleep behaviors warning
ramelteon is contraindicated with what drug
fluvoxamine
ramelteon side effects
GI upset, next day somnolence, hyperprolacinemiat
tasimelteon and ramelteon are ____ substrates
1A2
orexin antagonists
suvorexant, lemborexant, daridorexant
how much sleep should you get with orexin antagonists
at least 7 hours
orexin -exants contraindication
narcolepsy
orexin antagonists are ____substrates
3a4
how does doxepin work
tricyclic antidepressant exerts effect through H1 histamine antagonism
doxepin side effects
anticholinergic
trazodone is ____ for insomnia
not FDA approvedt
trazodone has a _____ halflife
long, next day hangover
mirtazapine use
sleep agent for use in depression
quetiapine for sleep ?
low dose not recommended unless comorbid psych disorder
melatonin is a _____ substrate
1A2
german chamomile consideration
allergic rxn in pts with daisy/ragweed allergy
obstructive sleep apnea diagnosis
at least 5 obstructive apneas per hour of sleep confirmed by polysomnography
obstructive sleep apnea symptoms
excessive daytime sleepy
snoring
pauses in breaths
headache
irritability
sore throat
ED
GERD
if pts have insomnia and apenea what should be treated first
apnea
when do we do polysomnography?
cardiorespiratory disease
sleep related hypoventilation
chronic opioid medication use
hx stroke
severe insomnia
treatments for sleep apnea
weight loss
smoking cessation
avoid alcohol/CNS depress
sleep on side
medication for sleep apnea
CPAP
modafanil
armodafanil
narcolepsy tetrad
excessive daytime sleepiness
cataplexy (weakness)
hallucinations
sleep paralysis
meds for cataplexy
sodium oxybate (Xyrem)
Xywav
Lumryz
Xywav sodium content and age of use
low sodiun
7 and older
Lumryz dosing and age
ER dosage form, once nightly dosing, adults only
excessive daytime sleepiness treatment drugs
modafanil/armodafanil
sodium oxybate
pitolisant
solriamfetol
narcolepsy drugs with potential rash
modafanil, armodafanil
pitolisant MOA
H3 antagonist, inverse agonist
pitolisant contraindication
hepatic impairment
pitolistant concert
QT interval
pitolisant substrate and inducer
2D6/3A4
induces 3A4
pitolistant caution with which drug
oral contraceptives, reduce efficacy of OCs
what to avoid with pitolisant
OTC antihistamines
H1 antagonists
solriamfetol MOA
dopamine norepinephrine reuptake inhibitor
avoid solriamfetol in what
CV disease, bipolar, psychosis,
dosing of solriamfetol
start 37.5 max 75
renal: starting and max dose 37.5
monitoring for solriamfetol
BP and HR, can increase
treatment for wakefulness or night shift workers
modafanil, armodafanil
when to take modafanil and armodafanil
1 hour before work period starts
restless leg syndrome treatment
gabapentin enacarbil
ropinerole, pramipexole
iron supplementation
