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MJ- Pharm Exam 3 > Sleep Wake 2- SG > Flashcards

Sleep Wake 2- SG Flashcards

1
Q

What are the 3 “newer hypnotics?”

A
  • Zolpidem
  • Zaleplon
  • Eszopiclone
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2
Q

Do benzodiazepines or “newer hypnotics” bind more selectively?

A

Newer hypnotics

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3
Q

When taking “newer hypnotics,” what drug can antagonize CNS depressant effects?

A

Flumazenil

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4
Q

What is a barbiturate that is not available in the US, is an adjunct to anesthesia (rapid / short acting) and is used as a truth serum?

A

Thiopental

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5
Q

Which drug?

  • Facilitates / prolongs inhibitory effects of GABA and glycine
  • Binds to receptor site different from benzodiazepines
  • Actions not antagonized by flumazenil
  • May also block excitatory transmitter glutamic acid & at high concentrations (sodium channels)
A

Barbiturates (tal)

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6
Q

3 uses for Barbiturates

A
  • Anesthesia (thiopental)
  • Insomnia / Sedation (secobarbital)
  • Seizure disorders (phenobarbital)
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7
Q

Which drug?

  • Extension of CNS depressant actions
  • Tolerance
  • Dependence liability > benzodiazepine
A

Toxicities of Barbiturates

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8
Q
  • Which drug leads to coma/death?
  • Which drug leads to just medullary depression/anesthesia?
A
  • Barbiturates (coma)
  • Benzodiazepines (anesthesia)
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9
Q

______ & _____ induce liver enzymes causing drug interactions.

A
  • Barbiturates
  • Carbamates
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10
Q

Barbiturates and carbamates induce liver enzymes causing drug interactions.

  • Enzyme induction
  • Can precipitate acute intermittent _____ in susceptible patients
  • ___ ____ may displace coumarins from plasma protein binding sites and increase anticoagulant effects
A
  • porphyria
  • Chloral hydrate
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11
Q

Which drug?

  • exhibit sedating properties
  • effective in tx of mild insomnia & are generally safe
  • tolerance develops to sedative effects
  • increasing the dose will not produce linear increase in response
  • Disadvantage of ______ side effects
  • Histamine 1 receptor
A

Antihistamines

  • anticholinergic
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12
Q

Antihistamines

  • Diphenhydramine & doxylamine are more sedating than ______.
A

pyrilamine

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13
Q

Which drug?

  • Are effective for inducing “sleep continuity”
  • anticholinergic activity
  • adrenergic blockade
  • cardiac conduction prolongation adverse effects
A

Antidepressants

  • amitriptyline
  • doxepin
  • nortriptyline
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14
Q

Low dose ____ has FDA approval for tx of sleep maintenance insomnia.

A

Doxepin

(antidepressant)

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15
Q

What are the 2 sedating antidepressants?

  • ___ may promote sleep (cause daytime sedation/weight gain)
  • ____ at bedtime is sedating and can improve sleep continuity
A
  • Mirtazapine
  • Trazodone
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16
Q

Which antidepressant should you prescribe for:

  • pts prone to substance abuse (dependence is NOT a problem)
  • pts w. selective serotonin reuptake inhibitor & buproprion-induced insomnia
A

Trazodone

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17
Q

Which drug’s side effects?

  • Carryover sedation
  • alpha adrenergic blockage –> orthostasis can occur at any age, but is more dangerous in elderly
  • Priapism is a rare but serious side effect (prolonged erection)
A

Trazodone

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18
Q

Which antidepressant turns off wake signaling orexin (hypocretin)?

A

Suvorexant

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19
Q

What is the primary role of Orexin?

A

control of sleep and arousal

20
Q

Instead of inducing sleepiness, Suvorexant does what?

A

Turns off wake signaling

21
Q

What are the 4 most commonly reported side effects of Suvorexant?

A
  • Somnolence (MC)
  • Sleep paralysis
  • Cataplexy
  • Narcolepsy-like sxs
22
Q
  • What drug is approved for tx of sleep onset insomnia?
  • Selective MT1 & MT2 receptors
  • Regulates circadian rhythm & sleep onset
A

Remelteon (a melatonin receptor agonist)

23
Q

Ramelteon is a melatonin receptor agonist

  • forms _____ via CYP1A2
  • Generally well tolerated
  • What are the 3 MC adverse events?
A
  • active metabolite
  • HA, dizziness, somnolence
24
Q

Ramelteon (melatonin receptor agonist) effectively treats ____ in patients w/ which 2 conditions?

A
  • sleep onset difficulties
  • COPD & sleep apnea
25
Q

Which drug?

  • herbal sleep remedy
  • studied for its sedative-hypnotic properties in pts w/ insomnia
  • MOA not fully understood
  • May involve increasing concentrations of _____.
A

Valerian

  • GABA
26
Q

Pts complain bc this drug smells like old gym socks

A

Valerian (herbal sleep remedy)

27
Q

What 4 characteristic sxs differentiate narcolepsy from other sleep disorders?

(Narcolepsy tetrad)

A
  • Excessive daytime sleepiness
  • Cataplexy
  • Hallucinations
  • Sleep paralysis
28
Q
  • Impairment of both onset and offset of REM/NREM sleep
  • Arousals & disturbed sleep during the night
A

Excessive Daytime Sleepiness

(Part of Narcolepsy Tetrad)

29
Q
  • Sudden bilateral loss of muscle tone varying severity / duration w/o loss of consciousness
  • Often precipitated by highly emotional situations
  • Brief, lasting ___ to ____
A

Cataplexy

  • Seconds to several minutes
30
Q
  • Falling asleep (hypnagogic) & on awakening (hypnopompic)
  • Brief, dream-like experiences that intrude wakefulness
  • 70% of narcoleptics experience this
A

Hallucinations

(1 of 4 characteristics of Narcolepsy)

31
Q
  • Episodic loss of voluntary muscle tone that occurs when the individual is falling asleep or waking
  • Conscious but not able to move or speak
A

Sleep paralysis

32
Q

Narcolepsy is dysfunction of _____ system

A

hypocretin / orexin neurotransmitter system

33
Q

Vaccines licensed in US w/o adjuvants are or are not associated w/ increased risk of narcolepsy?

A

Are not

34
Q

Wake Disorder Tx options include

  • encouragement of good sleep hygiene and __ or more daytime naps daily (as little as 15 mins)
  • Pharmacotherapy focuses on ____ and ____ sleep abnormalities
A
  • 2
  • EDS (Excessive Daytime Sleepiness) & REM sleep
35
Q

3 tx for EDS (Excessive Daytime Sleepiness)

“MAM”

A
  • Modafinil
  • Armodafinil
  • Methylphenidate
36
Q

Tx for Cataplexy?

A

Tricyclic antidepressants (TCA)

SNRI, SSRI, MAOI

37
Q

Tx for EDS, Cataplexy, Hallucinations

A

Sodium oxybate

38
Q

What is the standard of tx for EDS?

Which other drug is FDA approved?

A
  • Modafinil
  • Armodafinil
39
Q

4 SE of Modafinil

A
  • HA
  • nausea
  • Nervousness
  • Insomnia
40
Q

Which 2 drugs?

  • Fast onset of effect
  • One has more risk of abuse/tolerance
  • SE: insomnia, HTN, palpitations, irritability
A

Amphetamines & Methylphenidate

(Amphetamines have more risk of abuse/tolerance)

41
Q

Drug tx for what condition?

  • MOA: blockade of serotonin & norepinephrine reuptake in locus coeruleus & raphe and subsequent suppression of REM sleep
  • Tricyclic antidepressants
  • SNRI
  • SSRI
    *
A

Cataplexy

42
Q

What is the drug tx for Hypersomnolence and Cataplexy?

A

Selegiline

(REM suppression & increase in REM latency)

43
Q
A
44
Q

Which drug?

  • Tx for EDS, sleep paralysis, cataplexy, & hypnagogic hallucinations
  • Potent sedative (hypnotic)
  • Should NOT be used concomitantly w/ any other sedating medications
  • Changes “sleep architecture” to resemble normal sleep
A

Sodium oxybate

45
Q

5 SE of Sodium oxybate

(used to tx EDS, sleep paralysis, cataplexy, hypnagogic hallucinations)

A
  • Dizziness
  • Incontinence
  • Confusion
  • Somnolence
  • Nausea

(DICS Now)

MJ- Pharm Exam 3 (17 decks)

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