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Exam 6 > Sleep-wake disorders > Flashcards

Sleep-wake disorders Flashcards

1
Q

What are the 5 benzodiazepines that are FDA approved for insomnia and which is most commonly prescribed?

A

Temazepam is most commonly prescribed
others: estazolam, furazepam, quazepam, triazolam
all are pregnancy category X

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2
Q

MOA for benzodiazepines and insomnia:

A

nonselective binding BZ-GABA

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3
Q

Tolerance to benzodiazepines for insomnia develops after ____

A

1 month

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4
Q

What effect does zolpidem have on sleep stages

A

increase stage 2, decrease REM

no effect stage 3

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5
Q

MOA for nonbenzodiazepine receptor agonists is?

A

enhancement of GABA. selective binding to α-1->sedation

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6
Q

What is the big warning with using zolpidem (ambien)? What dosing should be used in females + geriatric patients?

A

complex sleep behaviors (walking, eating, driving)

IR->5mg. CR-> 6.25mg (decreased clearance)

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7
Q

What is the difference between Zolpidem IR and Zolpidem CR?

A

IR is labelled for short term use and the max dose is 5

CR not labelled for short term use and the max dose is 6.25

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8
Q

Why would a patient take Zaleplon (sonata)

A

take if patient wakes in the middle of night but has >4 hours before waking up for the day.
short half life (no effect on next morning)

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9
Q

Zaleplon (sonata) is labelled for (short/long) term use

A

short <1month

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10
Q

Eszopiclone (lunsta) use and duration of action

A

decrease sleep latency + number awakenings

duration of axn up to 6 hours

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11
Q

Eszopiclone (lunesta) is labelled for (short/long) term use

A

long

the choice NZBRA for chronic insomnia

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12
Q

What is the benefit for taking nonbenzodiazepine receptor agonist over benzodiazepines? Why is that?

A
  • lower rates of withdrawal, tolerance, rebound insomnia, daytime sedation
  • selective for α1
  • no active metabolites
  • reduced effect on sleep architecture
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13
Q

Nonbenzodiazepine receptor agonist should or should not be taken with food? How much before sleep time should it be taken?

A

Do not take with food-> delay absorption

Take 30 minutes before sleep time

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14
Q

Nonbenzodiazepine receptor agonists are metabolized by ___ with a short half life and ______

A

CYP3A4, no active metabolites

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15
Q

What are some conditions that would caution someone from being prescribed nonbenzodiazepine receptor agonists?

A

sleep apnea, respiratory disorders (COPD), liver disease, geriatric
better than BZ but still on Beer’s criteria

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16
Q

Nonbenzodiazepine receptor agonists are schedule __ and pregnancy category __?

A

IV (abused, avoid in SUD dependance, withdrawal)
C
need to taper to reduce

17
Q

Ramelteon (rozerem) MOA is

A

Agonist at melatonin MT1 and MT2

NO gaba effect

18
Q

Onset of effect and half life for Ramelteon?

A

Onset = 30 minutes

Half life = 3 hours

19
Q

What are adverse effects from Ramelteon?

A 
Really not many. 
Not controlled-> use in SUD
Not short term
Good choice for people who can't be on nonbenzodiazepine receptor agonist 
Preg category C
20
Q

Suvorexant (Belsomra) MOA is ?

A

Orexin receptor antagonist
reversible at orexin 1 and 2 receptors in hypothalamus->orexin rises in AM and effect down
no gaba affinity

21
Q

What are some adverse effects of suvorexant?

A

next day somnolence

block orexin on arousal->dampen arousal from hist, Ash, monoamines

22
Q

What is the half life of orexin

A

12 hours-> next day sleepiness

23
Q

Survorexant (is/is not) a controlled substance, used for (short/long) term use, should be taken ___ minutes before bedtime, and is pregnancy category __

A 
Is
long
30
C
do not take with food
24
Q

When would you use trazodone, doxepin, mitazapine for insomnia? What about quetiapine?

A

Comorbid depression
Comorbid anxiety, bipolar, or schizophrenia
For both: if failed other meds or contraindicated for BZ/NZBRA

25
Q

What is the different between modafinil and armodafinil? (Treatments for narcolepsy)

A

modafinil is a racemic mix, armodafinil is the r-isomer of modafinil

26
Q

What are the uses for modafinil and armodafinil?

A

Narcolepsy. This is excessive daytime sleepiness-> use to increase alertness and daytime performance.

27
Q

What is MOA for modafinil and armodafinil?

These are schedule ___

A

not well understood
Increase DA by inhibit reuptake inhibitor->increase hist and orexin
increase 5HT and glutamate -> decrease gaba
IV

28
Q

What is sodium oxybate (Xyrem) used for?

A

excessive daytime sleepiness, decrease sleep paralysis, cataplexy, hypnagogic hallucinations

29
Q

MOA for sodium oxybate (Xyrem)?

A

not well understood; agonist at GABA-B -> effects NE, DA, 5HT, gaba
increase slove wave sleep, decrease night awakenings, increase REM

Exam 6 (14 decks)

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