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iTx ii > Sleep/Wake Disorders > Flashcards

Sleep/Wake Disorders Flashcards

1
Q

Benzodiazepines (BZDs)

A

Temazepam, Triazolam

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2
Q

Nonbenzodiazepine GABAa Agonists

A

Eszopiclone, zaleplon, zolpidem

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3
Q

Melatonin receptor agonist

A

Ramelteon

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4
Q

Nonprescription/OTC sleeping aids

A

Diphenhydramine, melatonin, valerian root

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5
Q

Orexin receptor antagonist

A

Suvorexant, Lemborexant

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6
Q

Sedating antidepressants

A

Doxepin

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7
Q

BZD Hypnotics

A

-relieve insomnia by reducing sleep latency and increasing total sleep time
-triazolam (Halcion), temazepam (Restoril), estazolam (ProSom)

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8
Q

Contraindications of BZD Hypnotics

A

-pregnancy
-untreated sleep apnea
-hx of substance abuse
-obstructive sleep apnea
–AVOID alcohol and other CNS depressants

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9
Q

BZD Hypnotics con’t
-use in elderly population

A

-half-lives are prolonged in older patients which increases incidence of CNS SE
—flurazepam and quazepam are not recommended (assoc. w/ increased risk of falls and hip fractures)

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10
Q

Nonbenzodiazepine GABA-A Agonists used to treat…

A

-useful for decrease sleep latency
-selectively bind to GABA-A receptors and effectively include sleepiness
-no significant active metabolites

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11
Q

Zolpidem (Ambien, Ambient CR, Intermezzo, Edluar)

A

-effective at reducing sleep latency. nocturnal awakenings, increasing total slow time. no significant effects on next-day psychomotor performance

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12
Q

Zolpidem AE

A

drowsiness, amnesia, dizziness, HA, GI complaints (dose-related)
sleep eating –> weight gain

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13
Q

What NBZD formulation has the fastest onset of action and helps with middle of night awakening?

A

Zolpidem sublingual

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14
Q

Rozerem (Ramelteon)

A
  • A melatonin receptor agents approved for the treatment of sleep onset insomnia
    — selective for the MT1 and MT2 melatonin receptors, thought to regulate the circadian rhythm and sleep onset for use up to six months
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15
Q

Rozerem (Ramelteon) AE

A

-HA, dizziness, somnolence
(generally well-tolerated)

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16
Q

Meds recommended for sleep onset Insomnia

A
  • eszopiclone (Lunesta)
  • Ramelteon (Rozerem)
  • Temazepam (Restoril)
  • Triazolam (Halcion)
  • Zaleplon (Sonata)
  • Zolpiden (Ambient, Intermezzo)
17
Q

Meds recommended for sleep maintenance Insomnia

A
  • Doxepin (Silenor)
  • Eszopiclone (Lunesta)
  • Temazepam (Restoril)
  • Suvorexant (Belsomra)
  • Zolpidem (Ambient, Intermezzo)
18
Q

What consists of the Narcolepsy Tetrad?

A
  • excessive daytime sleepiness (EDS)
  • hallucinations
  • sleep paralysis
  • cataplexy
19
Q

Narcolepsy non-pharmacological approach

A
  • pt counseling
  • good sleep hygiene
  • family awareness to alleviate misconceptions about individual’s behavior
  • two or more schedule daytime naps lasting 15 minutes each
20
Q

Pharmacologic Mgmt. of Narcolepsy:
Treatment of Excessive Daytime Sleepiness

A

Modafinil; Armodafinil
Methylphenidate
Dextroamphetamines
Amphetamine-Dextroamphetamine

21
Q

Pharmacologic Mgmt. of Narcolepsy:
For Cataplexy

A

Venlafaxine
Fluoxetine
Clomipramine

22
Q

Stimulants MOA

A

CII
-promote wakefulness by blocking the reuptake of/and increase the release of dopamine

23
Q

Cataplexy Treatment

A

most common treatments is TCAs (clomipramine (off-label use), imipramine, nortripyline)
- moa: through blockade of serotonin and norepinephrine reuptake in the brain to suppress REM sleep

24
Q

FDA approved meds for Narcolepsy

A
  • sodium oxybate (Xylem)
  • Ca/Mg/K/Na oxybate (Xywav)
  • Solriamfetol (Sunosi)
  • Pitolisant (Wakix)
    *all used for both with the exception of Solriamfetol–EDS only-not Cataplexy
25
Q

Sodium oxybate (Xyrem)

A
  • improves EDS, decreases episode of sleep paralysis, cataplexy, hypnagogic hallucinations
26
Q

Sodium oxybate (Xyrem) MOA

A

MOA: GABA-B agonist that modulates GABA-A and GABA-C
-changes sleep architecture to resemble normal sleep
-increases slow-wave sleep, decreases nighttime awakenings, and increase REM efficiency

27
Q

Sodium oxybate (Xyrem) CI, SE, etc.

A

CI: avoid use with other CNS depressants
SE: nausea, somnolence, confusion, dizziness, and incontinence
**REMS drug! - only available as liquid

28
Q

What is sodium oxybate (Xyrem) FDA approved for?

A

cataplexy and narcolepsy
excessive somnolence - narcolepsy

29
Q

Restless Legg Syndrome

A

first line: Dopamine Agonists & Anticonvulsants

30
Q

Dopamine Agonists

A
  • pramipexole, ropinirole, rotigotine patch
  • Adverse Rxn: compulsive behavior
31
Q

Anticonvulsants

A
  • gabapentin, pregabalin
  • adverse rxn: dizziness
32
Q

Iron therapy in RLS

A

Data suggests that RLS can be caused by iron deficiency in the substantial nigra in the CNS

33
Q

Parasomnias non-pharm. treatments

A
  • putting safety latches on doors windows
  • removing hazardous. objects from bedrooms
  • covering glass doors with heavy curtains
34
Q

Parasomnias pharm. treatment

A
  • BZD (FOR slp terrors and sleepwalking)
    —- > Clonazepam is the treatment of choice for REM behavior disorder
  • SSRIs (NREM behavior disorders + sleepwalking)
  • TCAs (NREM behavior disorders + sleepwalking)
  • Melatonin (REM behavior disorders)
  • Pramipexole (REM behavior disorders)

iTx ii (4 decks)

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