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7453 Neuro Test 4 > Sleep/Wake Disorders > Flashcards

Sleep/Wake Disorders Flashcards

1
Q

2 types of primary sleep disorders according to DSM-5?

A
  • dyssomnias

- parasomnias

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2
Q

What is the most common dyssomnia?

A

primary insomnia

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3
Q

What kind of sleep disorder are nightmares, sleep terrors, and sleepwalking?

A

parasomnias

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4
Q

2 major phases of sleep cycle?

A
  • REM (25%)

- NREM (75%)

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5
Q

How long is is one sleep cycle?

A

70-120mins

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6
Q

Which NREM stage is a transition to sleep (0.5-7mins), low voltage EEG?

A

stage 1

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7
Q

Which NREM stage is associated with sleep spindles 10-16Hz EEG?

A

stage 2

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8
Q

Which NREM stage has high amplitude slow waves?

A

stage 3 and 4

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9
Q

Which sleep phase is low voltage, mixed frequency?

A

REM

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10
Q

How many sleep cycles/night?

A

4-6

dreams occur in the last part

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11
Q

Which neurotransmitter in the locus ceruleus maintains normal sleep pattern, causing increased activity and decreased REM sleep?

A

NE

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12
Q

5 brain regions involved in NREM?

A
  • hypothalamus
  • basal forebrain
  • thalamus
  • medulla
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13
Q

Cholinergic cells in what three areas affect REM?

A
  • mesencephalic
  • medullary
  • pons
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14
Q

Which neurotransmitter is involved in sleep regulation?

A

serotonin

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15
Q

Does a decrease in 5HT/dorsal raphe damage increase or reduce sleep?

A

reduce

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16
Q

Which neurotransmitter has an alerting effect?

A

dopamine

increase causes wakefulness, decrease causes sleepiness

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17
Q

The DSM5 describes primary insomnia as difficulty falling asleep, maintaining sleep, or non restorative sleep for at least ___ months and ___ nights/week.

A

3, 3

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18
Q

6 Pharmacological causes of insomnia?

A
  • anticonvulsants
  • central adrenergic blockers
  • diuretics
  • SSRIs
  • steroids
  • stimulants
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19
Q

What sleep agent was removed by the FDA?

A

L-tryptophan

caused 27 deaths to eosinophilia-myalgia

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20
Q

Diphenhydramine is a potent inhibitor of what CYP?

A

2D6

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21
Q

How long does it take for max diphenhydramine sedation?

A

1-3hrs

duration of sedation: 3-6hrs

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22
Q

Which non-benzo is the oldest agent metabolized to trichloroethanal with a half life of 8hrs?

A

chloral hydrate

REM/NREM not markedly altered

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23
Q

What kind of agents are glutethimide, methyllprylon, and ethchlorvynol?

A

barbiturate-like agents

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24
Q

Low dose __ 3-6mg is FDA approved for insomnia maintenance?

A

doxepin

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25
Q

Sleep apnea pts that are still sleep with CPAP can be given what two drugs?

A
  • modafinil

- armodafinil

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26
Q

Venlafaxine, fluoxetine, sodium oxybate, imipramine, protriptyline, or selegiline are given for narcolepsy, excessive daytime sleepiness or sleep paralysis/cataplexy/hypnagogic hallucinations?

A

sleep paralysis/cataplexy/hypnagogic hallucinations

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27
Q

What is given if no adequate response to initial short term insomnia Tx?

A
  • trazodone
  • different BZDRA
  • suvorexant
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28
Q

3 Tx options for jet lag (circadian rhythm disorder)?

A
  • short acting benzo
  • ramelteon
  • melatonin
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29
Q

Zolpidem is metabolized by what CYP?

A

3A4

interactions with ketoconazole and rifampin; no interactions with cimetidine

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30
Q

Does zolpidem cause tolerance?

A

no

no tolerance, no rebound insomnia, no next day psychomotor activities

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31
Q

___ binds to the BZ-1 receptor producing minimal anxiolytic effects and no muscle relaxant and antiepileptic effects?

A

zolpidem

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32
Q

Duration of zolpidem?

A

6-8hrs

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33
Q

Should zolpidem be taken with food?

A

no

decreases AUC, take on empty stomach

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34
Q

Do women or men need lower zolpidem doses?

A

women

50% lower than men

CYP3A4 activity lower in women, but this is one of few drugs shown to have PK difference

pronounced PD effects

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35
Q

Which Z drug is metabolized by aldehyde oxidase?

A

zaleplon

duration only 4-5hrs

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36
Q

What effect do cimetidine and rifampin have on zaleplon?

A

cimetidine: increases Cpss
rifampin: decreases Cpss

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37
Q

Which Z drug binds to GABA receptor allosterically close to benzo receptors?

A

eszopiclone

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38
Q

Eszopiclone is metabolized by what two CYPs?

A
  • 3A4

- 2E1

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39
Q

Which Z drug causes unpleasant taste, HA, and sedation?

A

eszopiclone

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40
Q

Eszopiclone is FDA approved for up to __ months

A

6

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41
Q

What is eszopiclone dose for elderly pts?

A

< 2mg

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42
Q

What nonbenzo is a melatonin receptor agonist with one active metabolite?

A

ramelteon (Rozerem)

43
Q

Which sleep drug should be dosed carefully in pts with liver problems, but not renally impaired pts?

A

ramelteon

metabolized by CYP1A2, 2C, and 3A4

44
Q

Ramelteon recommended dose is __mg and take within __ mins of bedtime.

A

8, 30

45
Q

Should ramelteon be taken with food?

A

no

increases AUC 31%
decreases Cmax 22%
delay of Tmax by 45mins

46
Q

What drug causes a 190 fold AUC increase and 70 fold Cmax increase in ramelteon?

A

fluvoxamine

47
Q

Benzos increase what sleep stage?

A

stage 2

48
Q

Benzos decrease the durations of what sleep stages?

A

1, 3, 4

49
Q

Typical use FDA approved duration of benzos for sleep is __ to __ days.

A

14, 28

50
Q

How should benzos be taken for transient insomnia?

A

3-4 nights/week for 3-4 weeks

stressors > 1 week

51
Q

5 FDA approved benzos for sleep?

A
  • estazolam
  • eszopiclone
  • flurazepam
  • quazepam
  • temazepam
52
Q

3 flurazepam metabolites?

A
  • desalkyl (up to 100hrs half life)
  • hydroxyethyl
  • aldehyde
53
Q

Which orexin receptor antagonist decreases hyperarousal and improves sleep?

A

suvorexant

54
Q

Stay in bed how long with suvorexant and lemobrant?

A

7hrs

take 30mins before sleep

55
Q

Do obese women have higher or lower suvorexant AUC?

A

higher 46%

56
Q

Do not take > __mg of suvorexant.

A

20

57
Q

Avoid strong/moderate CYP__ inhibitors with lemobrant?

A

3A4

max 5mg dose with weak 3A4 inhibitors

58
Q

Orexin antagonists should be used with caution in __ pts

A

narcolepsy

59
Q

Primary hypersomnia is excessive sleepiness for at least ___, prolonged sleep episodes or daytime sleepiness almost daily.

A

1 month

60
Q

Primary hypersomnia is average sleep time of > __hrs

A

9

evaluate over 10-14 days

61
Q

What is Kleine-Levin syndrome?

A

primary hypersomnia

sleep as along as 18020hrs/day

usually in males

62
Q

Treatment with ___ is effective in 3/4 of Kleine-Levin syndrome

A

stimulants

63
Q

Mild sleep apnea AHI?

A

5-15/hr

64
Q

Moderate sleep apnea AHI?

A

15-30/hr

65
Q

Severe sleep apnea AHI?

A

> 30/hr

66
Q

Severe obstructive sleep apnea is > __ apneas/hr and excessive daytime sedation.

A

20

moderate: 5-10 apneas/hr

67
Q

For obstructive sleep apnea avoid all CNS depressants except possibly __

A

zaleplon

68
Q

__ is indicated for obstructive sleep apnea at 200-400mg/day

A

modafinil (Provigil)

69
Q

What is treatment for central sleep apnea?

A

PAP and ventilatory O2

< 10%, temporary loss of respiration during sleep

70
Q

3 drug choices for Tx of mild OSA?

A
  • SSRIs (fluoxetine)
  • clonidine
  • TCAs (protriptyline)
71
Q

Narcolepsy is sleep attacks __ times/week for at least __ months

A

3, 3

72
Q

Narcolepsy:

__ is brief seconds-minutes sudden bilateral loss of muscle tone with consciousness precipitated by laughter or joking

A

cataplexy

73
Q

Narcolepsy is hypocretin < __ pg/mL

A

110

74
Q

EEG narcolepsy is sleep latency REM < __mins

A

15

75
Q

What chromosome is associated with narcolepsy?

A

4P13-q21

76
Q

What HLA antigen is associated with narcolepsy?

A

Dq6/DQB1

DR2

77
Q

In narcolepsy the neuropeptide orexin (hypocretin) is found only in the posterior or lateral __

A

hypothalamus

78
Q

Do increased or decreased levels of orexin cause sleepiness?

A

decreased orexin = sleepy

79
Q

What drug was used to treat canine narcolepsy/cataplexy?

A

venlafaxine

80
Q

Narcolepsy daytime sleep attacks last up to ___ mins

A

30

84% occur before age 30

81
Q

Narcolepsy:

Sleep paralysis occurs during falling asleep and upon awakening and lasts up to __ mins

A

10

82
Q

Narcolepsy:

__ hallucinations occur when falling asleep and are usually visual, but can be auditory/tactile and bizarre?

A

hypnagogic

occur weekly

83
Q

Narcolepsy:

__ hallucination occur upon awakening and last < 10 mins

A

hypnopompic

84
Q

What is gamma-hydroxybutyrate a Tx for?

A

narcolepsy

85
Q

Narcolepsy:

All stimulants are ineffective for ___ symptoms.

A

cataplectic

86
Q

What is the least sedating agent for cataplexy?

A

protriptyline

87
Q

___ is effective for hypersomnia and cataplexy

A

selegiline

88
Q

What SNRI is used for cataplexy?

A

venlafaxine

89
Q

The FDA approved ___ in 2002 in oral solution (CIII) for excessive daytime somnolence?

A

sodium oxybate

90
Q

Is GHB Cmax higher or lower with food?

A

lower

70% higher Cmax while fasted

91
Q

Which narcolepsy drug has risk management program?

A

GHB

orphan and FDA worked out a system to minimize diversion

92
Q

GHB risk management program MDs are allowed to write for __ months and reevaluate pts. Refills for only __ months.

A

3, 3

93
Q

What type of dyssomnia is common among the blind and pts with traumatic brain injury?

A

non-24hr sleep wake type

94
Q

What MT1/MT2 receptor agonist is used to treat non-24hr sleep wake type dyssomnia?

A

tasimelton

95
Q

Should tasimelton be taken with food?

A

no

96
Q

Tasimelton is metabolized by what 2 CYPs?

A
  • 1A2

- 3A4

97
Q

What is Ekbon’s syndrome?

A

restless legs syndrome (dyssomnia)

98
Q

___ are defined as acute, episodic, and physical phenomena occurring during sleep.

A

parasomnias

99
Q

Somnambolism (parasomnia) occurs within first ___ hours of sleep

A

3

100
Q

Are violent behaviors associated with somnambolism/

A

no

101
Q

Are violent behaviors associated with sleep terrors?

A

yes

102
Q

3 things used to Tx sleep related eating disorder?

A
  • opiates
  • dopaminergic agents (L-dopa)
  • topiramate
103
Q

Parasomnias are often self limiting.

a. true
b. false

A

a. true

104
Q

What are the two most common Sx found in persons with narcolepsy?

A
  • daytime sleepiness

- cataplexy

7453 Neuro Test 4 (9 decks)

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