Sleep-Wake DOs Flashcards
- Which are Non-Benzo BZRAs?
- Which are Benzos Hypnotics BZRAs?
- Eszopiclone, Zaleplon, Zolpidem
- Estazolam, Flurazepam, Temazepam, Triazolam, Quazepam
BZRAs = Benzo Receptor Agonists
- Non-Benzo BZRAs = Eszopiclone, Zaleplon, Zolpidem
- Benzo BZRAs = Estazolam, Flurazepam, Temazepam, Triazolam, Quazepam
1st line Pharm Tx options for Insomnia
Which sleeping DO is Doxepin and Ramelton used for?
Insomnia
Wake-promoting chemicals
- Orexin
- Catecholamine
- Histamine
Sleep-promoting chemicals
- GABA
- Serotonin
- Adenosine
- Melatonin
- Prostaglandin
Hypersomnolence Tx
- Modafinil (Non-amphetamine CNS Stimulant)
- Armodafinil, Methylphenidate, Amphetamines
- Oxybate Salts (Xywav) -> DEEP SLEEP (REMS Program d/t date rape)
- Mixed Oxybate salts (Xywav) is for _____
- Sodium Oxybate (Xyrem) is ONLY for ______
Narcolepsy or Hypersomnia
Xywav = Hypersomnia
Xyrem = Narcolepsy ONLY
What is Cataplexy? What sleeping DO is this commonly seen in?
Sudden muscle weakness
Narcolepsy Type 1
In order to be Dx with CHRONIC Insomnia, Hypersomnolence, or Narcolepsy, you must have difficulty ____ nights a week for 3mo+
3
Drug class?
* Daridorexant, Lemborexant, Suvorexant
Dual Orexin Receptor Antagonists (DORAs)
Orexin keeps you awake. Antagonize Orexin -> SLEEPY
Used for insomnia
Drug Class?
Doxepin
Low-dose Histamine Receptor Antagonist
used for insomnia
Drug Class?
Ramelteon
Melatonin Receptor Agonist
used for insomnia
Narcolepsy Tx
- Modafinil, Armodafinil, Pitolisant, Solriamfetol
- Amphetamines, Methylphenidate
- Severe sleepy & fail 1 med or Severe Cataplexy -> ADD or SWITCH Oxybates
- Residual Cataplexy -> Effexor, Fluoxetine, Duloxetine, TCA
- Milder Insomnia -> Short BZRA
- Peds -> Traditional stimulants or Oxybates
Hyperventilation -> _____
Hypoventilation -> _______
CPAP or BIPAP?
Hyperventilation -> CPAP
Hypoventilaiton -> BiPAP
OSA Dx
* ____ Apneas/Hr + SS
* _____Apneas/Hr (regardless if SS or not)
- 5 Apneas/Hr + SS
- 15 Apneas/Hr
Central Sleep Apnea Dx
_____ Apneas/Hr
5
Sleep related hypoventilaiton DO is episodes of _____Respiration with ____PaCO2
High or low?
LOW Respiration
HIGH PaCO2
Tx for Sleep related hypoventilation DO
BiPAP
Tx for Delayed Sleep Phase Type
A SPECIFIER for any sleeping DO
- Bright light therapy
- Chronotherapy
- Melatonin
- Ramelteon (melatonin receptor agonist)
Tx for advanced sleep phase type DO
Bright light therapy
Melatonin
Which sleeping DO?
Old person goes to bed early (6-9pm) and wakes up early (2-5am)
Advanced sleep phase type DO
- Delayed sleep phase type = young person on their phone all night
- Advanced sleep phase = seen in ADVANCED ages (old ppl)
Which sleeping DO?
Sleep during day and awake at night
Irregular Sleep-wake DO
Irregular Sleep-Wake DO Tx?
- Bright light therapy
- Structured physical/social activity
- Melatonin
Non-24Hr sleep-wake DO:
SS?
WU?
- Sleep time jumps around
- Sleep Diary
Non-24Hr sleep-wake DO Tx:
- Blind?
- Sighted?
- Blind -> Melatonin, Tasimelteon
- Sighted -> Melatonin
Tasimelteon (Hetlioz) $$$ Melaotnin Agonist is Melatonin fails or pt doesnt want to try it
Shift Work Sleeping DO Tx
- Change work schedule
- Sleep schedule
- Zolpidem (Ambien) - Non-Benzo BZRA
- Triazolam, Temazepam - Benzo BZRA
BZRA = Benzo Receptor Agonist
Sleepwalking and nightmare DO are _____ Sleep DOs
NREM or REM?
NREM (Non-rapid eye mvmnt)
Tx for SEVERE Sleepwalking
- #1 & #2
- Sexual Behaviors?
- Eating SS?
- Melatonin
- Benzos - Clonezapam (Klonopin)
- Sexual -> SSRIs
- Eating -> Topiramate (Anticonvulsant)
Pharm Tx for Nightmare DO
Prazosin
Tx for REM sleep DO
- Melatonin
- Clonazepam (Klonopin)
- Donepezil (Aricept), Revastigmine (Exelon) - Ach Inhib
Restless leg syndrome Dx: ss for ____mo+
3
Restless leg syndrome Tx
Restless Leg Tx if daytime ss
Carbidopa-Levodopa PRN (benzo)
Restless leg Tx if CHRONIC
- GABA (Pregabalin, Gabapentin)
- Dopamine Agonist (Pramipexole, Ropinirole, Rotigotine)
Restless leg Tx if REFRACTORY
- Combo -> Dopamine agonist, GABA, Benzos
- Low-dose Tramadol, Codeine
- High-potency Oxycodone, Methadone
