stroke, sleep

Question 1

drugs to avoid in OSA

Answer 1

CNS depressants:
- benzos
- z drugs
- opioids
- antihistamines
- sedating antidepressants
- barbiturates
- gabapentin

alcohol
drugs that inc weight

Question 2

OSA first line

Answer 2

CPAP or BYPAP

Question 3

OSA treatment if still EDS and on PAP

Answer 3

• modafinil
• armodafinil
• solriamfetol
• pitolisant

**all wakefulness promoting agents

Question 4

modafinil and armodafinil dose

Answer 4

in morning (makes sense)

Question 5

modafinil and armodafinil CI

Answer 5

• pregnancy
• CV disease (left ventricular hypertrophy)

Question 6

modafinil and armodafinil DDI

Answer 6

dec effectiveness of contraception (3a4 inducers)

Question 7

modafinil and armodafinil AE

Answer 7

• **HA
• dizzy
• N

***SJS/TENS/DRESS

Question 8

modafinil and armodafinil warnings

Answer 8

• maina, exacerbation of psychosis
• CV events

Question 9

modafinil MoA

Answer 9

• inc DA, dec GABA, inc serotonin

Question 10

armodafinil MoA

Answer 10

r-enantiomer of modafinil
- inc DA

Question 11

solriamfetol MoA

Answer 11

DA and NE reuptake inhibitor

Question 12

solriamfetol dose

Answer 12

qd in morning
**avoid within 9 hours of bed

Question 13

solriamfetol CI

Answer 13

• MAOI (14 day washout)
• unstable CVS, arrhythmia

Question 14

solriamfetol AE

Answer 14

• HA
• insomnia

Question 15

pitolisant MoA

Answer 15

antagonist at histamine-3 receptors

**not controlled
- off label for EDS in OSA –> approved in narcolepsy

Question 16

pitolisant dose

Answer 16

qd in morning
- lower MDD if poor 2D6 metabolism or 3A4 DDI

Question 17

pitolisant CI

Answer 17

• severe hepatic impair
• arrhythmias