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Stroke & Sleep Flashcards

1
Q

mini stroke due to brief blockage of blood flow to the brain with temporary symptoms that go away quickly

A

transient ischemic attack

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2
Q

modifiable risk factors for stroke

A

hypertension, hyperlipidemia, smokinh, diabetes, Afib, CAD, obesity, post-menopausal hormonal therapy

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3
Q

nonmodifiable stroke risk factors

A

age >55, black/hispanic race, male FH, PH of stroke

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4
Q

most important piece of history for med administration for stroke

A

when was the last time they were normal

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5
Q

symptoms of stroke

A

visual changes, facial droop, motor function of arms/legs, limb ataxia, sensory changes, language, dysarthria

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6
Q

therapeutic time window for stroke for reversible deficits

A

<2 hours

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7
Q

therapeutic time window for stroke for some but incomplete recovery

A

2-6 hours

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8
Q

therapeutic time window for stroke for little recovery

A

> 6 hours

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9
Q

BP goals for someone who is not a candidate for thrombolytics

A

permissive HTN up to 220 mmHg systolic

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10
Q

2 choices of thrombolytics for stroke

A

alteplase (TPA)
tenecteplase (TNK)

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11
Q

AE of thrombolytics

A

intracerebral hemorrhage

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12
Q

BP goals while on thrombolytics

A

systolic <180 mmHg and diastolic <110 mmHg for 24 hours

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13
Q

IV agents for BP management for thromboloytics

A

labetalol and nicardipine

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14
Q

main reasons TNK differs from TPA

A

bolus only, longer half life

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15
Q

symptoms of a bleed from thrombolytics

A

acute neurologic change, HA, NV, acute HTN, lethargy

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16
Q

inclusion criteria for thrombolytics

A

ischemic stroke diagnosis
symptoms onset <4.5 hr prior to treatment
18 or older
deficit measured on NIHSS
CT w/ no evidence of ICH

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17
Q

when does 3 hours become the cutoff for thrombolytics

A

80 or older, severe stroke

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18
Q

2 main B&W exclusion criteria for thrombolytics

A

seizure at stroke onset
anticoagulants in the last 48 hours

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19
Q

drug class chosen for stroke prophylaxis when a small vessel lacunar, large vessel embolic, or large vessel thrombotic stroke

A

antiplatelet therapy

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20
Q

drug class chosen for stroke prophylaxis when cardioembolic

A

anticoagulant

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21
Q

MOA of clopidogrel & ticagrelor

A

irreversibly blocks ADP receptors on platelets

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22
Q

MOA of aspirin

A

inhibits COX1 and thromboxane

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23
Q

why is prasugrel not used for stroke

A

BBW/CI for stroke
increased risk for cerebral hemorrhage

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24
Q

plavix is a prodrug activated by _ & __ which can lead to DDIs

A

CYP3A4 & 2C19

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25
potential 3A4 & 2C19 DDIs with plavix
statins (not crestor) CCBs Ambien/Lunesta Glyburide PPIs
26
max dose of ASA when taking brilinta
100 mg
27
potential DDI that can affect ASA
NSAIDs (not celecoxib) herbals
28
antiplatelet agent not really used anymore than inhibits plasma adenosine and platelet phosphodiesterase
dipyridamole (Aggrenox)
29
do not use which antiplatelet with migraines
aggrenox
30
avoid this antiplatelet agent with spastic colon or irritable bowel
ASA
31
scenarios requiring DAPT for stroke
coronary artery stents new cerebral ischemia Afib not candidate for anticoag cerebral vessel dissection fail mono high risk post stroke 1st 3-6 mos
32
drugs that can cause insomnia
alcohol, caffeine, nicotine, anticholinergics, SSRI, SNRI, a-block, b-block, ACE, ARB, cholinesterase inhibitors, bronchodilators, CNS stimulant, corticosteroids, decongestants, diuretics, H2RA2, statins, opioids
33
drug for sleep ONSET when want to avoid BZRA and morning sedation
ramelteon
34
drug choices for sleep ONSET when want to avoid BZRA and do not care about morning sedation
DORA or ramelteon
35
drugs for sleep ONSET when not avoiding BZRA and want to avoid morning sedation
non-benzo BZRA (zalep, zolp), ramelteon
36
drugs for sleep ONSET when not avoiding BZRA and do not care about morning sedation
DORA, non-benzo BZRA, ramelteon
37
which benzo has the most favorable safety profile for insomnia
temazepam
38
agents with what indication for insomnia may have a higher risk for morning sedation
dual indication for maintenance and onset
39
drugs of choice for insomnia in elderly
ramelteon, low dose doxepin >> eszopiclone, zolpidem
40
drugs of choice for insomnia in pregnancy
diphenhydramine, doxylamine >> low dose doxpein
41
drugs of choice for sleep MAINTENANCE when want to avoid BZRA
DORA or doxepin
42
drugs of choice for sleep MAINTENANCE when do not want to avoid BZRA
DORA, doxepin, non-benzo BZRA
43
MOA of BZDRAs
agonist at GABA receptors
44
AEs of BZDRAs
drowsy, dizzy, confusion, falls, withdrawal when d/c
45
caution for what AE and use in who for BZDRAs
complex sleep behaviors caution in elderly
46
counsel on avoiding what when taking BZDRAs
avoid alcohol and opioids
47
benzo for insomnia with longest t1/2
quazepam
48
benzo for insomnia with quickest onset of action
flurazepam
49
which 2 benzos for insomnia have metabolites
quazepam, flurazepam
50
caution using benzos in pt with
sleep apnea or sub abuse
51
BBW for benzos
concomitant opioid use, risk for abuse/dependence
52
are benzos or z drugs more disruptive of sleep stages
benzos
53
Z-drug BBW do what if this occurs?
complex sleep behaviors, may result in injury (ex sleepwalking) d/c therapy
54
how should z drugs be taken
immediately before bed with 7-8 planned hours of sleep
55
how is absorption of eszopiclone and zaleplon affected by food
delayed
56
eszopiclone & zaleplon can have DDI with
3A4 inhibitors for eszopiclone inducers for zaleplon
57
which Z drug is ultra short acting with rapid onset used ONLY FOR SLEEP ONSET
zaleplon
58
dosing of zolpidem differs for
males vs females
59
formulations of zolpidem include
SL, ER, IR tab, IR cap
60
orexin A and B receptor antagonists which turn off wake signaling
suvorexant lemborexant daridorexant
61
DORAs are CI in
narcolepsy
62
DORAs have a DDI with
CYP3A4
63
which DORA has the longest t 1/2
lemborexant
64
AEs of suvorexant
sleep paralysis, abnormal dreams
65
AEs of lemborexant
complex sleep behaviors, abnormal dreams, NEXT DAY DROWSINESS/FALL RISK (prolonged CNS depression due to t 1/2)
66
which DORA has delayed absorption with food
daridorexant
67
AEs of daridorexant
complex sleep behaviors, hallucinations, sleep paralysis
68
melatonin receptor agonist that induces sleepiness and regulates circadian rhythm
ramelteon
69
ramelteon is indicated for what? why? how long?
ONSET, quick onset and short t1/2 long term
70
insomnia agent that blocks reuptake of serotonin and NE and antagonizes H1
doxepin
71
doxepin is used for what??
MAINTENANCE
72
how long to avoid food before/after doxepin
do not take within 3 hours
73
supplement OTC used for insomnia
melatonin
74
do not use melatonin in
autoimmune conditions Alzheimer's
75
agent used off label to help sleep continuity
trazodone
76
which comorbidities may trazodone be good for
hx of sub abuse and/or depression
77
AEs of trazodone
carryover sedation & alpha block --> orthostasis
78
2 antihistamines used for insomnia
diphenhydramine, doxylamine
79
what is the standard of treatment for obstruct sleep apnea
positive airway pressure (PAP)
80
lifestyle mods for sleep apnea include
weight loss, change sleep position, avoid alcohol and sedatives
81
which drugs to avoid in sleep apnea
CNS depressants drugs causing weight gain
82
which 4 drugs are used for excessive daytime sleepiness in sleep apnea
modafinil, armodafinil solriamfetol pitolisant
83
modafinil & armoadifinil may have a DDI with
OCs effectiveness decrease
84
main AE of modafinil/armodafinil
headache
85
caution using modafinil or armodafinil in patients with
CV disease
86
warnings of modafinil and armodafinil include
mania, CV events, SJS/TEN, DRESS
87
when should EDS drugs be taken
upon awakening
88
EDS drug that blocks DA & NE reuptake
solriamfetol
89
avoid solriamfetol in patients with
unstable CV disease, arrhythmias
90
solriamfetol is CI with
use of an MAOI
91
avoid administration of solriamfetol within
9 hours of sleep
92
EDS drug that is an antagonist/inverse agonist at H3 receptors
pitolisant
93
AE of pitolisant
HA
94
3 main symptoms of narcolepsy that can be treated
EDS cataplexy REM sleep abnormalities
95
5 agents used for EDS ONLY in narcolepsy
modafinil, armodafinil, solriamfetol, amphetamines, methylphenidate
96
4 agents used for CATAPLEXY ONLY in narcolepsy
venlafaxine, fluoxetine, duloxetine, clomipramine
97
2 agents used for BOTH EDS AND CATAPLEXY in narcolepsy
sodium oxybate, pitolisant
98
sodium oxybate is a
CNS depressant
99
how is sodium oxybate administered
at bedtime on empty stomach (2 hours after food) lie down immediately after, stay there, 2nd dose in 2.5-4 hours suspension is a single dose
100
BBW for sodium oxybate
CNS depression, abuse/misuse, restricted access
101
following admin of sodium oxybate do not.... (rems)
do not engage in hazardous activities requiring mental alertness or motor coordination for at least 6 hours after taking
102
meds of choice if needed for jet lag
melatonin, ramelteon, Z drugs, BZDs
103
drugs of choice for shift work disorder
melatonin, ramelteon, suvorexant, Z drugs, BZD, modafinil/armodafinil
104
withdrawal of which meds can cause restless legs syndrome
central acting antihistamine antidepressants antipsychotics anti-nausea that act on DA
105
drugs for intermittent symptoms of RLS
carbidopa levodopa BZDRA (clonazepam)
106
alpha-2-delta Ca channel ligands used for chronic persistent RLS symptoms (especially painful)
pregabalin, gabapentin
107
DA agonists used for chronic & persistent ALS symptoms
IR pramipexole, ropinirole, rotigotine

Therapeutics (34 decks)

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