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PHRM 845 Therapeutics > Exam 4 - Lec 62 Sleep Disorders Ott > Flashcards

Exam 4 - Lec 62 Sleep Disorders Ott Flashcards

1
Q

Look at slide 3 for disease states, meds, and substances assoc with insomnia

A

Ok sure thing

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2
Q

select the FALSE statement about DSM-5 criteria for insomnia:

a. insomnia is considered difficulties with sleep initiation (latency), sleep maintenance, and/or early‐morning awakening
b. takes place at least 3 nights per week
c. present for at least 6 months

A

c. present for at least 6 months (3 months)

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3
Q

first line tx for insomnia disorders

A

non-pharm (AASM recommends CBT and behavioral therapies first line)

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4
Q

which med class are the most commonly used sleep medications?

A

Z-hypnotics (zolpidem, zaleplon, eszopiclone)

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5
Q

T or F: the initial dose of zolpidem is higher in women and elderly - 10 mg

A

F (lower; 5 mg)

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6
Q

which Z-hypnotic causes a metallic taste?

a. zolpidem
b. eszopiclone
c. zaleplon

A

b. eszopiclone

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7
Q

Z-hypnotics can cause _________, which are unusual actions while a person is sleeping

A

parasomnias

(this is a warning for all sleep meds)

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8
Q

benzodiazepine used for sleep

A

temazepam

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9
Q

two melatonin receptor agonists drugs

A

ramelteon
tasimelteon

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10
Q

ramelteon is CI with which med?

A

fluvoxamine (1A2 inhibitor)

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11
Q

drug that is FDA‐approved for non‐24 sleep‐
wake disorder in adults

a. ramelteon
b. tasimelteon

A

b. tasimelteon (used in blind ppl)

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12
Q

SE for ramelteon (4 of them; slide 9)

A

GI upset, next day somnolence, hyperprolactinemia, prolactinoma

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13
Q

melatonin receptor agonists are substrates of which CYP?

A

1A2 (watch for 1A2 inducers and inhibitors)

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14
Q

3 orexin receptor antagonist drugs (same ending)

A

suvorexant
lemborexant
daridorexant

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15
Q

the orexin receptor antagonists (-orexants) are substrates of which CYP?

A

3A4

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16
Q

how many hours of sleep do you need when taking orexin receptor antagonists?

A

at least 7 hours

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17
Q

CI for the orexin receptor antagonists

A

CI in narcolepsy, causes narcolepsy-like SE

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18
Q

how does doxepin work for sleep?

A

TCA, low doses exert effect through H1 receptor antagonism

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19
Q

SE of doxepin

A

anticholinergic SE

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20
Q

T or F: trazodone is FDA-approved for sleep

A

F (not FDA-approved, but is used)

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21
Q

which drug has a long half-life and can cause daytime hangover?

a. doxepin
b. trazodone
c. mirtazapine
d. quetiapine

A

b. trazodone

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22
Q

Clinically used as a sleep agent, especially in
patients with depression who have difficulty
sleeping

a. doxepin
b. trazodone
c. mirtazapine
d. quetiapine

A

c. mirtazapine

23
Q

Low dose __________ is not recommended for
use in insomnia unless there is a co‐morbid
psychiatric disorder

a. doxepin
b. trazodone
c. mirtazapine
d. quetiapine

A

d. quetiapine

24
Q

T or F: diphenhydramine/doxylamine is not recommended by the AASM for insomnia

A

T

25
Q

__________ can be considered in jet lag
and patients with low __________
levels; 1A2 substrate

(same drug in each blank)

A

melatonin

26
Q

melatonin/valerian/chamomile can cause an allergic rxn in which pts?

A

pts with daisy or ragweed allergies

27
Q

DSM-5 criteria for obstructive sleep apnea: pt must have evidence of at least ___ obstructive apneas per hour of sleep confirmed by polysomnography

A

5

28
Q

which is treated first in a pt that has both sleep apnea and insomnia?

A

sleep apnea

29
Q

diagnostic test for obstructive sleep apnea

A

polysomnography (there is more in bold on slide 16)

30
Q

some non-pharm interventions for tx of sleep apnea

A

Weight loss (adjunctive rather than curative), smoking cessation, avoid alcohol and CNS depressants, sleep on side rather than back

31
Q

what machine is used for tx of sleep apnea?

A

CPAP machine

32
Q

Excessive daytime sleepiness (EDS) due to sleep apnea can be treated with what two drugs?

A

modafinil or armodafinil - need to review CPAP adherence first and possibility of RLS or PLMS

33
Q

T or F: When considering treating apnea and insomnia, ensure that the obstructive apnea is addressed before recommending sedative/hypnotic drug therapy

A

T

34
Q

narcolepsy tetrad

A

-EDS
-cataplexy
-hallucinations
-sleep paralysis

35
Q

T or F: excessive daytime sleepiness (EDS) occurs in 50% of narcolepsy pts, generally more severe in Type I narcolepsy (narcolepsy w/ cataplexy or hypocretin deficiency syndrome)

A

F (EDS occurs in 100% of pts)

36
Q

what is cataplexy?

A

sudden loss of muscle tone triggered by emotion

37
Q

3 drugs for tx of cataplexy in narcolepsy

A

-sodium oxybate (Xyrem)
-Xywav
-Lumryz

38
Q

which is for adults and children aged 7 or older, and is also approved for idiopathic hypersomnia in adults?

a. sodium oxybate (Xyrem)
b. Xywav
c. Lumryz

A

b. Xywav

39
Q

which drug is for adults only, ER dosage form, has once nightly dosing, and high sodium content?

a. sodium oxybate (Xyrem)
b. Xywav
c. Lumryz

A

c. Lumryz

40
Q

which has the lowest sodium content?

a. sodium oxybate (Xyrem)
b. Xywav
c. Lumryz

A

b. Xywav

41
Q

drugs for excessive daytime sleepiness (slide 20)

A

modafinil/armodafinil
sodium oxybate
pitolisant and solriamfetol

42
Q

CI for pitolisant (Wakix)

a. severe hepatic impairment
b. severe renal impairment
c. thyroid C-cell tumors
d. Huntington’s Chorea

A

a. severe hepatic impairment

43
Q

pitolisant (Wakix) MOA

A

H3 receptor antag/inverse agonist

44
Q

pitolisant (Wakix) is a weak _____ inducer, may reduce effectiveness of oral contraceptives

A

3A4

45
Q

which of the following is FALSE about pitolisant (Wakix)?

a. CI in severe hepatic impairment
b. prolongs QT interval
c. H3 antagonist/inverse agonist
d. 1A2/3A4 substrate
e. avoid use with centrally-acting H1 receptor antagonists

A

d. 1A2/3A4 substrate

(it is a 2D6/3A4 substrate)

46
Q

which is TRUE about Solriamfetol (Sunosi)?

a. it is an SNRI
b. indicated for insomnia
c. increases BP and HR; avoid in unstable CV disease and arrhythmias
d. no dose adjustment needed in renal impairment

A

c. increases BP and HR; avoid in unstable CV disease and arrhythmias

(a. it is a DNRI; b. indicated for EDS due to narcolepsy or OSA; d. does need to be dose adjusted in moderate-severe impairment)

47
Q

how should Solriamfetol be dosed in moderate or severe renal impairment?

A

moderate: start 37.5 mg, may inc to 75 mg after at least 7 days

severe: starting and max dose is 37.5 mg

48
Q

T or F: Solriamfetol should be used with caution in pts with history of psychosis or bipolar disorder

A

T (dec dose or d/c if psychiatric sx develop)

49
Q

T or F: Solriamfetol should be used with caution with dopaminergic drugs

A

T

50
Q

what are the drugs of choice for shift work sleep disorder? (2 of them)

A

modafinil and armodafinil (take 1 hour before the work period starts during “wake time”)

51
Q

drugs for restless legs syndrome (3 of them; slide 24)

A

-gabapentin enacarbil
-pramipexole
-ropinirole

52
Q

what is the gabapentin prodrug that is FDA-approved for RLS?

A

gabapentin enacarbil

53
Q

_____ supplementation may be considered with restless legs syndrome

A

iron

PHRM 845 Therapeutics (34 decks)

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