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A - NAPLEX > Chapter 68: Sleep Disorders - Insomnia, RLS & Narcolepsy > Flashcards

Chapter 68: Sleep Disorders - Insomnia, RLS & Narcolepsy Flashcards

1
Q

A diagnosis of chronic insomnia occurs when:

A

The patient has symptoms at least 3 times per week for at least 3 months

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2
Q

Key drugs that can worsen insomnia

A 
Acetylcholinesterase inhibitors (e.g., donepezil)
Alcohol
Antiretrovirals
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants
Diuretics
Fluoxetine, if taken late in the day
Steroids
Stimulants
Varenicline
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3
Q

What are some natural products used for insomnia

A
  • Melatonin (note: it is a 1A2 substrate and if taken with inhibitors like cipro or fluvoxamine, can cause prolonged effects)
  • Valerian
  • Chamomile tea
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4
Q

What is first-line treatment for insomnia

A

Non-drug treatment like CBT, keep bedroom dark, regular sleep schedule, avoid daytime naps, etc.

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5
Q

What drugs can be used if a patient complains of not being able to fall asleep

A

Eszopiclone
Zolpidem
Ramelteon
Zaleplon

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6
Q

What drugs can be used for a patient who needs help staying asleep

A

Eszopiclone
Zolpidem
Doxepin
Suvorexant

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7
Q

What drugs can be used in a patient who needs help falling and staying asleep

A

Eszopiclone

Zolpidem

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8
Q

Patients may self-treat insomnia short-term with which OTC products

A

antihistamines like Benadryl or doxylamine

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9
Q

The American Academy of Sleep Medicine (AASM) guidelines state that the following treatments are not recommended for chronic use:

A

Benadryl, melatonin, tiagabine, trazadone, and valerian

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10
Q

MOA of hypnotics

A

The non-BZDs act selectively at BZD receptors to increase GABA, an inhibitory NT which causes CNS depression

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11
Q

Eszopiclone brand name

A

Lunesta

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12
Q

Zolpidem brand name

A

Ambien, Ambien CR

Edluar, Intermezzo (SL tabs)

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13
Q

What drug schedule are hypnotics

A

Schedule IV

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14
Q

Dosing for Ambien, Edular, Zolpimist

A

Female/Elderly: 5 mg PO/SL/spray QHS

Male: 5-10 mg PO/SL/spray QHS

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15
Q

T/F: Hypnotics do not have potential for abuse and dependance

A

False

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16
Q

SE of hypnotics

A

Somnolence, dizziness, ataxia, can cause parasomnias (unusual actions while sleeping, which the pt may be unaware of)

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17
Q

MOA for orexin receptor antagonists

A

Block the orextin neuropeptide signaling system, which promotes wakefulness

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18
Q

Which drug is an orexin receptor antagonist

A

Suvorexant (Belsomra)

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19
Q

What schedule of drugs is orexin receptor antagonists

A

C-IV

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20
Q

Side effect of Suvorexant

A

Somnolence

21
Q

Which drugs are melatonin receptor agonists

A

Ramelteon and tasimelteon

has the word MEL for melatonin

22
Q

Brand name for Remelteon

A

Remeron

23
Q

Brand name for tasimelteon

A

Hetlioz

24
Q

Side effect of melatonin receptor agonists

A

somnolence

25
Q

MOA of TCAs

A

inhibit NE and 5HT reuptake. Also block ACh and histamine receptors, which contributes to side effects

26
Q

Which TCA is used for insomnia

A

Doxepin (Silenor)

27
Q

CI for doxepin

A

Requires a 2 week washout period for MAOi

28
Q

Which BZDs are FDA approved for insomnia

A

Lorazepam and oxazepam

29
Q

Doxylamine OTC brand name

A

Unisom SleepTabs

30
Q

With which disease states should Doxylamine be avoided in

A

BPH and glaucoma

31
Q

What are the primary treatments of RLS

A

Dopamine agonists (pramipexole and ropinirole) and gabapentin

32
Q

Brand name for pramipexole

A

Mirapex

33
Q

Brand name for ropinirole

A

Requip

34
Q

For RLS, the IR formulation of pramipexole and ropinirole is taken ___ hours before bedtime

A

1-3

35
Q

Which dopamine agonist comes as a patch

A

Rotigotine (Neupro)

36
Q

SE of dopamine agonists

A

orthostasis, somnolence, and nausea

37
Q

Gabapentin used for RLS should be taken at what time

A

~5 PM

38
Q

What is narcolepsy

A

excessive daytime sleepiness with cataplexy (sudden loss of muscle tone) and sleep paralysis

39
Q

How is narcolepsy treated

A

Stimulants, such as modafinil or armodafinil, or with sodium oxybate (Xyrem), or H3 receptor antagonist/inverse agonist (Pitolisant) and dopamine and NE reuptake inhibitor (Solriamfetol)

40
Q

Brand name for modafinil

A

Provigil

41
Q

Brand name of armodafinil

A

Nuvigil

42
Q

What schedule of drugs are stimulants used for wakefulness

A

C-IV

43
Q

Side effects of stimulants used for wakefulness

A

Severe rash that can be lifethreatening

44
Q

Sodium Oxybate is derived from

A

GABA

45
Q

What schedule of drug is sodium oxybate for narcolepsy

A

C-III

46
Q

sodium oxybate brand name

A

Xyrem

47
Q

Sodium oxybate is a C-I when used as an illicit drug, also known as

A

“date rape” drug

48
Q

Which drug used for narcolepsy requires a REMS program

A

sodium oxybate

A - NAPLEX (83 decks)

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