Chapter 67: Sleep Disorders

Question 1

A diagnosis of chronic insomnia occurs when:

Answer 1

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

Question 2

What is the first-line treatment for insomnia?

Answer 2

Non-drug treatment like CBT, keeping the bedroom dark, maintaining a regular sleep schedule, and avoiding daytime naps.

Question 3

What are some natural products used for insomnia?

Answer 3

• Melatonin
• Valerian
• Chamomile tea

Question 4

Key drugs that can worsen insomnia

Answer 4

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

Question 5

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

Answer 5

Eszopiclone, Zolpidem, Ramelteon, Zaleplon

Question 6

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

Answer 6

Eszopiclone, Zolpidem, Doxepin, Suvorexant

Question 7

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

Answer 7

Eszopiclone, Zolpidem

Question 8

What OTC products may patients use for short-term self-treatment of insomnia?

Answer 8

Antihistamines like Benadryl or doxylamine.

Question 9

Which treatments are not recommended for chronic use according to AASM guidelines?

Answer 9

Benadryl, melatonin, trazodone, and valerian.

Question 10

What is the MOA of non-BZD hypnotics?

Answer 10

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

Question 11

What is the brand name of Eszopiclone?

Answer 11

Lunesta

Question 12

What are the brand names of Zolpidem?

Answer 12

Ambien, Ambien CR

Edluar, Intermezzo (SL tabs)

Question 13

What drug schedule are hypnotics?

Answer 13

Schedule IV

Question 14

What is the dosing for Ambien, Edular, Zolpimist?

Answer 14

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

Question 15

True or False: Hypnotics do not have potential for abuse and dependence.

Answer 15

False

Question 16

What are the side effects of hypnotics?

Answer 16

Somnolence, dizziness, ataxia, headache

Question 17

What is the mechanism of action (MOA) for orexin receptor antagonists?

Answer 17

Block the orexin neuropeptide signaling system, which promotes wakefulness

Question 18

Which drug is an orexin receptor antagonist?

Answer 18

Suvorexant (Belsomra)

Question 19

What schedule of drugs are orexin receptor antagonists?

Answer 19

C-IV

Question 20

What is a side effect of Suvorexant?

Answer 20

Somnolence

Question 21

Which drugs are melatonin receptor agonists?

Answer 21

Ramelteon and tasimelteon

Has the word MEL for melatonin.

Question 22

Brand name for Ramelteon?

Answer 22

Remeron

Question 23

Brand name for tasimelteon?

Answer 23

Hetlioz

Question 24

Side effect of melatonin receptor agonists?

Answer 24

Somnolence

Question 25

What is the mechanism of action (MOA) of TCAs?

Answer 25

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

Question 26

Which TCA is used for insomnia?

Answer 26

Doxepin (Silenor)

Question 27

What is a contraindication (CI) for doxepin?

Answer 27

Requires a 2 week washout period for MAOi.

Question 28

Which BZDs are FDA approved for insomnia?

Answer 28

Temazepam

Question 29

Temazepam brand name

Answer 29

Restoril

Question 30

Temazepam side effects

Answer 30

Dizziness, Drowsiness, fall risk, cognetive impairement

Question 31

What is the OTC brand name for Doxylamine?

Answer 31

Unisom SleepTabs

Question 32

In which disease states should Doxylamine be avoided?

Answer 32

BPH and glaucoma

Question 33

What are the primary treatments of RLS?

Answer 33

Dopamine agonists (pramipexole and ropinirole) and gabapentin

Question 34

Brand name for pramipexole?

Answer 34

Mirapex

Question 35

Brand name for ropinirole?

Answer 35

Requip

Question 36

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

Answer 36

1-3

Question 37

Which dopamine agonist comes as a patch?

Answer 37

Rotigotine (Neupro)

Question 38

What are the side effects of dopamine agonists?

Answer 38

orthostasis, somnolence, and nausea

Question 39

Gabapentin used for RLS should be taken at what time?

Answer 39

~5 PM

Question 40

What is narcolepsy?

Answer 40

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

Question 41

How is narcolepsy treated?

Answer 41

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).

Question 42

Brand name for modafinil?

Answer 42

Provigil.

Question 43

Brand name of armodafinil?

Answer 43

Nuvigil.

Question 44

What schedule of drugs are stimulants used for wakefulness?

Answer 44

C-IV.

Question 45

Side effects of stimulants used for wakefulness?

Answer 45

Severe rash that can be life-threatening.

Question 46

Sodium Oxybate is derived from?

Answer 46

GABA.

Question 47

What schedule of drug is sodium oxybate for narcolepsy?

Answer 47

C-III.

Question 48

Sodium oxybate brand name?

Answer 48

Xyrem.

Question 49

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

Answer 49

“date rape” drug.

Question 50

Which drug used for narcolepsy requires a REMS program?

Answer 50

Sodium oxybate.