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PHM701 > Exam 2 - Sleep Disorders > Flashcards

Exam 2 - Sleep Disorders Flashcards

1
Q

What medications can cause/worsen insomnia? (17)

A

alcohol, caffeine, nicotine, anticholinergics, SSRIs/SNRIs, alpha blockers, beta blockers, ACEi/ARBs, cholinesterase inhibitors, bronchodilators, CNS stimulants, corticosteroids, decongestants, diuretics, H2RAs, statins, opioids

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2
Q

What is first-line for long-term insomnia treatment?

A

CBT

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3
Q

What is the treatment for sleep-onset insomnia for those avoiding BZDRAs and morning sedation?

A

ramelteon

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4
Q

What is the treatment for sleep-onset insomnia for those avoiding BZDRAs and who can tolerate morning sedation? (2)

A

DORAs, ramelteon

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5
Q

What is the treatment for sleep-onset insomnia for those who can tolerate BZDRAs and are avoiding morning sedation? (2)

A

ramelteon, z-drugs

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6
Q

What is the treatment for sleep-onset insomnia for those who can tolerate BZDRAs and morning sedation? (3)

A

DORAs, ramelteon, z-drugs

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7
Q

What is the treatment for sleep-maintenance for those avoiding BZDRAs? (2)

A

DORAs, doxepin

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8
Q

What is the treatment for sleep-maintenance for those who can tolerate BZDRAs? (3)

A

DORAs, doxepin, z-drugs

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9
Q

What is the MOA of BZDRAs?

A

GABA receptor agonist

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10
Q

What are boxed warnings for BZDRAs? (3)

A

concomitant depressant effects, risk of abuse, risk of dependence and withdrawal

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11
Q

What is a boxed warning for z-drugs?

A

parasomnias and complex sleep behaviors

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12
Q

Which BZDRA has the longest and shortest half-life, respectively?

A

longest = quazepam, shortest = zaleplon

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13
Q

Which BZDRAs have clinically-active metabolites? (2)

A

flurazepam, quazepam

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14
Q

What is the indication for eszopiclone (Lunesta)?

A

sleep-onset and sleep-maintenance

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15
Q

What are important PKPD characteristics of eszopiclone (Lunesta)? (2)

A

duration 6-9 hours, CYP3A4 substrate

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16
Q

What are adverse effects of eszopiclone (Lunesta)?

A

HA, dysgeusia, anxiety, xerostomia, infection

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17
Q

What is the indication for zaleplon (Sonata)?

A

short-term insomnia

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18
Q

What does zaleplon (Sonata) not help with?

A

nighttime awakening

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19
Q

What are important PKPD characteristics of zaleplon (Sonata)? (2)

A

duration 3-4 hours, CYP3A4 substrate

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20
Q

What is the indication for zolpidem?

A

sleep-onset and sleep-maintenance

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21
Q

What is the dosing for sleep-onset zolpidem (Intermezzo)?

A

take if more than 4 hours remain before waking and trouble returning to sleep

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22
Q

What is the dosing for sleep-maintenance zolpidem (Edluar)?

A

take immediately before bedtime with 7-8 hours of planned sleep before waking

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23
Q

Which Ambien formulation is for sleep-onset only?

A

Ambien IR (NOT CR)

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24
Q

What is the indication for DORAs?

A

sleep-onset and sleep-maintenance

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25
In what medical condition are DORAs contraindicated?
narcolepsy
26
What are important PKPD characteristics of suvorexant (Belsomra)? (3)
onset < 30 minutes, t1/2 = 12 hrs, CYP3A4 interactions
27
What are adverse effects of suvorexant (Belsomra)? (3)
sleep paralysis, abnormal dreams, HA
28
What are important PKPD characteristics of lemborexant (DayVigo)? (4)
onset < 30 minutes, t1/2 = 17-19 hrs, CYP3A4 interactions, CNS depression may persist several days after discontinuation
29
What are adverse effects of lemborexant (DayVigo)? (3)
complex sleep behaviors, abnormal dreams, HA
30
What are important PKPD characteristics of daridorexant (Quviviq)? (4)
onset < 30 minutes, t1/2 = 8 hrs, CYP3A4 interactions, onset delayed if taken with food
31
What is the MOA of ramelteon (Rozerem)?
melatonin receptor agonist
32
What is the indication for ramelteon (Rozerem)?
sleep-onset only
33
What are contraindications for ramelteon (Rozerem)? (1)
fluvoxamine use
34
What are two interesting points about ramelteon (Rozerem)?
not as effective in patients with BZDRAs, not controlled
35
What is the MOA of doxepin?
TCA
36
What is the indication for doxepin?
sleep-maintenance only
37
What is the dosing for doxepin?
3-6 mg/d
38
What is an important counseling point for doxepin?
Do not take within 3 hours of a meal
39
When should melatonin be avoided? (2)
patients with autoimmune conditions or Alzheimer's disease
40
What are important points regarding first-generation antihistamines? (3)
avoid in older adults, tolerance develops quickly, anticholinergic side effects
41
What is an off-label treatment for patients with a history of substance abuse?
trazodone
42
What are other off-label insomnia therapies? (3)
amitryptiline, mirtazapine, gabapentin
43
What medications can elderly use? (4)
ramelteon, doxepin, eszopiclone, zolpidem
44
What medications can pregnant women use? (3)
diphenhydramine, doxylamine, doxepin
45
What are the treatments for obstructive sleep apnea? (4)
behavior modifications, PAP, avoid CNS depressants, medications
46
What are contraindications for modafinil (Provigil) and armodafinil (Nuvigil)? (2)
pregnancy, cardiovascular disease
47
What are adverse effects of modafinil (Provigil) and armodafinil (Nuvigil)? (4)
HA, mania, cardiovascular symptoms, SJS
48
What is the MOA of modafinil (Provigil)?
unknown
49
What is the MOA of armodafinil (Nuvigil)?
unknown
50
What is the MOA of solriamfetol (Sunosi)?
DA and NE reuptake inhibitor
51
What are contraindications for solriamfetol (Sunosi)? (2)
use of MAOI, cardiovascular disease
52
What is the MOA for pitolisant (Wakix)?
histamine-3 receptor antagonist
53
What are adverse effects of pitolisant (Wakix)? (2)
HA, QTc prolongation
54
What obstructive sleep apnea medications must be administered in the morning? (4)
armodafinil, modafinil, pitolisant, solriamfetol
55
What are the treatments for narcolepsy? (3)
behavior modifications, avoid CND depressants, medications
56
What is the indication for sodium oxybate (Xyrem)?
cataplexy and excessive daytime sleepiness
57
What are BBWs for sodium oxybate (Xyrem)? (3)
CNS depression, abuse (REMS), restricted access
58
How is sodium oxybate (Xyrem) dosed?
at bedtime on empty stomach, then again 2.5-4 hours later
59
How is sodium oxybate (Lumryz) different?
single dose suspension
60
How is sodium oxybate (Xywav) different?
contains other cation salts
61
What are REM-suppressing drugs used for cataplexy? (4)
venlafaxine, fluoxetine, duloxetine, clomipramine
62
What can abrupt withdrawal of REM-suppressing drugs cause?
status cataplecticus
63
What are medications that treat both cataplexy and excessive daytime sleepiness? (2)
pitolisant and sodium oxybate
64
What are treatments for jet lag disorder? (3)
melatonin, ramelteon, z-drugs
65
What are non-pharm treatments for shift work disorder? (3)
sleep hygiene, exposure to bright lights at night and darkness during day, CBT-I
66
What are pharm treatments for shift work disorder? (5)
melatonin, ramelteon, suvorexant, z-drugs, modafinil/armodafinil
67
What are non-pharm causes of RLS? (4)
nutrition (iron, vitamin B, folate, caffeine, alcohol, weight loss), smoking, exercise, sleep
68
What are medications that can cause RLS? (4)
centrally-acting (1st gen) antihistamines, antidepressants (NOT BUPROPION), antipsychotics, anti-nausea drugs that block dopamine
69
What are treatments for intermittent symptoms of RLS? (2)
caribodopa-levodopa, BZDRAs (clonazepam)
70
What are treatments for chronic and persistent symptoms of RLS? (2)
alpha-2-delta calcium channel ligands (pregabalin, gabapentin encarbil (Horizant)), dopamine agonists (pramipexole, ropinirole, rotigotine)

PHM701 (14 decks)

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