Exam 4 - Ott Sleep Disorders

Question 1

Disease states, medications, and substances associated with insomnia (12 total)

Answer 1

anxiety
mood disorders

caffeine
modafinil
amphetamines
methylphenidate
decongestants
beta-agonists
beta-blockers
nicotine
bupropion
thyroid medications

Question 2

insomnia must take place at least ___ nights of the week and be present for at least ___ months

Answer 2

3,3

Question 3

most commonly used medications for insomnia

Answer 3

z-hypnotics:
zolpidem
eszopiclone
zaleplon

Question 4

initial dose of zolpidem in women and elderly

Answer 4

5mg

Question 5

SE of z-hypnotics (6)

Answer 5

metallic taste (eszopiclone only)
somnelence (sleepiness)
dizziness
ataxia
HA
unusual activities while person is asleep (sex, phone calls, driving, etc.) (this includes all medications FDA approved for insomnia)

Question 6

what benzo is used for sleep

Answer 6

temazepam

Question 7

SE of temazepam

Answer 7

dizziness, drowsiness, cognitive impairment, increased fall risk

Question 8

ramelteon CI

Answer 8

fluvoxamine
angioedema with past use of ramelteon

Question 9

substrate for ramelteon and tasimelteon

Answer 9

1A2

Question 10

SE of ramelteon and tasimelteon

Answer 10

GI upset
next day tiredness
hyperprolactinemia
prolactinoma

Question 11

only drug FDA approved to treat non-24 hour sleep wake disorder

Answer 11

tasimelteon

Question 12

orexin antagonists (C-IV) CI

Answer 12

narcolepsy

Question 13

orexin antagonists (C-IV) CI substrate (same for all 3 agents)

Answer 13

3A4

Question 14

suvorexant dose and dose timing

Answer 14

10mg within 30 mins of bedtime and at least 7 hours to sleep

Question 15

lemborexant dose and dose timing

Answer 15

5mg at bedtime with at least 7 hours to sleep

Question 16

daridorexant dose and dose timing

Answer 16

25mg at bedtime with at least 7 hours to sleep

Question 17

doxepin MOA and SE

Answer 17

TCA that works by H1 antagonism
anticholinergic SE (can’t see, can’t spit, can’t pee, can’t shit)

Question 18

T/F: trazodone is not FDA approved for sleep

Answer 18

T

Question 19

2 birds, 1 stone medications and the reason they are this

Answer 19

mirtazapine and quetiapine
-antidepressant and antipsychotic that are both sedating

Question 20

mirtazapine major SE (all pines cause this)

Answer 20

weight gain

Question 21

melatonin substrate

Answer 21

1A2

Question 22

first line therapy for insomnia

Answer 22

CBT

Question 23

diagnostic criteria for sleep apnea

Answer 23

must have evidence of at least 5 obstructive apneas per hour of sleep confirmed by polysomnography

Question 24

treatment of sleep apnea

Answer 24

weigh loss (not curative)
smoking cessation
avoid alcohol and CNS depressants
sleep on side rather than back

Question 25

common sx of narcolepsy

Answer 25

EDS (all pts)
cataplexy
hallucinations
sleep paralysis

Question 26

treatment of narcolepsy based on what sx pt has (cataplexy)

Answer 26

sodium oxybate (Xyrem) - GHB (high Na+)
Xywav (lower Na+ content, ages 7+)
Lumryz (high Na+, ER form, adults only)

Question 27

treatment of narcolepsy based on what sx pt has (EDS)

Answer 27

modafinil or armodafinil
sodium oxybate (Xyrem)
pitolisant and solriamfetol

Question 28

pitolisant (Wakix) counseling points (4)

Answer 28

-histamine antagonist/inverse agonist
-2D6/3A4 substrate (may reduce the effectiveness of oral contraceptives because of 3A4 inducing)
-cannot use OTC antihistamines while taking this
-CI in severe hepatic impairment

Question 29

solriamfetol (Sunosi) C-IV counseling points

Answer 29

-used in pts with EDS due to narcolepsy or sleep apnea
-BP and HR increases
-avoid/use caution in pts with unstable CV diseases, bipolar or with other dopaminergic drugs
-renal impairment:
moderate: start on 37.5mg and move to 75mg after 7 days
severe: 37.5mg only

Question 30

shift work sleep disorder treatment options

Answer 30

modafinil or armodafinil taken 1 hour before work period starts

Question 31

restless leg syndrome (RLS) treatment options

Answer 31

1st choice: gabapentin enacarbil (gabapentin prodrug)
next: dopamine agonists (IR form) like pramipexole or ropinirole