Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

therapeutics 3 - exam 4 > lecture 63 > Flashcards

lecture 63 Flashcards

ott - pharmacotherapy of sleep disorders

1
Q

what disease states are associated with insomnia?

A

anxiety
hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what drugs are associated with insomnia?

A

amphetamines
beta agonists
BB
bupropion
caffeine
decongestants
methylphenidate
modafinil
nicotine
thyroid meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how are insomnia disorders defined in the DSM-5?

A

difficulties with sleep initiation (latency), sleep maintenance, and/or early-morning awakening
takes place at least 3 nights per week
present for at least 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is first line treatment of insomnia?

A

non-pharmacological
sleep hygiene principles are necessary and should be counseled by the pharmacist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what drugs are most commonly used for insomnia?

A

z-hypnotics –> zolpidem, eszopiclone, zaleplon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the CP of zolpidem?

A

initial dose lower in women/elderly at 5 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the CP of all z-hypnotics?

A

3A4 substrates (metabolism is impacted by 3A4 inhibition and induction)
can cause parasomnias
controlled substances due to potential of misuse
additive effects with other CNS depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the SE of z-hypnotics?

A

somnolence, dizziness, ataxia, HA
eszopiclone only – metallic taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what benzo is used for insomnia and what is its SE profile?

A

temazepam
drowsiness
dizziness
cognitive impairment
increased fall risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are CP of ramelteon?

A

melatonin receptor agonist (so 1A2 substrate)
CI with fluvoxamine
SE –> GI upset, next day somnolence, hyperprolactinemia, prolactinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the CP of tsimelteon?

A

melatonin receptor agonist (so 1A2 substrate)
FDA-approved for non-24 sleep wake disorders in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what drugs are orexin receptor antagonist?

A

suvorexant
lemborexant
daridorexant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the CP of orexin receptor antagonists?

A

need at least 7 hours of sleep
CI in nacrolepsy due to causing narcolepsy-like SE
3A4 substrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are important CP of doxepin?

A

TCA
low doses exert effects through H1 receptor antagonism
anticholinergic SE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the CP of trazodone?

A

not FDA-approved for insomnia
long half-life so may see daytime hangover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is mirtazapine used in insomnia?

A

clinically used as a sleep agent, especially in pts with depression who have difficulty sleeping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is quetiapine used in insomnia?

A

low dose can have sedation effects but not recommended unless there is a co-morbid psychiatric disorder

18
Q

what OTC products are not recommended in insomnia?

A

diphenhydramine/doxylamine (by AASM)
KAVA (due to hepatotoxicity)

19
Q

when can melatonin be considered?

A

in jet lag pts and pts with low melatonin levels
1A2 substrate

20
Q

how is obstructive sleep apnea defined according to the DSM-5?

A

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

21
Q

what are symptoms of obstructive sleep apnea?

A

excessive daytime sleepiness
snoring
pauses in breathing during sleep
HA
irritability
sore throat
erectile dysfunction
impaired memory
GERD
mood disturbances

22
Q

if a pt has both insomnia and obstructive sleep apnea, what should be treated first?

23
Q

when should polysomnography by used?

A

only if there is significant cardiorespiratory disease
potential respiratory muscle weakness (due to neuro-muscular condition)
sleep related hypoventilation
chronic opioid use
hx of stroke
severe insomnia

24
Q

what are the treatment options of sleep apnea?

A

weight loss (adj)
smoking cessation
avoid alcohol and CNS depressants
sleep on side rather than back
CPAP (continuous positive airway pressure)

25
how can excessive daytime sleepiness (EDS) be treated?
with modafinil or armodafinil need to review CPAP adherence first and posibility of RLS or PLMS
26
how is narcolepsy defined in the DSM-5?
recurring episodes of irresistible need to sleep, fall asleep, or nap three times per week over the past 3 months (EDS)
27
how is EDS associated with narcolepsy?
occurs in 100% of pts generally more severe in type 1 (narcolepsy with cataplexy or hypocretin deficiency syndrome)
28
what is cataplexy?
sudden loss of muscle tone triggered by emotions occurs in type 1 nacrolepsy
29
what are other symptoms of narcolepsy?
hallucinations sleep paralysis
30
how can cataplexy be treated when associated with nacrolepsy?
sodium oxybate (xyrem) for GHB/high sodium content Xywav Lumryz
31
who should xywav?
treat cataplexy in adults and children aged 7 or older also approved for idiopathic hypersomnia in adults lower sodium content
32
who should lumryz?
treat cataplexy in adults only ER dosage form, once nightly dosing, high sodium content
33
what are all the possible treatments of EDS associated with nacrolepsy?
modafinil/armodafinil (life threatening rash associated) sodium oxybate pitolisant and solriamfetol
34
what are important counseling notes of pitolisant (wakix)?
H3 receptor antagonist/inverse agonist CI in severe hepatic impairment QTc interval prolongation 2D6 and 3A4 substrate (weak 3A4 inducer so may reduced effectiveness of OCs) avoid use with centrally acting H1 receptor antagonists lke OTC antihistamines
35
what are the CP of solriamfetol (sunosi)?
dpamine NE reuptake inhibitor (DNRI) needs dose adjustment for renal impairment indicated for improvement of wakefullness in adults with ESD due to narcolepsy or obstructive sleep apnea
36
what is the renal dosing of solriamfetol?
moderate --> start 37.5 mg, may increase to 75 mg after at least 7 days severe --> starting and max dose 37.5 mg
37
what are the warnings associated with solriamfetol?
BP and HR increase so avoid in unstable CV disease and arrhythmias use caution in pts with a hx of psychosis of BPD (decrease dose or d/c if psychiatric symptoms develop) use with caution with dopaminergic drugs
38
how should shift work sleep disorders be treated?
take modafinil and armodafinil 1 hour before work period starts during wake time
39
how should restless legs syndrome be treated?
gabapentin enacarbil dopamine agonists (IR formulation of pramipexole or ropinirole) iron supplement
40
what is gabapentin enacarbil?
prodrug of gabapentin FDA-approved for RLS growing evidence base for effectiveness so may be considered first-line treatment

therapeutics 3 - exam 4 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions