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Pharmacology > Sleep disorders/ADHD > Flashcards

Sleep disorders/ADHD Flashcards

1
Q

Insomnia disorders

A

chronic

short-term

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2
Q

“other” sleep disorders

A

restless leg syndrome (Willis-Ekbom disease)

obstructive sleep apnea

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3
Q

REM v NREM sleep

A

REM brain is active and dreaming occurs (20% of sleep)

NREM deep rest where pulse, respiration, and brain activity slow (80% of sleep)

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4
Q

sleep cycle

A

light NREM, deep NREM, REM, repeat

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5
Q

hypnotic use for insomnia

A

lowest effective dose for shortest duration of time

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6
Q

intermediate acting BZDs

A

temazepam

lorazepam

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7
Q

long acting BZD

A

flurazepam

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8
Q

triazolam and erythromycin

A

must reduce triazolam dose by 50%

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9
Q

oral contraceptives and BZDs

A

low dose contraceptives may decrease clearance of lorazepam and temazepam

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10
Q

main differences between BZDs and BZRAs

A

BZRAs do not induce anxiolysis or muscle relaxation

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11
Q

BZRA drugs

A

eszopiclone (Lunesta)
zolpidem (Ambien)
zolpidem tartrate (Intermezzo)
zaleplon (Sonata)

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12
Q

eszopiclone (Lunesta) and high fat meal

A

peak concentration can be delayed if taken with a high fat meal

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13
Q

starting dose of zolpidem

A

lower for females than males

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14
Q

zaleplon (Sonata) dosing

A

can be dosed a second time during the night as long as there is at least 4-5 hours of sleep time remaining

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15
Q

contraindications for zaleplon (Sonata)

A

concomitant use of sodium oxybate (Xyrem) or any type of fentanyl or valerian

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16
Q

Orexin receptor antagonist medication

A

suvorexant (Belsomra)

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17
Q

planned sleep time for Belsomra

A

at least 7 hours d/t risk of complex sleep behaviors

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18
Q

suvorexant (Belsomra) contraindications

A

narcolepsy

alcohol use

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19
Q

melatonin receptor agonist

A

ramelteon (Rozerem)

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20
Q

administration of ramelteon (Rozerem)

A

avoid with high fat meal

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21
Q

contraindications for ramelteon (Rozerem)

A

severe sleep apnea
severe hepatic impairment
angioedema

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22
Q

antihistamines used for sleep

A

diphenhydramine typically

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23
Q

most common antidepressants used for sleep

A 
mirtazepine
trazadone
doxepine (Silenor)
24
Q

1st line therapy for short term insomnia

A

BZD
BZRA
ramelteon

25
Q

only sleep med designated as pregnancy category A

A

doxylamine

26
Q

2nd line therapy for insomnia

A

alternate short acting BZRA or ramelteon

27
Q

3rd line therapy for insomnia

A

consider other sedating agents such as gabapentin or AAP

28
Q

what medications should be avoided in the elderly for insomnia

A

first-generation antihistamines

short or intermediate acting BZDs

29
Q

difference between restless leg and periodic limb movement disorder

A

PLMD occurs exclusively during sleep

30
Q

medications that may precipitate or worsen RLS/WED

A

antidepressants

dopamine antagonists

31
Q

pharmacologic agents for RLS/WED

A 
dopaminergic agents
dopamine agonists
opioids
BZDs
anticonvulsants
Iron
32
Q

dopamine agonists used for RLS/WED

A

ropinirole (Requip)
pramipexole (Mirapex)
rotigotine transdermal (Neupro)

33
Q

BZDs in RLS/WED

A

used as adjunctive therapy with a dopaminergic drug when monotherapy has failed

34
Q

when would you use an anticonvulsant for RLS/WED

A

when they describe the sensation as pain (gabapentin enacarbil)

35
Q

“other” features of narcolepsy

A

excessive daytime sleepiness
cataplexy (attacks of muscle weakness)
sleep paralysis
hypnagogic hallucination

36
Q

cataplexy attacks in narcolepsy

A

typically precipitated by highly specific situations or triggers of strong emotion

37
Q

pharmacologic agnets for tx of narcolepsy

A

psychostimulants
amphetamines
sodium oxybate
antidepressants

38
Q

psychostimulants for narcolepsy

A

Modafinil and armodafinil

39
Q

most commonly used amphetamine to tx narcolepsy

A

methylphenidate (Ritalin)

40
Q

antidepressants that may be useful when cataplexy is present

A

venlafaxine (Effexor)

duloxetine (Cymbalta)

41
Q

what influences the expression of ADHD symptoms

A

concentrations of available dopamine and norepinephrine and the functionality of their receptors

42
Q

initiation of methylphenidate in children with ADHD

A

4-5 CBT and methylphenidate if symptoms are severe
5+ meds if symptoms severe =/- CBT
in children >6 no preference is given to one stimulant over another

43
Q

mechanism of action of stimulants for ADHD

A

amphetamines directly stimulate release of dopamine and norepinephrine and inhibit their reuptake

44
Q

contraindication to stimulant medication for ADHD

A 
marked anxiety, tension, or agitation
glaucoma
hx of ticks
cardio disease/mod-severe HTN
hyperthyroidism
hx of substance abuse
45
Q

nonstimulant medications for ADHD

A 
atomoxetine (Strattera)
guanfacine IR and ER (Tenex, Intuniv)
Clonidine IR and ER (Catapres, Kapvay)
bupropion (Wellbutrin)
TCA antidepressants
46
Q

divergence in normal dosing of atomoxetine (Strattera)

A

starting dose should be maintained x4 weeks before titration in slow metabolizers or in patients taking agents with strong CYP2D6 effects (fluoxetine, paroxetine)

47
Q

typical time frame to make dose adjustments in strattera

A

within the first week

48
Q

contraindications to atomoxetine (Strattera)

A

MAOIs, narrow-angle glaucoma

49
Q

who should you prescribe Strattera to cautiously

A

HTN and underlying cardio disorders

50
Q

boxed warning for Strattera

A

may cause hepatotoxicity and SI in children and adolescents

51
Q

indication for prescribing a-agonists (clonidine, guanfacine)

A

adjunctive for ADHD (particularly in children) to tx behavioral manifestations, aggression, insomnia, tics

52
Q

abrupt discontinuation of clonidine or guanfacine

A

may precipitate HTN crisis

53
Q

guanfacine and clonidine interactions

A

avoid concomitant use of other CNS depressants

54
Q

1st line therapy for ADHD

A

stimulants unless there are contraindications

55
Q

2nd line therapy for ADHD

A

atomoxetine (Strattera)

56
Q

3rd line therapy for ADHD

A

bupropion or a2-agnonists (clonidine, guanfacine) may be considered as monotherapy or adjunctive therapy

Pharmacology (11 decks)

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