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Naplex
Sleep Disorders
| Question | Answer |
|---|---|
| Q1. Drugs can worsen insomnia | • ADHD: methylphenidate, atomoxetine • Psychiatric meds • Smoking cessation • Stimulants: caffeine, decongestant (pseudoephedrine), phentemine • Other: alcohol, diuretics, steroid, INSTI |
| Q2. Psychiatric drugs can worsen insomnia | • Acetylcholinesterase inhibitors: donepezil (TCA) • Aripiprazole, bupropion, fluoxetine (if take late in the day) |
| Q3. Conditions cause sleep disorder | • Chronic pain • Conditions causing SoB (HF, asthma, COPD) • Mental health conditions (eg, anxiety, depression) |
| Q4. Sleep onset meds | • Ramelteon (Rozerem) • Zaleplon |
| Q5. Meds for Difficulty staying asleep? | • Doxepin (TCA) • Suvorexant (orexin receptor antagonist) |
| Q6. Meds for both Difficulty falling asleep & Difficulty staying asleep | • Eszoniclone • Zolpidem |
| Q7. Not recommended for chronic use: | • Benzodiazepines (eg, temazepam) •1st generation antihistamines (eg, diphenhydramine) • Natural products (eg, melatonin, valerian) • Sedating antidepressants (eg, trazodone, mirtazapine) |
| Q8. NonBZD & BZD hypnotics | • C-IV • DDI: Additive CNS depression with other sedating drugs • Beers Criteria: Potentially inappropriate in ≥ 65 yrs old (LOT safest) |
| Q9. NonBZD hypnotics | • Eszopiclone (Lunesta) • Zolpidem (Ambien, Ambien CR, Edluar) • Zaleplon |
| Q10. Zolpidem max dose | • Males: 10 mg daily • Females/older adults: 5 mg daily |
| Q11. NonBZD hypnotics BW | • Complex sleep behaviors can cause serious injury or death Warnings • CNS depression • Potential for abuse and dependence |
| Q12. NonBZD - CNS depression | Increased risk w: • Higher doses • Concurrent CNS depressants • < 7-8 hours of sleep |
| Q13. NonBZD hypnotics SEs | • Somnolence, dizziness, ataxia, HA • Avoid taking with fatty food or heavy meal |
| Q14. Edluar | • Zolpidem SL |
| Q15. BZD w approved indication of sleep | • Temazepam (Restoril): preferred for older adults • Triazolam • Estazolam • Quazepam • Flurazepam |
| Q16. BZD box warning | • Use w opioids can cause sedation, respiratory depression, coma and death • Abuse and physical dependence • Caution in pregnancy |
| Q17. Benzodiazepines SEs | • Drowsiness, dizziness, falls, cognitive impairment |
| Q18. Others | • Melatonin Receptor Agonists: ramelteon • TCA: doxepin • Orexin Receptor Antagonists: suvorexant • Antihistamines: diphenhydramine, doxylamine |
| Q19. Melatonin Receptor Agonists | • MT1 and MT2 melatonin receptor agonist • Helps regulate circadian rhythm • Sleep onset |
| Q20. Doxepin (TCA) | • 2-wk washout from MAOi • Seizures & anticholinergic effects |
| Q21. Suvorexant | • Blocks orexin neuropeptide signaling system • C-IV |
| Q22. Antihistamines | • Blocks H1 histamine receptors • Anticholinergic effects: dry mouth, blurry vision, urinary retention, constipation, and confusion. • NOT chronic use • Avoid: older adults, BPH or glaucoma |
| Q23. Restless Legs Syndrome | • Gabapentinoids (eg, gabapentin enacarbil, gabapentin, pregabalin) • Dipyridamole • Opioids • DAs (eg, pramipexole, ropinirole, rotigotine) • Carbidopa-levodopa |
| Q24. Narcolepsy | • Modafinil, Armodafinil, Dextroamphetamine, Methylphenidate • Pitolisant, Solriamfetol, Sodium oxybate |
| Q25. Modafinil & Armodafinil | • Administered AM • C-IV • Dermatologic reactions: Severe rash, SJS • Psychiatric & cardiovascular effects |
| Q26. Sodium Oxybate | • QHS, C-III, REMS AEs: • Risk of abuse and misuse • CNS & respiratory depression |
| Q27. Classification of sleep disorder | • Chronic insomnia • RLS • Narcolepsy |
| Q28. Natural products | Melatonin: • 1-5mgQHS (jet lag 0.5-2mg pre-flight, 5mg post) • Substrate 1A2 Valerian, Kava: • Not recommend (hepatoxic) • Chamomile tea (PM): calmer |
| Q29. Need help falling sleep | • Eszopiclone • Zopidem • Zalepton • Ramelteon |
| Q30. Need help staying sleep | • Eszopiclone • Zopidem • Doxepin • Suvorexant |
| Q31. Need help falling and staying sleep | • Eszopiclone • Zopidem |
| Q.32 Pt self treated w OTC | • Benadryl • Doxylamin (sleep Aid) • Anticholinerics SEs • Avoid BPH, glaucoma, elderly • Tolerance if > 10ds |
| Q33. NOT recommend for chronic use | • Benadryl • Melatomin • Trazadone • Valerian |
| Q34. BZD for sleep incl L-O-T | • Oki if BZD used • Lorazepam: Ativan • Oxazepam • Temazepam: Restoril |
| Q35. Beers not for > 65yrs | • BZD • Non-BZD hypnotics (thuốc ngủ) • 1st antihistamines |
| Q36. Non-BZD Hypnotics: selectively act on BZD receptor, increase GABA | • Eszopiclone (Lunesta) • Zopidem (Ambien: IR, ER, Edluar: SL) • Zalepton (Sonata) |
| Q37. Non-BZD hypnotics BW | • Complex sleep behavior: Sleep walking / driving |
| Q38. Non-BZD hypnotics CI | • Hx Complex sleep behavior |
| Q39. Non-BZD hypnotics Warnings | CNS depression, next day impairement: • Dose increases • < 7-8h sleeping • CNS depression: alcohol Abnormal thinking Abuse (if > 2 wks use) |
| Q40. Non-BZD hypnotics SEs | • Somnolence, dizziness, ataxia, HA • Eszopiclone: dysgeusia (altered tast) |
| Q41. Non-BZD hypnotics DDI | • Additive CNS depression w sedating drugs • Caution w potent 3A4 inhibitor • Not take w fatty food or heavy meal: delay onset • Alcohol |
| Q42. Melatonin receptor agonist (MT1, MT2) | • Ramelteon (Rozerem): 8mg PO QHS, complex sleep behavior • Tasimelteon: 20mg PO QHS • Somnolene, dizziness • 1A2 substrate |
| Q43. TCA Doxepin (Silenor) | • 3-6mg PO QHS • 3mg: > 65yrs • BW: Suisical thought in children/young • CI: within 2 wks MAOi, narrow angle glaucoma, sever urine retention • Warning: complex sleep behavior • SEs: Seizure, somnolence, Anticholinergic effects |
| Q44. BZD enhance GABA, cause CNS depression. | • Temazepam: Restoril, prefer for older pts • Estazolam • Quazepam • Flurazepam • Triazolam: PO |
| Q45. BZD box warnings | • Use w Opioid: SEDATION, RESPIRATORY DEPRESSION, coma, DEATH • Life threatening withdrawal symptoms: taper off slowly • Abuse, misuse, dependence |
| Q46 BZD Contraindication | • Triazolam: NOT use w strong 3A4 |
| Q47. BZD warnings | • Complex sleeping behavior • Abnormal thinking • Worsen depression • Birth defect & neonatal withdrawal symptoms |
| Q48. BZD side effects | • Drowsiness, Dizziness, Fall risk, cognitive impairement |
| Q49. Orexin receptor antagonists (C-IV) | • Suvorexant: Belsomra , 5-20mg QHS • Daridorexant: Quvivig, 25-50mg PO QHS • Lemborexant: Dayvigo, 5-10mg QHS |
| Q50. Orexin receptor antagonists (C-IV) CI & warning | • CI: Narcolepsy Warnings • Depression, suicide, Sleep paralysis (bóng đè), hallucination • Sudden lost of muscle tone, complex sleep, daytime impairment |
| Q51. Orexin receptor antagonists (C IV) SEs | • Somnolence, HA, dizziness, abnormal dream • W food delay onset, NOT for hepatic impairment • NOT if sleep < 7h |
| Q52. RLS | • Iron supplement if needed • Gabapentin • Pregabalin • Dopamin agonist |
| Q53. Narcolepsy - Stimulants for narcolepsy, C IV | • Modafinil: Provigil, 200mg • Armodafinil: Nuvigil, 150-250mg • Warning: Pre-existing Cardiac,hepatic, renal, psychiasis, life-threatening rash • SEs: HA, insomnia, anxiety, nausea |
| Q54. Narcolepsy - Sodium oxybate: C-III (C-I if illicit use) | • BW: CNS / Respiratory depresion, coma, death, sex assult, REMS • CI: Sedative hypnotic, alcohol • Warn / SEs: Depression, suicide, anxiety, sleepwalk, confusion • Onset: 5-15 mins after 1st dose |
Created by:
dao.vo11017