Insomnia and Other Sleep Disorder Meds

Modafinil, Armodafinil

What medications are being described?

MOA: unclear, CNS stimulant

-Indications: first line therapy for excessive daytime sleepiness, due to its better side effect profile

headache, pain, SJS

ADRs and Warnings: Modafinil and Armodafinil

-ADRs: ________, appetite suppression, abdominal _____

-Warning: ___/TEN/DRESS

Sodium Oxybate

What drug is being described?

-MOA: CNS depressant taken QHS, promoting deep sleep and improving daytime sleepiness

-Only available through REMS program

-DOC for cataplexy, for pts with excessive daytime sleepiness who do not respond to modafinil/stimulants

loss, incontinence, depression, parasomnias

Sodium Oxybate ADRs and Warnings

-ADRs: weight ____, N/V, ___________, headache, confusion, dizziness

-Warnings: respiratory __________, behavioral/psychiatric effects, parasomnias

Pitolisant

What drug is being described?

-MOA: H3 receptor inverse agonist

-Indications: effective for excessive daytime sleepiness and cataplexy, not usually a first line agent

headache, QT

Pitolisant ADRs and Warnings

-ADRs: __________

-Warning: __ interval prolongation

Soriamfetol

What drug is being described?

-MOA: DA/NE reuptake inhibitor

-Indications: effective for excessive daytime sleepiness, not cataplexy

headache, increase

Solriamfetal ADRs and Warnings

-ADRs: _________

-Warnings: ________ in BP/HR, psychiatric effects

Benzodiazepines

What class of drugs used for insomnia is being described?

-MOA: Modulate GABA transmission through binding of GABA-A receptor benzodiazepine sites (Sedative +hypnotic effects)

• Reduce sleep latency and number of awakenings

-Indicated for sleep onset/maintenance insomnia, not first line

-Triazolam (short acting), estazolam and temazepam (intermediate acting), and flurazepam / quazepam (long acting)

• Short acting associated with rebound insomnia and early morning awakenings

• Intermediates are preferred

• Long acting are associated with “hangover” effects, avoid in elderly patients

drowsiness, amnesia, cognition, abuse, opioids, death

Benzodiazepines: Warnings and ADRs

-ADRs: somnolence, ___________, dizziness, and anterograde _______ (highest risk with short acting agents)

-Caution in elderly: slower metabolism allows for drug accumulation and increases risk for impaired _________, falls and hip fracture, and hangover effects

-Risk of ______/addiction, tolerance, dependence, and withdrawal

-Boxed Warning: use with _______ increase risk for profound sedation, respiratory depression, coma, and ______

Z-hypnotics

What class of insomnia drugs is being described?

-MOA: modulate GABA transmission through binding of GABA-A receptor benzodiazepine sites more selectively than benzos

-Zolpidem (sleep onset/maintenance), zaleplon (sleep onset), eszopiclone (onset/maintenance)

dizziness, depression, depression, parasomnias

Z-Hypnotics: ADRs and Warnings

-ADRs: somnolence, drowsiness, ___________

-CNS _________: increased risk with inadequate sleep and concurrent use of other CNS depressants

-Warnings: abnormal thinking and behavioral changes can occur, may worsen ___________

-Boxed Warning: complex sleep behaviors/____________

Orexin Receptor Antagonists

What class of drugs is being described?

-MOA: block orexin receptors A/B, suppressing wake drive usually promoted by orexin

-Indicated for sleep onset/maintenance insomnia

-Contraindicated in narcolepsy

-Agents: suvorexant and lemborexant

somnolence, paralysis, cataplexy

Orexin Receptor Antagonists: ADRs and Warnings

-ADR: ____________

-Warnings: abnormal thinking/behavioral changes, parasomnias, sleep ________, hypnagogic/hypnopompic hallucinations, ___________

Ramelton

What drug is being described?

-MOA: MT1/MT2 receptor agonist, facilitates sleep onset and reinforces normal circadian rhythm

-Indicated for sleep onset insomnia, effective in COPD and OSA pts

-Class: Melatonin receptor agonist

fatigue, insomnia, fatty

Melatonin Receptor Agonists ADRs and Warnings

-ADRs: somnolence, dizziness, _________, nausea, exacerbation of ________

-Ramelton: ______ food decreases absorption