RxPrep Sleep Disorders

3; 3 months

A diagnosis of chronic insomnia occurs when a patient has symptoms at least ________ time(s) per week occurring for at least ________, despite adequate opportunity to sleep.

cognitive behavioral therapy

What is the preferred non-drug treatment for insomnia?

sleep hygiene

Cognitive behavioral therapy for insomnia includes changes to ________.

acetylcholinesterase inhibitors, alcohol, antiretrovirals, aripiprazole, atomoxetine, bupropion, caffeine, decongestants, diuretics, fluoxetine, steroids, stimulants, varenicline

What are 13 drugs/classes that can worsen insomnia?

chamomile tea, melatonin, valerian

What are 3 natural products that are used for insomnia?

hepatotoxicity

Kava is a supplement used by patients for insomnia that is not recommended due to the risk of ________.

true

True or False: When treating insomnia, it is preferred to start with non-drug measures.

eszopiclone,

zolpidem

ramelteon,

zaleplon,

What 4 drugs are used when the patient needs help falling asleep?

zolpidem

eszopiclone,

suvorexant

doxepin,

What 4 drugs are used when the patient needs help staying asleep?

eszopiclone, zolpidem

What 2 drugs are used when the patient needs help with both falling asleep and staying asleep?

non-benzodiazepines

Which are preferred for patients using prescription drugs for insomnia long-term, benzodiazepines or non-benzodiazepines?

diphenhydramine, doxylamine

What are 2 OTC first-generation antihistamines patients can use to self-treat insomnia?

false

True or False: OTC first-generation antihistamines can be used long-term for the treatment of insomnia.

diphenhydramine, melatonin, tiagabine, trazodone, valerian

What 5 drugs are NOT recommended for the chronic treatment of insomnia?

benzodiazepines, first-generation antihistamines, non-benzodiazepine hypnotics

According to the Beers Criteria, what 3 drugs classes are considered potentially inappropriate for the treatment of insomnia in patients 65 years or older?

lorazepam, oxazepam, temazepam

If a benzodiazepine must be used for treatment of insomnia in the elderly, what 3 are preferred?

selectively; increase GABA

Non-benzodiazepine hypnotics act (non-selectively/selectively) at the benzodiazepine receptors to ________.

Lunesta

What is the brand name for eszopiclone?

complex sleep behavior

What is the boxed warning for non-benzodiazepine hypnotics?

abuse/dependence,

CNS depression

When taking non-benzodiazepine hypnotics, there's an increased risk for ________ and ________.

ataxia, dizziness, headache, parasomnia, somnolence

What are 5 side effects of non-benzodiazepine hypnotics?

C-4

What drug schedule are non-benzodiazepine hypnotics?

non-benzodiazepine hypnotics

Eszopiclone, zolpidem, and zaleplon are examples of ________.

Ambien

What is the brand name for zolpidem IR and ER tablets?

Edluar

What is the brand name for zolpidem sublingual tablets?

5 mg HS

What PO/sublingual zolpidem dosing is used for females?

5 mg HS

What PO/sublingual zolpidem dosing is used for the elderly?

5-10 mg HS

What PO/sublingual zolpidem dosing is used for males?

additive

Non-benzodiazepine hypnotics can have ________ effects when used with other sedating drugs.

alcohol, antihistamines, mirtazapine, muscle relaxers, pain medications, trazodone

What are 6 drugs/classes that can have additive effects when taken with non-benzodiazepine hypnotics?

orexin

The ________ neuropeptide signaling system promotes wakefulness.

orexin receptor antagonists

Daridorexant, lemborexant, and suvorexant are examples of ________.

narcolepsy

What is a contraindication for orexin receptor antagonists?

somnolence

What is a side effect of orexin receptor antagonists?

melatonin receptor agonists

Ramelteon and tasimelteon are examples of ________.

somnolence

What is a side effect of melatonin receptor agonists?

true

True or False: Melatonin receptor agonists are a non-controlled class of medication used in insomnia.

acetylcholine, histamine

What 2 receptors are blocked by tricyclic antidepressants?

doxepin

Which tricyclic antidepressant is FDA approved for insomnia?

increase in suicidal thoughts

What is the boxed warning for doxepin?

2 week; MAO inhibitors

When taking doxepin for insomnia, a(n) ________ washout period is required for ________.

trazodone

What antidepressant is used off-label for insomnia?

Restoril

What is the brand name for temazepam?

temazepam

What benzodiazepine is preferred when treating insomnia?

C-4

What drug schedule are benzodiazepines?

cognitive impairment, dizziness, drowsiness, increased fall risk

What are 4 side effects of benzodiazepines?

Benadryl

What is the brand name for diphenhydramine?

Unisom SleepTabs

What is the brand name for doxylamine?

sedation, urinary retention

What are 2 side effects of first-generation antihistamines?

BPH, glaucoma

First-generation antihistamine use should be avoided in patients with what 2 conditions?

restless legs syndrome

an urge to move the lower legs, which is sometimes described as a "creeping" sensation

night

At what time of day does restless legs syndrome worsen?

dopamine agonist

What drug class is preferred when treating restless legs syndrome?

pramipexole, ropinirole, rotigotine

What 3 dopamine agonists are preferred for restless legs syndrome?

immediate

Are extended or immediate release dopamine agonist formulations preferred for restless legs syndrome?

1-3 hours before bedtime

When are dopamine agonists taken to treat restless legs syndrome?

c

Which of the following comes in a patch formulation for restless legs syndrome?

a) pramipexole

b) ropinirole

c) rotigotine

orthostasis, somnolence

What are 2 side effects of dopamine agonists?

gabapentin

An extended-release formulation of ________ is approved for both postherpetic neuralgia and restless legs syndrome.

narcolepsy

excessive daytime sleepiness with cataplexy (sudden loss of muscle tone) and sleep paralysis

stimulant

What drug class is used to treat narcolepsy?

calcium/magnesium/potassium/sodium oxybate, dextroamphetamine,

dextroamphetamine/amphetamine,

methylphenidate,

modafinil,

sodium oxybate

What are 6 stimulants used to treat narcolepsy?

life-threatening rash

What is a side effect of modafinil?

GABA;

narcolepsy with cataplexy

Sodium oxybates are drugs derived from ________ and are indicated for ________.

C-3

What drug schedule is sodium oxybate when used for narcolepsy?

sexual assault

The active moiety of oxybate salts is used illicitly to facilitate ________.

Xyrem

What is the brand name for sodium oxybate?

Xywav

What is the brand name for calcium/magnesium/potassium/sodium oxybate?

sodium oxybate

What drug used in the treatment of narcolepsy has a REMS program associated with it?

dopamine/norepinephrine reuptake inhibitor,

histamine-3 antagonist/inverse agonist

What are 2 non-first line drug classes used in the treatment of narcolepsy?

histamine-3 antagonist

Pitolisant is an example of a(n) ________.

dopamine/norepinephrine reuptake inhibitor

Solriamfetol is an example of a(n) ________.