NAPLEX Sleep Disorders

Diagnosis for sleep problems are

symptoms for at least 3x/week for at least 3 months

Drugs that worsen insomnia

AChEi (Donepezil)

Alcohol

Antiretrovirals

Aripiprazole

Atomoxetine

Bupropion

Caffeine

Decongestants

Diuretics(peeing)

Fluoxetine, steroids, stimulants varenicline

1st line treatment for insomnia

non-drug treatments (CBT-> sleep hygiene): preferred

natural products

Natural Products for sleep (3)

melatonin,

valerian/kava (not rec'd d/t hepatotoxicity)

, chamomile tea

Which sleep drugs are best for helping fall asleep

Eszopiclone (lunesta)

Ramelteon

Zaleplon

Zolpidem

Which drug is best for help staying asleep

Doxepin

Eszopiclone

Suvorexant

Zolpidem

EZDanielSleep

Which drugs help with FALLING and STAYING asleep (2)

Eszopiclone

Zolpidem

EZ sleep

Which 2 meds can be used for any insomnia (falling/staying asleep/both)

Eszopiclone

Zolpidem

Patients can initially self-treat insomnia with

OTC 1st gen antihistamines (diphenhydramine, doxylamine) - Not for chronic use

Obvs melatonin and natural meds too

Benzos are preferred/not preferred for sleep

not preferred - short term only!!

L-O-T (loraz, oxax, temaz) if used

Non benzodiazepine hypnotics MOA + which

act selectively at benzodiazepine receptors to increase GABA (cns depression)

eszopiclone (lunesta)

zolpidem (ambien, edluar)

all are c4!!

Non benzodiazepine hypnotics (eszopiclone (lunesta); zolpidem (ambien, edluar))

SEs

somnolence

dizziness

ataxia

HA

parasomnia

abuse

Eszopiclone

Lunesta

Zoplidem (2)

Ambien, Ambien CR

Edular (SL tab)

Hypnotics increase risk of

respiratory depression

? are preferred over BZDs for 1st line treatment of insomnia d/t less risk of abuse

non bzd hypnotics (z drugs)

Parasomnia

abnormal behaviors during sleep including somnambulism and night terrors; usually occur during stage 3 or slow wave sleep

AE of Lunesta, Zolpidem

Zolpidem (ambien/edluar) dosing

Female/elderly: 5 mg QHS

Male: 5-10 mg QHS

Orexin receptor antagonists

MOA

C4!!

block orexin neuropeptide signaling system (= drowsiness)

suvorexant (belsomra) - ci in narcolepsy

Rozerem

a. generic name

b. mechanism

c. for falling/staying asleep

d. schedule

a. Ramelteon

b. melatonin receptor agonist

c. falling asleep

d. not a CS

TCAs

MOA

+ which for insomnia

block ach and histamine (= somnolence)

doxepin (silenor) er - ci w/i 14 days MAOI

T/F

Benzos can make you unable to store memories

true

temazepam name + schedule

c4

bzd - short term use only; beers

restoril

Antihistamines for insomnia

block h1

doxylamine (unisom, sleepTabs)

diphenydramine (benadryl)

Sleep Aid/ SleepTabs

doxylamine

Anti-histamine

Unisom

Doxylamine

Anti-histamine

antihistamines for insomnia should not be used in

BPH (can cause urinary retention d/t anti-choinergic), glaucoma (increases IOP)

Restless leg syndrome is treated with what class of drug?

Dopamine agonist

-pramiprexole (mirpex)

-ropinirole (requip)

-rotigotine (neupro) - patch!

gabanpentin er (horizant)

Mirapex

1. generic

2. MOA

3. Used for?

pramipexole

dopamine agonist

restless leg syndrome

Requip

1. generic

2. MOA

3. Used for?

1. ropinorole

2. dopamine agonist

3. RLS

Neupro

1. generic

2. MOA

3. falling asleep/staying asleep/restless leg syndrome

4. formulation

1. rotigotine

2. dopamine agonist

3. RLS

4. patch

Horizant

1. generic

2. MOA

3. falling asleep/staying asleep/restless leg syndrome

gabapentin enacarbil

GABA

RLS (also post-herpatic neuralgia)

sudden and uncontrollable sleep attacks with cataplexy

narcolepsy

What two stimulants are used for narcolepsy (brand

modafinil - Provigil (pro being vigilant)

armodafinil (r isomer of modafinil) - Nuvigil (the new version of a pro vigilance drug)

both are C4!!!

can also be used adhd meds: dextroamphetamine, dextroamphetamine/amphetamine, methylphenidate

what SE of modafinil (provigil) and armodafinil (nuvigil) must the patient be counsele don?

severe, life-threatening rash (eg sjs/tens)

Sodium oxybate

Xyrem - Used for narcolepsy with cataplexy

Not a bolded drug!

derived from gaba

cIII for narcolepsy

Rozerem

Rameleton

What formulations does Zolpidem come in?

IR tablet

CR tablet

Oral spray

SL tablet

Which are on the beer's criteria and may not be appropriate for patients over 65 for sleep (select all that apply)

a. hypnotics

b. benzos

c. antihistamines

d. melatonin

e. valerian

A,B,C

Edluar

Zolpidem SL

Nuvigil and Provigil require a MedGuide and careful pharmacist counseling due to this risk:

Severe rash which can be life threatening

Ramelteon

melatonin receptor agonist