Sleep

Question 1

symptom duration requirement for insomnia diagnosis

Answer 1

at least 3x/week for at least 3 months

Question 2

preferred management of insomina

Answer 2

CBT
sleep hygiene
treat underlying conditions
discontinue meds that may worsen

Question 3

drugs that can worsen insomina

Answer 3

ADHD- stims, atomoxetine
psych meds- AchEst, aripiprazole, bupropion, fluoxetine
smoking cessation- NRT, varenicline
stimulants- caffeine, decongestants, phentermine
alcohol, diuretics, steroids, INSTIs

Question 4

natural products for insomnia

Answer 4

melatonin
chamomile

Question 5

2 natural products NOT recommended due to hepatotoxicity risk

Answer 5

valerian, kava

Question 6

sleep hygiene recommendations (many)

Answer 6

keep room dark/comfy, regular sleep schedule, avoid naps, reserve room for sleep, turn the face of clock, if can’t sleep get up and do something, establish pre-bed ritual, avoid exercising before bed, do not eat heavy meals before bed, do not consume caffeine in PM

Question 7

drug options if need help FALLING asleep

Answer 7

eszopiclone, zolpidem, ramelteon, zaleplon

Question 8

drug options if need help STAYING asleep

Answer 8

eszopiclone, zolpidem, doxepin, suvorexant

Question 9

drug options for help FALLING AND STAYING asleep

Answer 9

eszopiclone, zolpidem

Question 10

non-___ are preferred for long term treatment at lowest dose and shortest duration to minimize AEs

Answer 10

benzos

no!

Question 11

OTC options to self-treat insomnia, not recommended long term

Answer 11

diphenhydramine, doxylamine

Question 12

PIMs according to Beers in >65 that might get used for sleep

Answer 12

Benzos
non-BZD hypnotics
1st gen antihistamines

Question 13

benzos to use in elderly if needed

Answer 13

LOT
lorazepam, oxazepam, temazepam

Question 14

act selectively at BZD receptors to increase GABA

Answer 14

hypnotics
eszopiclone, zolpidem, zaleplon

Question 15

control class of non-BZD hypnotics

Answer 15

CIV

Question 16

brand name eszopiclone

Answer 16

Lunesta

Question 17

brand name zolpidem

Answer 17

Ambien (CR)

Question 18

brand name of zolpidem SL tabs

Answer 18

Edluar

Question 19

recommended zolpidem dose in females/older adults

Answer 19

5 mg QHS

Question 20

recommended dose of zolpidem in males

Answer 20

5-10 mg QHS

Question 21

warnings for hypnotics

Answer 21

CNS depression
potential for abuse and dependence

Question 22

AEs of hypnotics

Answer 22

somnolence, dizziness, ataxia, HA

Question 23

DDI of hypnotics

Answer 23

additive CNS depression with other sedating drugs

opioids, muscle relaxants, antihistamines, mirtazapine, trazodone, alcohol

Question 24

agonists at the MT1 and MT2 melatonin receptors

Answer 24

ramelteon, tasimelteon

Question 25

AE of melatonin agonists

Answer 25

somnolence

Question 26

are melatonin agonists controlled

Answer 26

no

Question 27

TCA option that blocks NE and 5HT reuptake and blocks Ach and H receptors

Answer 27

doxepin

Question 28

contraindication doxepin

Answer 28

2 weeks of MAOI

Question 29

AE of doxepin

Answer 29

seizure

Question 30

preferred benzo for sleep/elderly

Answer 30

temazepam

Question 31

brand name of temazepam

Answer 31

Restoril

Question 32

block the orexin neuropeptide signaling system

Answer 32

orexin receptor antagonists daridorexant, lemborexant, suvorexant

Question 33

AE of orexin antagonists

Answer 33

somnolence

Question 34

2 antihistamine options

Answer 34

diphenhydramine (Benadryl) doxylamine (Unisom)

Question 35

avoid antihistamines in

Answer 35

BPH and glaucoma

Question 36

AEs of antihistamines

Answer 36

sedation peripheral AEs like urinary retention

Question 37

urge to move the lower legs, worse at night

Answer 37

restless legs syndrome

Question 38

what study should be assessed in RLS and supplemented if needed

Answer 38

iron

Question 39

options for RLS treatment

Answer 39

gabapentin ER (approved) pregabalin (off label) DA agonists (not recommended)

Question 40

excessive daytime sleepiness with cataplexy

Answer 40

narcolepsy

Question 41

treatment of narcolepsy includes

Answer 41

stimulants modafinil, sodium oxybate, ADHD meds

Question 42

when should modafinil or armodafinil be taken

Answer 42

QAM

Question 43

narcolepsy med that is derived from GABA, taken at night to help sleep and used in combo with a stimulant

Answer 43

sodium oxybate

Question 43

warning for modafinil/armodafinil

Answer 43

rash, can be life threatening

Question 44

control class of sodium oxybate

Answer 44

CIII

Question 45

control class of modafinil/armodafinil

Answer 45

CIV

Question 46

BBW sodium oxybate

Answer 46

illicit use, may be used to facilitate sexual assault REMS

Question 47

H3 antagonist/inverse agonist taken QAM for narcolepsy

Answer 47

pitolisant

Question 48

DA and NE reuptake inhibitor taken QAM for narcolepsy

Answer 48

solriamfetol