Specific Meds

Question 1

Propranolol (beta blockers)
either lipid soluble (labetalol, oxprenolol, propranolol and timolol) or non lipid soluble (atenolol, nadolol, sotalol)

Answer 1

nonselective beta blocker with lipophilic properties allowing it to cross the BBB

Decreases REM duration

Causes EDS, daytime fatigue, insomnia, nightmares, sleep terrors and hallucinations

case reports describe beta blocker induced REM behavior disorder

PSG-
- increase in wake time after sleep onset
-increase in NREM stage 1 sleep
- increase in REM sleep latency
- decrease in REM sleep (less with atenolol and metoprolol)

Question 2

Bupropion

Answer 2

Antidepressant that blockes reuptake of NE and Dop

Does not decrease REM duration

Used for depression and for smoking cessation

Question 3

Reserpine

Answer 3

Depletes catecholamines

Increases REM sleep

Question 4

Physostigmine

Answer 4

Cholinesterase inhibitor

Increases REM sleep

Question 5

Donepezil

Answer 5

Centrally acting chplinesterase inhibitor

Increases REM sleep

Question 6

Dexamethasone (corticosteroids)

Answer 6

Decrease REM sleep

Decrease number of REM periods

Decrease N3 sleep

Increase in REM latency

Increase time spent awake

Question 7

MAO inhibitors (inhibit enzymes in the metabolism of NE, Dop, Ser)

Answer 7

Most potent REM inhibitors

Decreased TST

Increased wake time after sleep onset

No change in SWS

Increased REM sleep latency

REM rebound upon drug withdrawal

Types: classic- irreversible enzyme in hibition -phenelzine, Trancypromine or
Newer reversible (brofaromine)

Question 7

Benzodiazepines

Answer 7

Act on GABA receptors and enhance activity of GABA

Increase in TST

Reduces sleep latency

Reduction in frequency of arousals

Reduction in wake time after sleep onset

Increase in N2 sleep

Reduction in N3 sleep (SWS)

Increase in REM sleep latency

Reduction in REM sleep

Increase in spindle density at 12-14 cycles/sec and pseudospindle density

Increase in sleep continuinty

Question 8

Ropinirole (Requip)

Answer 8

treats RLS

Non effective for non motor symptoms of RBD

In mild RBD with frequent comorbid periodic limb movements pramipexole decreases nocturnal behavior

Question 9

Baclofen

Answer 9

Agonist at GABA receptor and inhibits transmission of both monosynaptic and polysynaptic reflexes at spinal cord by hyperpolarization of primary afferent fibre terminals

used to treat spasticity

Question 10

melatonin

Answer 10

initial therapy for RBD symptoms and at high doses at bedtime (6-15mg) augments REM sleep atonia

Question 11

Obstructive apneas

Answer 11

opiates BDZs by reducing tone in upper airway dilator muscles

alcohol ingestion leading to inhibition of upper airway muscle

Barbs decrease tone in upper airway dilator muscles

Question 12

Olanzapine- atypical antipsychotic

Answer 12

Binds to Dop receptors D1/D2, serotonin receptor 5HT-2, muscarinic Ach receptors, alpha 1 receptor, Histaminergic receptor H1

Increases REM sleep latency

Decreases REM sleep

Increases REM sleep density (quantitative measure of phasic eye movement)

Question 13

Opiates

Answer 13

cause central sleep apnea such as methadone in creases risk of cSA in a dose dependent fashion with erratic, ataxic, irregular breaqthing

decreases SWS

Question 14

Temazepam

Answer 14

can worsen OSA

Question 15

Tiagabine

Answer 15

GAT-1 inhibitor

Increases SWS

Question 16

Hydroxyzine (antihistamines)

Answer 16

Modest suppression of REM sleep and increased sleep continuity

Question 17

Phenobarbital (GABA receptor agonist)

Answer 17

Increases sleep continuity

Decreases both REM and SWS

Minimally affects SWS

Question 18

Amphetamines

Answer 18

Increase MAO neurotransmitters NE, Dop, Ser by increasing their presynaptic release or blocking reuptake

Enhance wakefulness and alertness producing insomnia

Decrease in sleepiness

Increase in sleep latency

Decrease in sleep efficiency

increase in wake time after sleep onset

Decrease in TST

Increase in sleep fragmentation

Decrease in SWS

Increase in REM sleep latency

Decrease in REM sleep

Question 19

Discontinuation of amphetamines

Answer 19

increase in sleepiness

increse in SWS

Increase in REM sleep

Question 20

Carbamazepine works through sodium channels

Answer 20

Increases SWS while decreasing REM sleep

Question 21

Phenytoin works via sodium channel blockade

Answer 21

Chronic use decreases SWS

Acute use increases SWS

Question 22

Lamotrigine works via sodium blackade

Answer 22

Decreases SWS

Question 23

Diazepam works as a GABA agonist

Answer 23

Decreases both REM and SWS

Question 24

Phenobarbital works as GABA agonist

Answer 24

Decreases both REM and SWS

Question 25

Antihistamines

Answer 25

First generation (antagonists of H1 receptors- diphenhydramine, cyproheptadine, hydroxyzine, doxylamine- significant CNS penetrating and strong sedating effects- lipophilic Second generation- loratadine, cetrizine - minimal CNS penetrating and less sedating effects

Question 26

TCAs

Answer 26

Used to treat insomnia sedating- amitryptyline, doxepine, nortryptyline, trimipramine increase REM sleep latency decrease REM sleep SE- anticholinergic (constipation or dry mouth), drowsiness, dizzyness, confusion, blurred vision, urinary retention, arrythmias, weight gain, abnormalities in caridac conduction, orthostatic hypotension, exacerbation of symptoms of restless legs and PLmovements during sleep or REM sleep behavioral disorder

Question 27

Eszopiclone (non BDZ/ BDZ-receptor agonist)

Answer 27

Half life of 6 hours Time of onset between 10 and 30 mins Used for sleep onset and sleep maint insomnia

Question 28

Zaleplon (non BDZ/ BDZ-receptor agonist)

Answer 28

Half life of 1 hour Time of onset between 10 and 20 mins Used for sleep onset insomnia

Question 29

Ramelteon (melatonin receptor agonist)

Answer 29

Half life of 1-2.6 hour Time of onset between 20 and 30 mins Used for sleep onset insomnia

Question 30

Triazolam (BDZ)

Answer 30

Half life of 2-5 hour Used for sleep onset insomnia

Question 31

Amitryptyline (TCA) also Doxepin, imipramine, nortriptyline, desipramine

Answer 31

increases stage N3 decreases relative percentage of REM sleep Increases REM latency Causes sedation

Question 32

Fluoxetine (SSRI) sertraline also citalopram, paroxetine, escitalopram

Answer 32

increases REM latency decreases REM sleep decrease N3 (SWS) Slow rolling eye movements (SREM) increased also called Prozac eyes esp during drowsiness and stage N1

Question 33

Trazodone (atypical antidepressant)

Answer 33

increases REM latency decreases relative percentage of REM Causses sedation

Question 34

Phenelzine (MAO in hibitor)

Answer 34

increases REM latency Decreased REM sleep

Question 35

Venlafaxine (SSRI) similar to duloxetine and desvenlafaxine

Answer 35

increases REM latency Decreases REM sleep

Question 36

Tylenol PM

Answer 36

has both acetaminophen and diphenhydramine (antihistamine with anticholinergic and sedative effects-