Naplex 2025 😭 > Sleep > Flashcards

Sleep Flashcards

(35 cards)

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1
Q

What is chronic insomnia?

A
  • Having symptoms (difficulty falling asleep, reduced sleep, poor sleep quailty) 3x a week for 3 months
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2
Q

What are some of the non drug treatments for insomnia?

A
  • Cognitive Behavioral Therapy (sleep hygiene)
  • Treating any medical conditions that worsen insomnia (Pain, SOB in HF, Anxiety, Bipolar, Depression)
  • DC’ing any medication that worsen insomnia
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3
Q

What are the cognitive behavorial therapies that help with insomnia?

A
  • Keeping room dark, comfortable, quiet
  • Keeping regular sleep schedule
  • avoiding naps or limit to 30 mins
  • Turn the face of clock (avoids any anxiety)
  • If unable to sleep, get up and do something
  • Pre-bedtime ritual
  • Avoid exercise right before bed
  • DO NOT eat heavy meals
  • DO NOT consume caffiene in afternoon
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4
Q

What are some medications that can worsen insomnia?

A
  • Acetylcholineesterase Inhibitors (Donepezil)
  • Alcohol, Caffeine, Nicotine, Verenicline. Bupropoin
  • Aripiprazole
  • Atomoxetine
  • Decongestants (Pseudoephedrine)
  • Diuretices (because of peeing at night)
  • Fluoxitine (if taken late in the day)
  • INSTIs
  • Steriods
  • Stimulants (Methylphenidate, Phentermine)
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5
Q

What are some natural products that can help with insomnia?

A
  • Melatonin 1 - 5 mg in the evening
  • Chamomile tea can calm you down before bed
  • Valerain or Kava should NOT be used due to increased risk of Hepatotoxicity
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6
Q

What are some of the drug classes that are used for insomnia?

A
  • Hypontics
  • Orexin Receptor Antagonist
  • Melatonin Receptor Agonist
  • TCAs
  • Benzos
  • Antihistamines
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7
Q

What is the MOA for the Hypnotics used for insomnia?

A
  • Act on Benzo receptors increasing GABA, enhacning the acitivty

Pretty mucht the same as the Benzos

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8
Q

What are the Hypnotics that are used for insmonia?

A
  • Eszoplicline (lunesta)
  • Zolpidem (Ambian)

C-IV
Boxed Warnings: complex sleeping issues [Parasomnia] (sleep walking, sleep driving, other activities while sleeping)

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9
Q

What are the Warnings for Hypotics used in insmonia?

A
  • Increased risk for CNS Depression
  • Needs ~8 hours of sleep to avoid next day impairment
  • Potential for abuse
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10
Q

What are the side effects for hypnoitcs used in insmonia?

A
  • Somnolence, Dizziness, Ataxia, headache
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11
Q

What are the additional notes for hypnotics used in insmonia?

A
  • Preferred over benzos (to help minimize abuse)
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12
Q

What is the MOA for the Orexin Receptor Antagonist?

A
  • Blocks orexin neuropeptide signaling system = drowsiness
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13
Q

What are the orexin receptors antagonists that are used for insomnia?

What is the common naming?

A
  • Daridorexant (Quviviq)
  • Lemborrexant (DayVigo)
  • Suvorexant (Belsomra)

“-rexant”

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14
Q

What are the side effects for orexin receptor antagonist used in insmonia?

A
  • Somnolence, headache, dizziness, abnormal dreams
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15
Q

What are the MOA for the melatonin receptor agonist

A
  • Agonist for the melatonin receptors to help promote sleepiness
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16
Q

What are the melatonin receptor agonist that are used for Insomnia

similar naming?

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A
  • Remelteon (Rozerem)
  • Tasiemelteon (hetlioz)

“-melteon”

17
Q

What are the side effects for melatonin receptor agonist used in insmonia?

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A
  • Somnolence, Dizziness
18
Q

What are the additional notes for melatonin receptor agonist used in insmonia?

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A
  • Not a controlled substance (like the others)
19
Q

what is the MOA for the tricycle antidepressants that are used for insomnia?

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A
  • Blocks serotonin and norepi reuptake BUT it also blocks acetylcholine and histamine reupatke causing the sleepiness
20
Q

What are the Tricycle antidepressants that are used for insomnia?

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A
  • Doexpin (Slienor)
21
Q

What are the contraindications for tricyclie antidepressants used in insmonia?

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A
  • used within 2 weeks of an MAOi
22
Q

What are the side effects for tricyclic antidepressants used in insmonia?

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A
  • Seizures, somnolence, anticholinerigic effects (blurred vision, constipation, urinary retention, dry mouth)
23
Q

What is the MOA for the benzodiazepines used for insomnia?

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A
  • Enhances GABA = CNS depression

Not Inhibiting it

24
Q

What are the benzodiazepines that are used for insomnia?

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A
  • Temazepem (Restoril)
  • Estazolam
  • Quazepam (Doral)
  • Flurazepem
  • Triazolam (Halcian)

C-IV

25
What are the **boxed warnings** for **Benzodiazepines** used in **insmonia**?
- When used with **opioids** = increased risk of **sedation, respiratory depression, coma, death** - Increased risk of **abuse, missue, addiction** - **Phyiscal dependence**
26
What are the **Contraindications** for **Benzodiazepines** used in **insmonia**?
- Pregnancy (teratogenic)
27
What are the **side effects** for **Benzodiazepines** used in **insmonia**?
- Drowsiness, Dizziness/increased fall risk, cognitive inpairment
28
What are the **additional notes** for **Benzodiazepines** used in **insmonia**?
- Lorazepam, Oxazepem, Temazepem (**L-O-T**) is best for eldery ## Footnote L: Ativan O: Serax T: Restroil
29
What is **restless leg syndrome**?
- urge to move the lower legs (worse at night)
30
What is the **primary drug treatment** for **restless leg syndrome**?
- Dopamine Agonists (**Pramipexole & Ropinirole**) - **Rotigotin** is a patch applied once daily - **Gabapentin IR** is an off label use
31
What is **Narcolepsy**?
- excessive daytime sleepiness with catapley (which is falling asleep suddenly)
32
What are some of the **drug treatment** for **Nacrolepsy**?
- Stimulants (**Modofinil (Provigil), Armodafinil (Nuvigil), or Sodium Oxybate (Xyrem)**) - **Dextroamphetamine, Dextroamphetamine/Amphetamine, and Methylphenidate** could also be used
33
What are some of the **treatment options** to help with **falling asleep**?
- Eszopiclone - Zolpidem - Ramelteon - Zaleplon
34
What are some **treatment options** to help with **staying asleep**?
- Eszoopiclone - Zolpidem - Doxepin - Suvorexant
35
What are some of the **treatment options** to help with **falling and staying asleep**?
- Eszopiclone - Zolpidem
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