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Drugs and Sleep Disorders
Pharmacotherapy Exam 4
72
Pharmacology
Professional
04/23/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
cause insomnia
Definition
bupropion, venlafaxine, prednisone, stimulants, theophylline and antineoplastics
Term
first line
Definition
benzodiazepine receptor agonists (BZRAs and BZDs) and melatonin receptor agonist
Term
second line
Definition
BDZ, BZRAs not previously chosen
Term
third line
Definition
sedating low dose antidepressant
Term
fourth line
Definition
combo of BZRAs and antidepressant; anecdotal evidence at this point, makes sense as they have differing MOA without as many SEs
Term
BZRAs (short acting)
Definition
Restoril (temazepam), Halcion (triazolam)
Term
Halcion (triazolam)
Definition
has more rebound anxiety, makes old people crazy, and not recommended for first line
Term
MOA BZRA
Definition
binds the BZD receptor on GABAergic neurons to increase INHIBITORY firing in the CNS
Term
short acting BZD
Definition
better sedative hypnotic effects than long acting BZDs but more anxiety and withdrawal symptoms
Term
intermediate acting BZDs
Definition
alprazolam, clonazepam, lorazepam, oxazepam, and temazepam
Term
long acting BZDs
Definition
not used for sleep
Term
Z hypnotics
Definition
Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone)
Term
temazepam
Definition
of the intermediate acting, it is most commonly used for sleep
Term
HA, dizziness, day time sedation, parasomnias, potential for CNS depression
Definition
SEs of Z-hypnotics
Term
Zolpidem (ambien)
Definition
reduce sleep latency, increased total sleep time; no tolerance, dependence, rebound insomnia "hangover"
Term
zaleplon (sonata)
Definition
reduces sleep latency; if taken with food will increase daytime sedation without increased sleep benefit
Term
eszopiclone (lunesta)
Definition
FDA approved for chronic insomnia, decreased awakening and sleep onset; increased HA and unpleasant taste
Term
Melatonin receptor agonist
Definition
Rozerem (ramelteon)
Term
MOA melatonin receptor agonist
Definition
agonist at MT1 and MT2 contributing to sleep promotion and maintenance of circadian rhythm
Term
most appropriate for patients with a history of substance abuse and has less side effect profile for elderly patients
Definition
ramelteon
Term
low dose antidepressants
Definition
trazedone, mirtazapine, doxepin
Term
trazodone
Definition
little anti-cholinergic effect, studied as an adjunct sleep aid with full dose antidepressant
Term
mirtazapine
Definition
associated with wt gain but effective in elderly patients with comorbid depression and wt loss
Term
doxepin
Definition
very anti-cholinergic
Term
monamine oxidase inhibitors
Definition
isocarboxazid, phenelzine, tranylcypromine, selegiline
Term
MAOIs mechanism of action
Definition
suppress REM sleep, no effect on memory, transient alleviation of depressive symptoms
Term
TCAs
Definition
amitriptyline, desipramine, nortriptyline, imipramine
Term
TCA mechanism of action
Definition
suppresses REM sleep, no effect on memory, more often used as sleep aids than antidepressants
Term
antihistamines
Definition
benadryl and unisom
Term
antihistamine for sleep aids
Definition
unfavorable SE profile, used often but little support for use in insomnia but occasional use could be beneficial
Term
Alcohol
Definition
possibly the most used insomnia self-treatment
Term
alcohol use as sleep aid
Definition
not recommended due to: short duration of action, adversely affects sleep stages/ cycles, exacerbates sleep apnea and large potential for abuse and dependence
Term
Herbals
Definition
valerian and melatonin
Term
valerian
Definition
small benefit on sleep latency but no significance in sleep duration; inconsistent effects on sleep continuity and structure
Term
melatonin
Definition
small effect on sleep latency, little to no effect on wakening and total sleep time; studies show there is chronobiotic effect but no hypnotic effect
Term
FDA approved but not recommended
Definition
chloral hydrate, barbituates, and non-barbituate/ non-BZD (meprobamate)
Term
chloral hydrate
Definition
can be used to procedural sedation or EtOH withdrawal suppression
Term
exploring DORAs
Definition
Orexin/ hypocretin-cells in the brain that maintain wakefulness
Term
DORAs
Definition
Alvorexant, Suvorexant
Term
treatment of sleep apnea
Definition
PAP, wt loss, surgical treatment, oral appliances and pharmacotherap
Term
PAP (sleep apnea)
Definition
positive airway pressure
Term
C-PAP (sleep apnea)
Definition
continuous positive airway pressure that keeps airways open
Term
Bi-PAP (sleep apnea)
Definition
bilevel positive airway pressure, that provides less pressure for the expiration and more pressure for inspiration
Term
surgical options for sleep apnea
Definition
adenoidectomy, tonsillectomy, bariatric surger and tracheostomy
Term
respiratory stimulants
Definition
acetazolamide, theophylline, progesterone
Term
acetazolamide
Definition
carbonic anhydrase inhibitor leads to metabolic acidosis; lowers the CO2 apnea threshold
Term
theophylline
Definition
increases central respiratory drive and cardiac contractility in cases of SOB
Term
progesterone
Definition
increases chemoreceptiveness and improves daytime gas exchange in OH
Term
narcolepsy treatment: daytime sleepiness
Definition
stimulants: modafanil/ammodafamil, amphetamines and maxindol
Term
narcolepsy treatment: cataplexy
Definition
antidepressants: TCAs, (SS, SN, NSRIs), and MAOIs
Term
modafanil
Definition
chemically unrelated to amphetamine and methylphenidates
Term
modafanil MOA
Definition
alpha 1 stimulation, direct and indirect stimulation of dopamine, serotonergic/ GABAergic are all possible
Term
side effect profile for modafanil
Definition
HA (should resolve ater weeks of treatment), nausea, and nervousness
Term
methylphenidate
Definition
less reductionin appetite and less effect on blood ressure than amphetamine products
Term
MOA for CNS stimulants
Definition
low dose dopamine release is greater than NE and 5HT release; high dose monaminergic depletion and reuptake inhibition occurs (not seen with methylphenidate use)
Term
SE profile for stimulants
Definition
minor irritability, hyperactivity, mood changes, HA, palpitations, sweating, tremors, anorexia, insomnia
Term
sodium oxybate
Definition
neurotransmitter that may acti via stimulation of GABA-B, silencing DAminergic neurons
Term
treats cataplexy in narcolepsy and may enhance daytime alertness and improve night sleep
Definition
sodium oxybate
Term
SE profile for sodium oxybate
Definition
nausea and enuresis
Term
clonidine and prazosin
Definition
worsens cataplexy seizures
Term
increases oral contraceptive metabolism
Definition
modafanil
Term
L-DOPA with Carbidopa
Definition
dopamine agonist with DOPA decaarboxylase inhibitor; used in RLS
Term
nausea dyskinesia
Definition
SE of L-DOPA with Carbidopa
Term
carbidopa
Definition
decreases nausea associated with levodopa
Term
bromocriptine
Definition
ergot derivative and dopamine agonist, pro-lactin inhibitor
Term
nausea and CNS effects
Definition
SE of bromocriptine
Term
pramipexole and popinirole
Definition
binds to D2 and D3 (non-ergot) dopamine
Term
dizziness, hypotension, nausea
Definition
SE or pramipexole and popinirole
Term
pramipexole
Definition
renally eliminated
Term
ropinirole
Definition
hepatically eliminated
Term
anticovulsants for RLS
Definition
potential for benefit in pts who cannot tolerate the insomnia from dopamine agonists and when avoiding opiods is optimal
Term
supplements for RLS
Definition
iron supplementation is appropriate for patients who are anemic and have RLS, magnesium has been associated with improving symptoms of RLS
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