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Flashcards in Hypnotics/ADHD Deck (34)
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1

FDA approved sleep aid medication, takes forever to work and lasts forever (like Slak). It should be avoided in elderly patients.

Diphenhydramine

2

What are the major ADRs associated w/diphenhydramine?

- anticholinergic effects
- next day impairment
- large doses = hallucinogenic effect

3

What medication is beneficial for sleep maintenance but must be avoided in pt w/CVD?

Doxepin (TCA)

4

When should you consider BZDs for sleep? Which has the quickest onset?

Last resort!

Quickest onset: Triazolam

5

Anterograde amnesia and complex sleep related behaviors are an adverse drug reaction from what class of meds?

BZDs and NBRAs

6

Which class of medications is approved for short term use for both sleep onset and sleep maintenance, but has minimal efficacy?

NBRAs

7

List the 3 NBRAs

Zaleplon
Zolpidem
Eszopiclone

"z drugs"

8

Which class of meds require a lower dose for the elderly and women and are also on the Beer's list?

NBRAs

9

Which NBRA commonly has a metallic aftertaste?

Eszopiclone

10

What is the benefit of NBRAs over BZDs?

less tolerance, dependence, withdrawal, abuse

11

Melatonin is best for treating which type of sleep issues?

Sleep latency (falling asleep)

12

Which medication is used for the treatment of non-24hr sleep wake disorder?

Tasimelteon

13

What are the 2 orexin receptor antagonists used to treat sleep latency +/- sleep maintenance?

- suvorexant
- lemborexant

14

In general, ADs, 2nd gen antipsychotics, and AEDs/neuropathic analgesics should only be used to treat insomnia if _____.

they are already being taken to treat an underlying comorbid disease

15

What is the 1st and 2nd step for treatment of insomnia?

1. Nonpharm (CBT)
2. Pharm - if necessary.
- start low and go slow
- 4-5x higher mortality in pt on rx drug for sleep

16

Ritalin generic

Methylphenidate

17

Adderall generic

Amphetamine-dextroamphetamine

18

Vyvanse generic

Lisdexamphetamine

19

Which 3 drugs do stimulants typically interact with?

1. anti-HTN meds
2. MAOI, linezolid
3. sympathomimetics, caffeine

20

You recently started your patient on methylphenidate for their ADHD. What do you need to warn the patient/family about regarding potential ADRs?

- **anorexia, wt loss, appetite disturbance
- sleep disturbance
- feeling zombie-like, less spontaneous

21

The methylphenidate you prescribed is causing too many issues for your patient and you want to take them off. What do you do?

TAPER - important with all stimulants

22

What monitoring is important for patients who are on stimulants?

BP/Pulse
Growth rate in children

Also
- s/s of depression, aggression, hostility
- signs of CNS stimulation

23

Your patient has been diagnosed with ADHD and while doing a thorough family hx, they mention a Fhx of Tourettes. What meds should you avoid?

Stimulants

24

What are 3 non stimulants for ADHD?

1. Atomoxetine (SNRI)
2. Guanfacine
3. Clonidine

25

What drugs should you avoid for patients with atomoxetine?

MAOI
Linezolid

26

Which ADHD med has a BBW?

Atomoxetine (SNRI) - suicidal ideation

27

Which 2 meds for ADHD have interactions with anti-HTN & vasodilators AND additive sedations w/other CNS depressants?

Guanfacine
Clonidine

28

What is the major side effect of Guanfacine?

somnolence
hypotension

29

What is the major side effect of clonidine?

sedation

other: irritability, emotional flattening, depression, insomnia, nightmares, withdrawal syndrome

30

Which non stimulants must be tapered over 1-2wk?

Guanfacine
Clonidine