The Night Shift
This stage of sleep is characterized by rapid eye movement, vivid dreams, and saw tooth waves on EEG.
What is stage 4/REM sleep?
SR is a 21-year-old on the following medications: fluoxetine 20 mg, ibuprofen 800 mg PRN, and doxycycline 100 for acne. Which of their medications is MOST likely to contribute to symptoms of insomnia?
What is fluoxetine?
This is the most common symptom that patients with narcolepsy present with.
What is excessive daytime sleepiness?
Supplementation with this can help to improve symptoms of RLS, possibly eliminating the need for other long-term medications.
What is iron?
When starting on gabapentin enacarbil for RLS, this is an important point to discuss with patients to promote safety.
More time is spent in stage ___ during the first half of the night.
What is 3?
Use of orexin receptor antagonists should be avoided with these types of medications (DDI).
What are strong CYP3A4 inhibitors?
These 2 agents are recommended as 1st line options for both symptoms of EDS and cataplexy?
What are sodium oxybate and pitolisant?
This receptor is the main target of dopaminergic agonists used in the management of RLS.
What is D3?
Patients starting on suvorexant should be instructed to take this medication based on this timing.
What is within 30 minutes of bedtime, with at least 7 hours prior to wakening?
As sleep progresses, we spend more time in this stage of sleep.
What is REM/stage 4?
This is the recommended amount of time benzodiazepines are to be used for insomnia management.
What is 1-12 weeks (short-term)?
IP is a 51-year old male with AUD, stage 4 heart failure, CKD stage 3, and narcolepsy. He has had symptoms of narcolepsy for several years, and is finally interested in trying medication to manage his symptoms. Which agent would you NOT want to recommend to IP when starting treatment for narcolepsy?
What is sodium oxybate?
This class of medications for the treatment of RLS may not be preferred if a patient concomitantly has schizophrenia.
What are dopamine agonists?
Patient FL approaches the pharmacy counter to pick up his new prescription of ramelteon. He asks if he can take this medication with his dinner. As the pharmacist, you let FL know that he should avoid ___ when taking ramelteon.
What is a high-fat meal?
This sleep parameter measures sleep maintenance, or the time spent awake after initial sleep onset until final awakening.
What is wake after sleep onset (WASO)?
In a female patient, this dose of IR zolpidem should be given at night.
What is 5 mg?
This dopamine and norepinephrine reuptake inhibitor can provide a benefit for symptoms of EDS within 1 week of starting.
What is solriamfetol?
In order to see improvement of RLS symptoms, doses of pregabalin need to generally be at least at this dose.
What is 150 mg/day?
TM calls your pharmacy to ask if any of his medications can cause an unpleasant, bitter taste. Upon review of his most recent prescriptions, you notice this medication, which is the likely reason for this side effect.
What is eszopiclone?
AK gets in bed for the night at 10pm. He falls asleep at 12am, sleeps through the night, and then wakes up at 7am to start his day. What is his sleep efficiency (percentage)?
What is 78%?
This medication should not be taken if ramelteon is being used for management of insomnia.
What is fluvoxamine?
This agent used for symptoms of EDS poses the risk of developing SJS/TEN within the first few weeks of initiation.
What is modafinil?
LB is seeking out pharmacologic treatment for her RLS. Her current medications include spironolactone 25 mg daily, amlodipine 10 mg daily, risperidone 2 mg BID, and Farxiga 10 mg daily. Before initiating treatment, what medication can we consider stopping to see if it improves her RLS?
What is risperidone?
You are asked to speak with a new patient in the sleep medicine clinic who will be starting zolpidem. Before you leave the patient, you make sure to counsel on these behaviors that may be caused by their medication.
What are parasomnias?