Sleep Medications in Psychiatry

Maggie Throckmorton
Quiz by Maggie Throckmorton, updated more than 1 year ago
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Quiz on Sleep Medications in Psychiatry, created by Maggie Throckmorton on 03/24/2018.
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Question 1

Question
All of the following are true about Trazadone (Desyrel, Olpetro) (select all that apply):
Answer
  • Blocks SERT
  • 5HT2A antagonism
  • Is really a poor anti-depressant that is used off-label for insomnia
  • Has a rare but serious side effect of priapism
  • Requires a baseline CMP in all patients before initiating
  • Is recommended by the AASM for sleep onset or maintenance insomnia

Question 2

Question
Which Schedule IV medication is FDA approved for sleep onset and maintenance?
Answer
  • Doxepin (Silenor, Sinequan)
  • Suvorexant (Belsomra)
  • Quetiapine (Seroquel)
  • Trazadone (Desyrel, Olpetro)

Question 3

Question
Suvorexant (Belsomra) is an Orexin 1 and 2 [blank_start]antagonist[blank_end] and is not recommended if a patient is on a strong [blank_start]CYP3A4[blank_end] [blank_start]inhibitor[blank_end] like nefazodone, suboxone, clarithromycin and certain HIV medications.
Answer
  • antagonist
  • agonist
  • CYP3A4
  • CYP2D6
  • inhibitor
  • inducer

Question 4

Question
Which brand name of Doxepin is used for sleep?
Answer
  • Silenor
  • Sinequan

Question 5

Question
Doxepin (Silenor) is a selective and potent [blank_start]Histamine[blank_end] 1 antagonist, that is used for sleep [blank_start]maintenance[blank_end] insomnia, and is the only [blank_start]non-controlled[blank_end] prescribed for sleep maintenance insomnia.
Answer
  • Histamine
  • Orexin
  • maintenance
  • onset
  • non-controlled
  • controlled

Question 6

Question
There is an increased risk for sedation with higher or lower doses of Doxepin (Silenor)?
Answer
  • Higher
  • Lower

Question 7

Question
T or F. Weight gain is unusual for low dose Sinequan (Doxepin).
Answer
  • True
  • False

Question 8

Question
The following are common and uncommon side effects for Doxepine (Silenor) (select all that apply):
Answer
  • Sweating
  • Fatigue
  • Paralytic illeus
  • EPS
  • QTc prolongation
  • Hair loss

Question 9

Question
Which medication can increase doxepin concentrations?
Answer
  • Depakote
  • ASA
  • Haldol
  • Lisinipril

Question 10

Question
[blank_start]Temazepam[blank_end] is also known as Restoril and is a [blank_start]benzodiazepine[blank_end] that is FDA approved for the [blank_start]short[blank_end]-term treatment of insomnia. It has a BBW of increased CNS depressant effects with [blank_start]opioids[blank_end].
Answer
  • Temazepam
  • Alprazolam
  • benzodiazepine
  • anti-convulsant
  • short
  • long
  • opioids
  • MAOi's

Question 11

Question
T or F. Temazepam may be more effective for mid-nocturnal awakenings than sleep onset insomnia.
Answer
  • True
  • False

Question 12

Question
Temazepam or Restoril should be dosed how soon before bedtime?
Answer
  • 1-2 hours
  • 3-4 hours
  • 5-7 hours
  • 30 minutes to an hour

Question 13

Question
The following is correct about Temazepam (Restoril) (select all that apply):
Answer
  • Can cause withdrawal symptoms when stopped suddenly
  • Elderly patients need a lower dose
  • Does not require any baseline labs in patients with co-morbid illness
  • Can cause retrograde amnesia

Question 14

Question
Which benzodiazepine used for sleep is more likely to cause anterograde amnesia, unusual behaviors and hallucinations.
Answer
  • Temazepam (Restoril)
  • Trialzolam (Halcion)
  • Zolpidem (Ambien)
  • Clonazepam (Klonopin)

Question 15

Question
[blank_start]Triazolam[blank_end] or Halcion is FDA approved for short-term insomnia but can be used in [blank_start]catatonia[blank_end]. The shorter half-life prevents [blank_start]sedation[blank_end] and may minimize interactions with daytime meds. [blank_start]Ranitidine[blank_end] may increase concentrations.
Answer
  • Triazolam
  • Temazepam
  • catatonia
  • depression
  • sedation
  • addiction
  • Ranitidine
  • Omeprazole

Question 16

Question
T or F. With Triazolam the clearance is slightly faster with women than men.
Answer
  • True
  • False

Question 17

Question
The following is correct about Zaleplon (Sonata)
Answer
  • Is also a Hyundai car model
  • Is FDA approved for short-term insomnia
  • Is recommended by the AASM for sleep onset insomnia
  • May have more side effects due to the short half-life
  • A high-fat meal will delay absorption and decrease beneficial effects
  • May cause more dependence than some other sedative hypnotics-especially in those without a substance abuse history

Question 18

Question
This medication can reduce the effectiveness of Zaleplon (Sonata).
Answer
  • Carbamazepine (Tegretol)
  • Fluoxetine (Prozac)
  • Levofloxacin (Levaquin)
  • Acetiminophen

Question 19

Question
This is a uncommon side effect of Zaleplon (Sonata).
Answer
  • Angioedema
  • Sedation
  • Ataxia
  • Reduced Appetit

Question 20

Question
Zaleplon (Sonata) has not been shown to [blank_start]increase[blank_end] total sleep time or decrease the number of [blank_start]awakenings[blank_end].
Answer
  • increase
  • decrease
  • awakenings
  • dreams

Question 21

Question
T or F. Zaleplon can be used for mid-nocturnal awakenings with 4 hrs of sleep time remaining because evidence shows no residual sedation after 4 hours.
Answer
  • True
  • False

Question 22

Question
Jerry is a 38-year-old male who struggled with insomnia for several months. After trials of medication for short-term insomnia he wants to explore a medication that has efficacy for long term us and has a low potential for abuse. Based on this patient's wishes, which medication should the PMHNP prescribe?
Answer
  • Eszopiclone (Lunesta)
  • Zolpidem (Ambien)
  • Trazadone (Desyeral)
  • Tamazepam (Restoril)

Question 23

Question
The following is true about Eszopiclone (Lunesta) (select all that apply):
Answer
  • AASM recommends for both sleep onset and maintenance insomnia
  • Can cause an unpleasant taste as a side effect
  • Should be taken with a high-fat meal
  • Titration is required
  • Rifampin decreases levels

Question 24

Question
Which baseline and routine labs are required with Eszopiclone (Lunesta)?
Answer
  • CMP, CBC. TSH
  • LFT, BUN, CrCl
  • None
  • ALT, AST, GGT

Question 25

Question
T or F. Sally has a history of a substance use disorder. She has been sober from drugs and alcohol for 5 years. She is now experiencing a period of insomnia. It is best practice for the PMHNP to prescribe Zolpidem (Ambien).
Answer
  • True
  • False

Question 26

Question
The FDA recommends avoiding this activity the whole day after taking Ambien CR.
Answer
  • Driving
  • Farming
  • Yoga
  • Trampoline Jumping

Question 27

Question
What formulation of Zolpidem can be used for nocturnal awakenings with difficulty falling back asleep, with at least 4 hours of bedtime remaining.
Answer
  • Edular
  • Intermezzo
  • Ambien CR
  • Zolpimist

Question 28

Question
Women and the elderly metabolize zolpidem more [blank_start]slowly[blank_end] than men, making them more vulnerable to [blank_start]next day[blank_end] effects. As such the max dose for women and the elderly is [blank_start]5[blank_end]mg.
Answer
  • slowly
  • quickly
  • next day
  • same day
  • 5
  • 8

Question 29

Question
T or F. Ambien CR may allow enough agent to remain at receptors to improve sleep time and prevent early morning awakenings.
Answer
  • True
  • False

Question 30

Question
[blank_start]Zolpidem[blank_end] has been shown to increase total [blank_start]sleep[blank_end] time and [blank_start]reduce[blank_end] the number of mid-nocturnal awakenings.
Answer
  • Zolpidem
  • Sonata
  • sleep
  • wake
  • reduce
  • increase

Question 31

Question
Quetiapine (Seroquel) is used off-label for [blank_start]insomnia[blank_end] and is best for [blank_start]insomnia[blank_end] in patients with a co-occurring psychiatric illness. There are significant [blank_start]metabolic[blank_end] side effects and a risk for [blank_start]QTc prolongation[blank_end].
Answer
  • insomnia
  • sleep maintenance
  • insomnia
  • sleep maintenance
  • metabolic
  • anti-cholinergic
  • QTc prolongation
  • Stevens-Johnson Syndrome
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