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46 Cards in this Set

  • Front
  • Back

Select the class of drugs used most commonly to treat Restless Legs Syndrome (RLS):


Answer


ABeta agonists


BBeta antagonists


CDopamine agonists


DDopamine antagonists


EAlpha-blocking agents

CDopamine agonists

Sodium oxybate (Xyrem) is a REMS drug and is highly sedating, causes altered consciousness and has a risk of respiratory depression. It can easily "knock" a person out and requires careful use. Which of the following are boxed warnings for this drug? (Select ALL that apply.)


Answer


AHepatotoxicity


BRespiratory depression


CIt is a salt form of GHB-a drug of abuse; do not use with other CNS depressants.


DRestricted access through the Xyrem REMS program.


EAddiction and physical dependence

BRespiratory depression


CIt is a salt form of GHB-a drug of abuse; do not use with other CNS depressants.


DRestricted access through the Xyrem REMS program.

Select common side effects of the narcolepsy stimulants modafinil and armodafinil:


Answer


ASomnolence, risk of severe rash


BSomnolence, espiratory depression, risk of severe rash


CParasomnias, restless legs, risk of severe rash


DHeadache, dizziness, anxiety, risk of severe rash


EPhotophobia, decreased night vision, blurry vision, risk of severe rash

DHeadache, dizziness, anxiety, risk of severe rash

A pharmacist is discussing the use of sleep agents on medical rounds. Which of the following statements are correct? (Select ALL that apply.)


Answer


AIt is not controlled.


BIt is considered safe to use long-term.


CIt can be taken with fatty food and will work within an hour when taken with a fatty meal.


DIt is more expensive than generic zolpidem, but works better.


EThe brand name is Sonata.

AIt is not controlled.


BIt is considered safe to use long-term.

Beth is a 46 year-old female who has been using Lunesta for sleep. Her other medications include lisinopril and a calcium plus vitamin D supplement. Her spouse complained that Beth had eaten his leftover birthday cake. Beth denied it. Cake crumbs were found in the bed and in Beth's teeth. What are likely reasons for the missing birthday cake? (Select ALL that apply.)


Answer


ABeth may have developed psychotic symptoms from an acute infection.


BBeth may be experiencing the beginning of dementia of the Alzheimer's type.


CBeth is being set-up by an angry spouse.


DBeth got up at night and ate the cake but does not remember eating it.


EBeth has experienced a parasomnia due to the use of Lunesta.

DBeth got up at night and ate the cake but does not remember eating it.


EBeth has experienced a parasomnia due to the use of Lunesta.

A patient arrives at the pharmacy with a prescription for new-onset Restless Legs Syndrome (RLS). Which of the following options would represent an appropriate starting treatment dose for this condition?


Answer


ARequip 0.25 mg taken 1-3 hours before bedtime


BRequip 1 mg taken 1-3 hours before bedtime


CRequip XL 2-4 mg daily


DMirapex 0.5 mg taken 1-3 hours before bedtime


EMirapex XL 0.75 mg daily

ARequip 0.25 mg taken 1-3 hours before bedtime

With some hypnotics, the counseling is to take right before bedtime. Why is this counseling correct? Select the most appropriate reason:


Answer


AThe drug is absorbed within a few minutes and starts to work within 5-10 minutes.


BThe patient may be at risk for falls immediately after taking the hypnotic.


CThe hypnotics cause tachycardia and should be taken lying down.


DThe patient may start to feel sleepy sooner than the drug is absorbed due to a placebo effect and in some patients it starts to have an effect within ~1/2 hour; it can be dangerous if the patient is up and about.


EThe patient may start to feel sleepy due to benzodiazepine receptors in the gut lining; it can be dangerous if the patient is up and about.

DThe patient may start to feel sleepy sooner than the drug is absorbed due to a placebo effect and in some patients it starts to have an effect within ~1/2 hour; it can be dangerous if the patient is up and about.

Which of the following drugs are used in the treatment of Restless Legs Syndrome (RLS)? (Select ALL that apply.)


Answer


ANeupro


BHorizant


CReglan


DMirapex


ERequip

ANeupro


BHorizant



DMirapex


ERequip

Select the correct characterization of the drugs modafinil and armodafinil:


Answer


AThese are CNS depressants.


BThese are dopamine agonists.


CThese act at the benzodiazepine receptor.


DThese are tricyclics, similar to doxepin.


EThese are stimulants.

EThese are stimulants.

A pharmacist is discussing the use of sleep agents on medical rounds. Which of the following statements are correct? (Select ALL that apply.)


Answer


AThe non-benzodiazepines can increase the risk of death, even if used intermittently, due to issues such as difficulty breathing at night, increased risk of falls, infection and possibly cancer.


BThese agents have minimal risks, if taken occasionally and not abused.


CIntermezzo SL is a form of zolpidem that is useful for patients who wake up during the night and need to sleep at least four more hours.


DThe non-benzodiazepines work by acting at the benzodiazapine receptor and acting as GABA agonists.


ERamelteon is a melatonin receptor antagonist.

AThe non-benzodiazepines can increase the risk of death, even if used intermittently, due to issues such as difficulty breathing at night, increased risk of falls, infection and possibly cancer.



CIntermezzo SL is a form of zolpidem that is useful for patients who wake up during the night and need to sleep at least four more hours.


DThe non-benzodiazepines work by acting at the benzodiazapine receptor and acting as GABA agonists.

In 2014 a new hypnotic called Belsomra was approved that is an orexin receptor antagonist. The orexin signaling system is involved in the following:


Answer


APromoting sleepiness/sedation


BPromoting wakefulness


CDecreasing restless legs symptoms


DDecreasing non-24 sleep


EReducing sleep onset

BPromoting wakefulness

A patient at the pharmacy does not wish to purchase brand Sominex. He does not have enough money in his wallet. What can the pharmacist recommend as a less expensive alternative that contains the same active ingredient?


Answer


ACetirizine


BLoratadine


CDiphenhydramine


DDextromethorphan


EPhenylephrine

CDiphenhydramine

Which of the following hypnotics requires a 14-day wash out period in someone who had been using phenelzine?


Answer


AHetlioz


BRozerem


CSilenor


DSonata


ELunesta

CSilenor

Janice enters the pharmacy with a prescription for Lunesta. What is the controlled (DEA) category for Lunesta?


Answer


AC-III


BC-IV


CC-V


DC-I


EC-II

BC-IV

Janice is a 70 year-old female. She is having difficulty sleeping since her cat died. She is not clinically depressed. She states she naps little during the day. The physician wishes to prescribe a hypnotic. From the choices below select the most appropriate option:


Answer


ALorazepam


BClonazepam


CZolpidem


DAlprazolam


CZolpidem

Why are modafinil and armodafinil rated as C-IV drugs by the Drug Enforcement Administration (DEA)?


Answer


AThey are a primary drug of abuse by street gangs.


BThey are commonly converted into methamphetamine in home laboratories.


CThey can cause severe constipation that requires prophylactic drugs, including stimulants.


DThey are euphoric.


EThey are stimulants, and have abuse and physical (physiological) dependence risk.

EThey are stimulants, and have abuse and physical (physiological) dependence risk.

When Xyrem is used for narcolepsy with cataplexy, it has the following scheduled category:


Answer


AC-I


BC-II


CC-III


DC-IV


EC-V

CC-III

What is the indication for the drug Xyrem?


Answer


AShift-work sleep disorder


BNarcolepsy with cataplexy


CInsomnia with sleep latency problems


DNon-24-hour sleep wake disorder


EJet lag

BNarcolepsy with cataplexy

A patient arrives at the pharmacy with a prescription for Horizant for restless legs syndrome (RLS). Select the correct statement regarding this drug:


Answer


AThe generic name is pregabalin.


BIt is indicated to help with fluid retention.


CIt is indicated for RLS and for painful episodes caused by a shingles outbreak.


DIt helps promote wakefulness.


EIt is a C-IV drug.


CIt is indicated for RLS and for painful episodes caused by a shingles outbreak.

Beth usually takes Lunesta prior to sleep. Last night, her husband took her out to dinner for her birthday. She brought home leftover fettuccini alfredo and birthday cake. She ate the leftovers with a glass of wine right before bed. When she took theLunesta shortly afterwards, she found that she could not get to sleep for almost two hours. What was the most likely reason that the Lunesta did not help her get to sleep quickly?


Answer


AShe drank wine before bedtime.


BShe got home later than usual.


CShe had sugary foods in her stomach when she took the sleeping medicine.


DShe had fatty food in her stomach when she took the sleeping medicine.


EAny of the above could be possible reasons why she could not get to sleep.


DShe had fatty food in her stomach when she took the sleeping medicine

A patient is beginning treatment with Silenor for difficulty with sleep latency. Which of the following statements concerningSilenor are correct? (Select ALL that apply.)


Answer


AIt is a C-IV medication.


BIf a patient is < 65 years the dose is 6 mg QHS; if the patient is 65 or older the dose is 3 mg QHS.


CThis drug requires a MedGuide (primarily due to the risk of suicidality in adolescents, but required to be dispensed with all new prescriptions and with refills).


DThe primary effect of this drug is somnolence.


EIt can be interchanged with generic doxepin.

BIf a patient is < 65 years the dose is 6 mg QHS; if the patient is 65 or older the dose is 3 mg QHS.


CThis drug requires a MedGuide (primarily due to the risk of suicidality in adolescents, but required to be dispensed with all new prescriptions and with refills).


DThe primary effect of this drug is somnolence.

A patient has been using zolpidem 10 mg but wishes to switch to Ambien CR. What is the equivalent dose?


Answer


A11 mg


B12.5 mg


C15 mg


D20 mg


E25 mg

B12.5 mg

Xyrem is taken in 1/4 cup of water, usually in an empty pharmacy container. The patient should be instructed to do the following after consuming the drug:


Answer


ADo some restful activity such as yoga.


BExercise briskly for 1/2 an hour so you can have restful sleep.


CRun to the market and pick up milk and eggs.


DHave an alcoholic drink (no more than 1 for women, 2 for men).


EImmediately lie down and stay in bed.

EImmediately lie down and stay in bed.

Esther is a 55 year-old female who has been prescribed Ambien for sleep. She has one glass of wine at bedtime. Esther should receive the following counseling:


Answer


ALimit alcohol to one drink nightly.


BLimit alcohol to two drinks nightly.


CIt is best not to use alcohol with any sleep medicine.


DIt is best to drink mixed alcoholic drinks instead of wine.


EIt is best to drink beer instead of wine.

CIt is best not to use alcohol with any sleep medicine.

Jerry is using tamsulosin, psyllium, atenolol, sertraline and latanoprost. He wishes to purchase over-the-counter diphenhydramine for sleep, as suggested by his physician. Choose the correct statements: (Select ALL that apply.)


Answer


AThis medication will cause excessive urination at night, making it more difficult to rest well.


BThis medication can cause dry mouth.


CThis medication can cause diarrhea.


DThis medication will make it more difficult to urinate; it can worsen prostate symptoms.


EThis medication might slightly worsen constipation.

BThis medication can cause dry mouth.



DThis medication will make it more difficult to urinate; it can worsen prostate symptoms.


EThis medication might slightly worsen constipation.

HG is a 61 year old male patient who has come in for his routine annual physical. He reports that he has developed an urge to move his legs when he tries to sleep at night, and the only way to stop it is to get up and move. If he stops moving, the feeling comes bank. HG states that this has occurred during the day a few times (when he was resting is his easy-chair) but it almost always happens when he first goes to bed. He describes it as "unpleasant, uncomfortable and creepy." Which condition is most likely causing HG's symptoms?


Answer


ANon-24 Sleep-Wake Disorder


BInsomnia


CCataplexy


DRestless Legs Syndrome


ENarcolepsy


DRestless Legs Syndrome

A pharmacist will instruct a medical resident about the medication Ambien. Which of the following statements regardingAmbien are correct? (Select ALL that apply.)


Answer


AThis medication comes as tablets (IR and CR), a spray, a sublingual tab called Edluar and a sublingual formulation that is for night-time awakening called Intermezzo.


BThe dosing for Intermezzo is 1.75 mg for males and 3.5 mg for females; take one SL tablet if you intend to sleep at least 2 more hours.


CIn addition to somnolence, this type of medication can cause dizziness, ataxia and has a risk of parasomnias. However, the long-term safety is considered fine.


DLifestyle changes should be attempted prior to the use of prescription hypnotics.


EDo not mix with alcohol.

AThis medication comes as tablets (IR and CR), a spray, a sublingual tab called Edluar and a sublingual formulation that is for night-time awakening called Intermezzo.




DLifestyle changes should be attempted prior to the use of prescription hypnotics.


EDo not mix with alcohol.

Beth uses Lunesta 1 mg for sleep. She tells the pharmacist that the medicine puts her to sleep, but she has difficulty staying asleep. The pharmacist should instruct the patient as follows:


Answer


AShe should return to the doctor to have the medication changed because Lunesta is generally less effective than zolpidem.


BShe should stop using the medicine as she has become addicted.


CShe should stop using the medicine as she has developed pseudo-addiction.


DShe should return to the doctor to have the medication changed because Lunesta is generally less effective than ramelteon.


EShe should return to her doctor; it is likely that the dose will be increased.

EShe should return to her doctor; it is likely that the dose will be increased.

Nuvigil and Provigil require a MedGuide and careful pharmacist counseling due to this risk:


Answer


ASevere rash and serious allergic reaction.


BDemyelinating disorder, causing nerve paralysis.


CProgressive Multifocal Leukoencephalopathy (PML)


DSevere abdominal pain with risk of pancreatitis


ENeuroleptic Malignant Syndrome (NMS)

ASevere rash and serious allergic reaction.

Do not use the narcolepsy stimulants modafinil and armodafinil or other stimulants in patients with this pre-existing condition:


Answer


AShift-work sleep disorder


BHearing loss


CCardiovascular disease


DVision Loss


EUrinary tract infections

CCardiovascular disease

A new prescription was received at the pharmacy for Hetlioz. What is the generic name for this hypnotic?


Answer


ATasimelteon


BRamelteon


CSuvorexant


DDoxepin


ETrazodone

ATasimelteon

The rationale behind avoiding benzodiazepines as sleep agents in the elderly is due to the following concerns: (Select ALLthat apply.)


Answer


AThe risk of falling and having injury.


BThe risk of tachycardia and hypertensive crisis with chronic use.


CThe risk of rebound hypertension.


DThe risk of cognitive impairment.


EThe risk of physical (physiological) dependence and having to live dose-to-dose

AThe risk of falling and having injury.




DThe risk of cognitive impairment.


EThe risk of physical (physiological) dependence and having to live dose-to-dose

Xyrem has a high content of which of the following:


Answer


AMagnesium, use caution in patients with diarrhea.


BAluminum, use caution in patients with constipation.


CSodium, use caution in patients with hypertension.


DPotassium, use caution in patients with renal impairment.


ECalcium, use caution in patients taking vitamin D supplements or with hypercalcemia.


CSodium, use caution in patients with hypertension.

A patient gave the pharmacist a prescription for Ambien 10 mg, take one tablet by mouth before bedtime. Which of the following is an appropriate generic substitution for Ambien?


Answer


AZolpidem


BZaleplon


CDoxepin extended-release


DRamelteon


EEszopiclone


AZolpidem

A patient gave the pharmacist a prescription for Lunesta 1 mg, take one tablet as-needed for sleep. Which of the following is an appropriate generic substitution for Lunesta?


Answer


AZolpidem


BZaleplon


CDoxepin extended-release


DRamelteon


EEszopiclone

EEszopiclone

A new prescription was received at the pharmacy for Belsomra. What is the generic name for this hypnotic?


Answer


AZolpidem


BEszopliclone


CRamelteon


DTasimelteon


ESuvorexant

ESuvorexant

Counseling for most hypnotics and for the erectile dysfunction drugs advises the patient to avoid fatty food when taking the drug. Why is this counseling accurate? Select the appropriate answer below:


Answer


AFatty food will slow down the absorption and the drug may not work at the desired time.


BFatty food increases the drug toxicity, causing hypotension and falls.


CFatty food will make the patient have flatulence in bed.


DFatty food increases the drug toxicity, causing priapism.


EFatty food increases absorption, causing drug toxicity.


AFatty food will slow down the absorption and the drug may not work at the desired time.

Melatonin is a hormone that regulates sleep by controlling the night-day cycle and the circadian "24-hour" rhythm cycle. Drugs that act as melatonin or melatonin agonists are used for the following purposes:


Answer


AAs a prescription agent to promote wakefulness in patients with narcolepsy.


BAs a prescription hypnotic for Non-24 hour sleep-wake disorder.


CAs a prescription hypnotic for typical insomnia cases.


DAs an over-the-counter natural product for sleep and jet lag.


EAs an over-the-counter natural product for depression.

BAs a prescription hypnotic for Non-24 hour sleep-wake disorder.


CAs a prescription hypnotic for typical insomnia cases.


DAs an over-the-counter natural product for sleep and jet lag.

A patient gave the pharmacist a prescription for Rozerem 8 mg tablets #15. Which of the following is an appropriate generic substitution for Rozerem?


Answer


AZolpidem


BZaleplon


CDoxepin extended-release


DRamelteon


EEszopiclone

DRamelteon

Which of the following descriptions best describes some of the pharmacologic characteritics of the stimulant Nuvigil?


Answer


AIt is the active metabolite of modafinil.


BIt contains the active ingredient modafinil.


CIt is a pro-drug of modafinil.


DProvigil contains only 50% (it's the R-isomer) of the mix of R and S isomers found in Nuvigil.


ENuvigil contains only 50% (it's the R-isomer) of the mix of R and S isomers found in Provigil.

ENuvigil contains only 50% (it's the R-isomer) of the mix of R and S isomers found in Provigil.

In recent years it has been recognized that the use of the non-benzodiazepine agents such as zolpidem are not without risk. A warning has been added for this risk with the use of these agents:


Answer


APancreatitis


BHepatic failure


CTeratogenicity


DStevens-Johnson/TEN rash


EIncreased mortality


EIncreased mortality

A patient came into the pharmacy with a prescription for Nuvigil. What is the generic name of this drug?


Answer


ASodium oxybate


BArmodafinil


CDoxylamine


DTasimelteon


ERamelteon


BArmodafinil

Several benzodiazepines are considered unsafe to use in elderly patients, and in many younger patients as well. Although all benzodiazepines carry health risks, select the agents below that should be avoided in elderly patients and should not be recommended even for short-term use: (Select ALL that apply.)


Answer


AQuazepam (Doral)


BFlurazepam (Dalmane)


CLorazepam (Ativan)


DTriazolam (Halcion)


ETemazepam

AQuazepam (Doral)


BFlurazepam (Dalmane)



DTriazolam (Halcion)

The zolpidem dose, along with the other non-benzodiazepines, must be lowered with concurrent use of these medications: (Select ALL that apply.)


Answer


AItraconazole


BTrileptal


CRitonavir


DSaquinavir


EErythromycin

AItraconazole



CRitonavir


DSaquinavir


EErythromycin

Chandra cannot get to sleep. She lies in bed unable to sleep even though her favorite rock band is playing on the radio. She just came from the gym and feels as if she should be tired since she just had a good workout. Chandra just ate a hamburger and fries and says that a heavy meal usually makes her tired. It has been recommended that she try cognitive therapy, including sleep hygiene, to help improve her sleep. What suggestions could help Chandra fall asleep and have restful sleep? (Select ALL that apply.)


Answer


AKeep the bedroom dark, relatively quiet (perhaps peaceful music), and comfortable.


BExercise prior to sleep (between 1-2 hours before bedtime) to exhaust yourself.


CAvoid eating heavy meals before bedtime; digestion takes energy and a full meal can keep a person from sleeping well.


DIf sleep does not seem possible (while lying in bed), get up and do something else for a short while.


EDo not consume caffeine close to bedtime.


AKeep the bedroom dark, relatively quiet (perhaps peaceful music), and comfortable.



CAvoid eating heavy meals before bedtime; digestion takes energy and a full meal can keep a person from sleeping well.


DIf sleep does not seem possible (while lying in bed), get up and do something else for a short while.


EDo not consume caffeine close to bedtime.

The primary type of patient who will receive tasimelteon (Heltioz) to help with sleep due to Non-24-Hour Sleep-Wake Disorder is a patient whose brain cannot distinguish easily between day and night. Which type of patient is this?


Answer


AA patient with severe cognitive dysfunction.


BA patient who has impairment due to narcolepsy.


CA patient who is blind.


DA patient who has failed non-benzodiazepine hypnotics.


EA patient who has failed benzodiazepine hypnotics.


CA patient who is blind.