Review Question - QID 106858

The patient has been diagnosed with narcolepsy. Currently preferred first-line treatment is modafinil, a non-amphetamine wakefulness promoting agent.

Narcolepsy is a chronic condition of disordered regulation of sleep cycles. It typically manifests with excessive daytime sleepiness, and may include episodes of cataplexy or hypnagogic or hypnopompic hallucinations. Modafinil is currently the preferred first line therapy for narcolepsy.

Ramar and Olson discuss the presentation of narcolepsy, which has a prevalence around 0.02%, and typically manifests in the teens or twenties. Episodes of cataplexy typically follow an emotional trigger (laughter, anger, surprise), and can manifest in a wide spectrum ranging from sudden loss of jaw muscle tone (jaw dropping) to complete collapse on the floor (loss of postural muscle tone).

Thorpy and Dauvilliers discuss current pharmacological strategies for narcolepsy. While several classes of medications, including methylphenidate and amphetamines, have been shown to be effect for some of the symptoms of narcolepsy, methylphenidate and amphetamines have significant abuse potential, and have been relegated to second-line and third-line therapy, respectively.

Incorrect Answers:
Answer 1-2: While the amphetamine medications are effective in the management of narcolepsy, they have significant abuse potential, and are not-first line medications for narcolepsy, especially in this patient with history of substance abuse.
Answer 3: Similarly to amphetamines, methylphenidate has significant abuse potential, and is not a first-line therapy for narcolepsy.
Answer 4: Zolpidem is used to promote sleep, not wakefulness.