1. Which of the following patients is presenting with stress-induced short-term insomnia?
A. AH, a 22-year-old female graduate student who has extreme daytime sleepiness. She is often woken up by a classmate at the end of lecture.
B. CS, a 32-year-old female who has had trouble falling asleep 2 times a week for the last 2 months. She cannot seem to relax until she has made a “to-do” list for the next day.
C. JB, a 42-year-old male who has woken up 6 times a night for the last year. His wife says he snores. He feels tired during the day even after being in bed for 8 hours at night.
D. PM, a 52-year old male who has had trouble falling asleep 3 times a week for the last 3 months. Just as he starts to relax, he feels an overwhelming need to move his legs.
E. Unsure
2. Which of the following groups experienced the most impact on sleep due to the COVID-19 pandemic?
A. Healthcare workers
B. Parents of small children
C. Patients with active coronavirus infection
D. General population
E. Unsure
3. KS is a 20-year-old male presenting to the community pharmacy for a recommendation. He recently quit smoking marijuana and has since been having trouble falling asleep. Which of the following is the best recommendation for KS?
A. Diphenhydramine 50 mg PO QHS
B. Doxylamine 25 mg PO QHS
C. Melatonin 2 mg PO QHS
D. Referral; not a self-care candidate
E. Unsure
4. DB is a 68-year-old female presenting to the community pharmacy requesting a recommendation from the pharmacist. DB has glaucoma, hypertension, and heart failure with preserved ejection fraction. She has been experiencing trouble falling asleep 3 times a week for the last month. Which of the following treatments is the best choice to recommend?
A. Diphenhydramine 12.5 mg PO QHS
B. Diphenhydramine 50 mg PO QHS
C. Doxylamine 25 mg PO QHS
D. Melatonin 2 mg PO QHS
E. Unsure
5. Which of the following antihistamines has a Food and Drug Administration (FDA) indication as a nighttime sleep aid?
A. Brompheniramine
B. Diphenhydramine
C. Doxylamine
D. Dimenhydrinate
E. Unsure
6. A patient approaches the community pharmacy with 2 bottles of melatonin from two different manufacturers. Only 1 bottle contains the USP seal of approval. You recommend the melatonin bottle containing the USP seal of approval. Why?
A. The USP seal indicates the ingredients within the bottle match what is on the label
B. The USP seal indicates that product safety has been established
C. The USP seal indicates product quality between batches and lots
D. The USP seal indicates that product efficacy has been established
E. Unsure
7. Which of the following counseling points should be included when discussing diphenhydramine?
A. The most common adverse effect is headache
B. Take 2 to 4 hours prior to bedtime
C. Utilize an “off” night after 3 consecutive nights of use
D. Take with food to prevent stomach upset
E. Unsure
8. Which of the following is an appropriate sleep hygiene recommendation?
A. Do not drive at night as concentration while driving can increase sleep latency
B. Eat a moderate-sized meal 1 hour before bed as satiety encourages one to fall asleep
C. Consume 1 ounce of alcohol prior to bedtime to decrease the number of times one wakes up during the night
D. If experiencing daytime sleepiness, try to limit napping to 20-30 minutes
E. Unsure
9. Which statement concerning the use of melatonin or valerian for the treatment of insomnia is true?
A. Melatonin does not appear to improve sleep latency but can improve quality of sleep.
B. Melatonin is recommended for the treatment of chronic insomnia by the American Academy of Sleep Medicine.
C. Valerian improves total sleep time by around 10 minutes.
D. Valerian is not recommended for the treatment of chronic insomnia by the American Academy of Sleep Medicine.
E. Unsure
10. A 37-year-old female comes to the pharmacy to ask for your assistance in selecting a “natural product” to help with her short-term insomnia. She has no exclusions for self-care, does not want to take melatonin as it has not worked for her in the past, and is opposed to prescription and nonprescription drugs. Which plan would you suggest?
A. Discuss good sleep hygiene practices and recommend diphenhydramine 25 mg at bedtime.
B. Discuss good sleep hygiene practices and recommend valerian 400 mg 1 hour before bedtime.
C. Refer her to a psychologist who specializes in cognitive behavioral therapy and recommend valerian 600 mg twice daily for up to 4 weeks.
D. Refer her to a psychologist who specializes in cognitive behavioral therapy and suggest that she try melatonin again but at a higher dose.
E. Unsure
Evaluation Questions
11. How confident are in your treatment choice for KS in question #3?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are in your treatment choice for DB in question #4?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
13. How confident are in your treatment choices for the 37-year-old patient in question #10?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
