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Study Daily > Insomnia > Flashcards

Insomnia Flashcards

1
Q

Parasomnias

A

Sleep disorders that involve abnormal movements, behaviors, emotions, perceptions or dreams

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2
Q

Sleep latency

A

Difficulty falling asleep

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3
Q

Neurotransmitters that regulate sleep

A

Sleep: Increased GABA and melatonin

Awake: increased histamine, norepinephrine, serotonin, Act, orexin

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4
Q

Sleep cycles

A

4 sleep cycles
Stage 3: Deepest (non-rem) sleep
*stage where body regrows/repairs tissues
*sleep walking, night terrors, bedwetting stage

REM: brain wave pattern on EEG
-muscle paralysis, rapid eye twitching,
-essential for emotional/cognitive well being

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5
Q

Medications that can worsen insomnia

A

Some SSRIs
-Citalopram
-Fluoxetine
-Fluvoxamine
-Paroxetine
-Sertraline

SSNIs:
-Bupropion
-Venlafaxine

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6
Q

Pharmacological options for insomnia:

A
  1. GABA-ergic medications
    Benzodiazepine receptor agonists and non-benzodiazepine receptor agonists
  2. Meltaonin receptor agonists
  3. Histamine Blockers
  4. Orexin Antagonists
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7
Q

GABA-ergic medications:

Benzodiazepine receptor agonists

List meds + adverse effects

A

Benzodiazepines:
-Estazolam
-flurazepam
-quazepam
-Temazepam
-Triazolam

-Have sedative, muscle relaxant, anxiolytic, and anticonvulsant properties
Adverse effects:
-residual daytime sedation
-confusion/forgetfulness
-falls/fractures
-abuse potential
-withdrawal syndrome

*Recommended for sleep maintenance

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8
Q

Meltaonin receptor agonists drugs

A

Melatonin
Ramelteon

*help only with sleep onset

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9
Q

Histamine Blockers

A

Diphenhydramine (Benadryl)
Dozylamine
Hydroxyzine

*Not

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10
Q

Best meds to treat sleep onset disorders

A

Melatonin
Eszopiclone (Lunesta)
Zaleplon (Sonata)
Zolpidem (Ambien)

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11
Q

Best meds to treat sleep maintenance disorders

A

Eszopiclone
Doxepin
Zolpidem

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12
Q

Best meds to treat older adults with insomnia

A

Doxepin
Melatonin
Ramelteon (Rozerem)

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13
Q

Best meds to treat depression + insomnia

A

Doxepin
Mirtazapine (Remeron)

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14
Q

GABA
non-benzodiazepine receptor agonists

List meds and adverse effects:

A

Non-benzo (Z-Drugs)
-Eszopiclone (Lunesta)
-Zaleplon (sonata)
-Zolpidem (Ambien)

-Have sedative properties only
Adverse effects:

-GI upset
-Dizziness
-Amnesia
-headaches
-unpleasant taste (eszopiolone)
-Falls/fractures

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15
Q

NOT FDA BZDs sometimes seen used for sleep:

A

Alprazolam (xanax), oxazepam (serox), Lorazepam (Ativan)

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16
Q

decrease _________________ if used with elderly pt

A

Benzos

17
Q

_____________ can increase parainsomnias

A

Ambien

18
Q

How long should BZD’s/Zdrugs be used for?

A

FDA approved only for short-term use
“safe for up to 12 months”

F/U required every 4-6 months

19
Q

Melatonin adverse effects:

A

Feeling cold, mild nausea, dizziness
*only used for sleep onset

20
Q

Ramelteon adverse effects:

A

Well tolerated in elderly patients (but expensive)
HA, dizziness, somnolence, fatigue

**AVOID IN HEPATIC DYSFUNCTION

21
Q

Avoid ________ if hepatic dysfunction

A

Ramelteon

22
Q

Diphenhydramine / Doxylamine

A

Antihistamine.anticholinergic

AE: blurred vision, dry mouth, constipation, urine retention, confusion

*NOT for chronic insomnia, short term of 1 week

23
Q

Do give ________ to geriatric patients with insomnia

A

Histamine blockers !
(Benadryl/doxylamine)

24
Q

Tri-cyclic antidepressants for insomnia

A

Recently FDA approved Doxepin & Amitriptyline

*well tolerated even in geriatric population

Good to treat both insomnia and depression

25
Q

Tri-cyclic antidepressants for insomnia (list and AE)

A

Doxepin
Amitriptyline
Mirtazapine

AE: Orthostasis, syncope, widened QRS
might increase seizure potential

26
Q

Quetiapine (Seroquel) AE

A

AE: MAJOR WEIGHT GAIN, dry mouth, daytime sedation, restless leg/akethesia

27
Q

Orexin antagonists for sleep

A

Suvorexant (only one)

promotes sleep by inhibiting orexin A + B

AE: Drowsiness, dry mouth, HA, abnormal dreams., sleep driving, SI

**CONTROLLED SUBSTANCE (may cause abuse)

28
Q

How to monitor effectiveness of sleep treatment

A

PSQI

(Pittsburg sleep quality index)

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