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Psychopharmacology > Insomnia > Flashcards

Insomnia Flashcards

1
Q

Chronic Primary Insomnia

A

Insomnia that’s not secondary to something else, like drugs or a medical condition

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2
Q

What is the most common type of sleep disorder?

A

Chronic primary insomnia

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3
Q

What percentage of primary care patients complain of insomnia?

A

30%

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4
Q

Insomnia can…

A

transient, acute, or chronic

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5
Q

What are of the vast majority of professional treatments for insomnia?

A

hypnotics (sleeping pills)

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6
Q

What are the most important factors affecting chronic insomnia that OTC’s and hypnotics neglect?

A

Behavioral and psychological factors

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7
Q

What structure of the brain houses the “sleep-wake switch”?

A

The hypothalamus

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8
Q

What NT is associated with sleep?

A

GABA, the primary inhibitory NT

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9
Q

What NT is associated with wakefulness?

A

Histamine

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10
Q

What are the 5 stages of sleep?

A

Stage 1, Stage, 2, Stage 3, Stage 4, and REM

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11
Q

How many cycles does a person go through on average per night?

A

4-5 cycles, each lasting about 90 minutes

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12
Q

Stage 1

A

transition from wakefulness to sleep

occupies 5% of sleep in healthy adults

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13
Q

Stage 2

A

Occupies 50% of sleep

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14
Q

Which stage(s) does a person experience ‘slow-wave’ sleep?

A

Stage 3 & 4; also known as delta sleep and deep sleep

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15
Q

What disrupts slow-wave sleep?

A

Stress, alcohol

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16
Q

How does stress disrupt sleep?

A

Corticotropic-releasing hormone (CRH) & cortisol disrupt slow-wave sleep

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17
Q

What is commonly synthesized during deep sleep?

A

5-HT, DA, & NE

18
Q

Hypnotics

A

Drugs used to treat insomnia

19
Q

T or F: BZD’s are commonly prescribed for sleep.

A

T; however, they have problems and should NOT be considered 1st-line Rx.

20
Q

What is a major concern for using BZD’s for insomnia?

A

They bind to GABA receptor in such a way as to change its shape, causing tolerance, dependence, withdrawal sx, and REBOUND INSOMNIA

21
Q

Rebound insomnia

A

insomnia that occurs upon discontinuing a medication for insomnia that is worse than the original insomnia that the medication was meant to treat.

22
Q

What is the problem with using antihistamines for treating insomnia?

A

They interfere with slow-wave sleep and can cause rebound insomnia when discontinued

23
Q

What are the “z” drugs?

A
  • zolpidem (Ambien, Ambien CR, Edluar, Zolpimist, Intermezzo)
  • zalepion (Sonata)
  • eszopliclone (Lunesta)
24
Q

How do the z drugs work?

A

They enhance action of GABA receptor but bind in such a way as to not interfere w/deep-stage sleep or cause tolerance, dependence, withdrawal sxs, or rebound insomnia.

25
Q

What are some common SE’s of z drugs?

A
  • headache, drowsiness, dizziness, lethargy, ‘drugged feeling’
  • complex sleep-related behaviors (e.g. sleep walking, sleep driving)
26
Q

When using z drugs, you should take caution with:

A

alcohol and other CNS depressants

27
Q

Which z drugs are often used for middle insomnia?

A

zaleplon (Sonata)

zolpidem (Intermezzo)

28
Q

What z drug is indicated for initial insomnia?

A

zaleplon (Sonata)

29
Q

ramelteon

30
Q

What is the MOA of Rozerem?

A

It functions as an agonist at melatonin receptors and is thought to resent normal circadian rhythms in pts w/shift-work disorder or jet lag; best for initial insomnia

31
Q

What are the SE’s of Rozerem (ramelteon)?

A

dizziness, headache

32
Q

What are the benefits of using Rozerem or melatonin supplements for insomnia?

A

No tolerance, dependence, withdrawal sxs, rebound insomnia, or interference w/sleep stages.

33
Q

What are some of the SE’s of melatonin supplements?

A

dizziness, headache, transient depression

34
Q

What are melatonin supplements best used for?

A

initial insomnia

35
Q

What are some antidepressants used primarily for insomnia?

A

trazodone & mirtazapine (Remeron)

36
Q

Phase-delay

A

you normal phase of when you wake up and when you go to sleep is delayed (like they go to sleep late and have trouble waking up in the morning)

37
Q

Phase-advance

A

used for patients like in the elderly population who tend to sleep and wake up earlier.

38
Q

What is the MOA of trazodone & Remeron for insomnia?

A

Antagonize H1 receptor when used at low doses

39
Q

T or F: Hypnotics are more efficacious than CBT.

A

F; efficacy research shows that CBT is more effective, both in the short and long term, than hypnotics

40
Q

CBT for insomnia targets

A
  • Cognitive and psychological factors
  • Behaviors that perpetuate insomnia
  • Arousal reduction
  • Sleep hygiene education
41
Q

What are the most common psychotropic treatments for insomnia?

A 
BZD's
OTC Antihistamines
ramelteon (Rozerem)
synthetic melatonin
trazadone & mirtazapine (Remeron)

Psychopharmacology (7 decks)

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