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Phar 507 > Management of Sleep Disorders > Flashcards

Management of Sleep Disorders Flashcards

1
Q

What are the types of insomnia

A

Sleep onset, sleep maintenance, early-morning awakening

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2
Q

What is sleep load, why would someone be awake when the sleep load is high

A

Accumulation of adenosine that causes someone to be tired, circadian alerting signal is also high keeping them awake

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3
Q

What is secreted remove the circadian alerting signal to keep the sleep load unopposed causing sleep

A

Melatonin

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4
Q

What commorbidities are associated with sleep deprivation

A

Obesity, Diabetes, CVD

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5
Q

What medications can keep patiens awake at night

A

Fluxetine and bupropion, stimulants, levothyroxine, caffeine, corticosteroids

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6
Q

What is obstructive sleep apnea

A

Patients stop breathing during sleep not allowing for REM sleep (leads to impared daytime function)

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7
Q

What drugs can make obstructive sleep apnea worse

A

alcohol, barbiturates, GABA mediated anxiolytics, BZD (reduce airway muscle tone)

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8
Q

T/F: Restless leg syndrome can be treated with iron tablets and dopamine agonists

A

True

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9
Q

What are behavioral strategies for treatment of insomnia

A

Cognitive therapy (challenge pt’s misconceptions), sleep restriction (limit time in bed), relaxation, stimulus control (relate bed strictly to sleep)

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10
Q

T/F: Medications are the first line for insomnia

A

False: CBT is the first line for insomnia

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11
Q

What antihistamines are used for insomnia, what is the consequence of using them

A

Diphenhydramine, high incidence of daytime sedation (avoid in elderly)

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12
Q

What is the most common antidepressant that is used in insomnia do to being sedation, others

A

Trazodone/ amitriptyline, doxepin, mirtazapine

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13
Q

When would doxepin be used for insomnia

A

Staying asleep (sleep maintenance)

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14
Q

What are the side effects in trazodone

A

Orthostatic hypotension, significant daytime hangover, priapism

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15
Q

What antipsychotics are used for insomnia

A

Quetiapine, Olanzapine

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16
Q

T/F: It is fine to used OTCs/Antihistamines, antidepressants, antipsychotics as ways to aid in simomnia along with other first line options

A

False: CBT and FDA- approved benzodiazepine receptor agonists are the only options shown to have consistent efficacy in aiding sleep

17
Q

If sleep onset is the problem what type of medication should be used, sleep maintenance, excessive daytime sleepiness

A

Fast onset of action, longer duration of action, shorter duration of action

18
Q

What are the five BZDs approved for insomnia

A

Triazolam, Temazepam, estazolam, flurazepam, quazepam

19
Q

What is the rapid onset short acting BZD, when would it be used

A

Triazolam, initiating sleep

20
Q

What are the delayed onset intermediate acting BZDs (maintaing sleep)

A

Temazepam, estazolam

21
Q

What are the rapid onset, long acting BZDs (maintaing sleep)

A

Flurazepam, quazepam

22
Q

T/F: While BZDs increase the total duration of sleep the quality of sleep may be compromised due to effected REM sleep

A

True

23
Q

T/F: Using BZDs long enough can lead to tolerance to hypnotic effects

A

True

24
Q

What are sleep related problems with using BZDs and which type of BZDs are associated with them

A

Residual daytime sedation, flurazepam (L) and quazepam (L)/ rebound insomnia, traizolam (S)

25
Q

What class of medications bind to BZD receptors but have less complications than BZDs, how is the binding different

A

Z-hypnotics, Only bind to omega-1 for hypnotic effect but DO NOT bind omega-2 or omega-3

26
Q

T/F: Like BZDs z-hypnotics also cause anterograde amnesia, anticonvulsion, hangover effects, withdrawl, and addiction

A

False: Z-hypnotics have LESS side effects, NO anticonvulsant action, LESS hangover effects, Less tolerance and less dependecne than with BZDs

27
Q

What are the Z-hypnotics

A

Zolpidem, zaleplon, eszopiclone

28
Q

What is a key side effect of Z-hypnotics

A

Complex sleep related behaviors (sleep walking)

29
Q

Put the z-hypnotics in order from shortest half life to longest

A

Zaleplon (4 hours before waking), zolpidiem (at least 4 hours before waking), eszopicalone (sleep maintenance)

30
Q

What is the selective melatonin receptor agonist

A

Ramelton (binds M1, sleepiness, binds M2, circadian rhythm)

31
Q

When would ramelton be used in insomnia, when is full effect realized , when may this agent be preferred

A

Sleep onset, 3 weeks, patients with history of substance abuse

32
Q

What is the orexin receptor antagonist

A

Suvorexant

33
Q

What does oxerin do in the body, what disease state is seen due to orexin deficiency and should not use suvorexant

A

Alerting neurotransmitter that promotes wakefulness, Narcolepsy

34
Q

What are the first line drugs for insomnia

A

Z-hypnotics

35
Q

What drugs can be used indefinitely for insomnia

A

Eszopiclone, Zolpidem, Ramelteon

Phar 507 (33 decks)

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