Monica - week14 - Exam 5 Flashcards
what is insomnia?
inability to fall asleep or remain asleep
insomnia may be associated with ____??
anxiety d/t lack of restful sleep
what is short term insomnia caused by?
attributed to unresolved daily conflicts like stress
what is considered “long term” insomnia?
lasting 30 days or longer
what is long term insomnia caused by?
depression, manic disorders, or chronic pain
what is another factor for insomnia?
restless sleep pattern
that are 6 factors that contribute to restless sleep pattern?
- foods or beverages containing stimulants like caffeine
- tobacco products
- alcohol (helps fall asleep but not restful sleep)
- large meal close to bedtime (↑ metabolic rate/really full)
- too much light or uncomfortable room temperature
- snoring or recurring nightmares
what are 7 non pharm interventions to promote sleep?
- lower or avoid caffeine
- smoking cessation
- limit or no alcohol intake
- increase exercise during the day
- establish sleeping pattern
- alternative and complementary therapies
- pharmacotherapy if interferes with ADLs
name 8 alternative and complementary therapies
kava, valerian root, chamomile, and lavender
*others include counseling, yoga, aroma therapy, massage, acupuncture
what should be assessed when using alt. and comp. therapies?
assess for contraindications with other drugs (chamomile)
what is the definition of anxiety?
worry, apprehension, fear, or uneasiness over a perceived threat
an anxiety response can last at least ________
6 months
what are 3 characteristics of anxiety?
o activates SNS and triggers symptoms of flight-or-fright
o may affect quality of life
o increased risk of GI and CV issues
what is obsessive compulsive disorder?
thoughts; obsess over same thoughts; occupy the mind for hrs/days
what is post traumatic stress disorder?
witnessed a traumatic event; keep on living experiences through nightmares hallucinations flashbacks
what is general anxiety disorder?
persists or at least 6 months; worry or fear; everyday life; inability to focus; impending doom
what is panic disorder?
similar to general anxiety disorder; what they fear most is having a panic attack that will cause them to freeze them from what they’re supposed to do
what is social anxiety disorder?
social phobia; reasonable persistent fear of being criticized; avoid public place and dont like people when they have to be social → great discomfort
Stress related to ______ often a symptom of an ______ _____-
anxiety; underlying disorder
non-pharmacological interventions r/t anxiety all have to do with addressing the _____ of the anxiety
cause
what are 6 strategies to address the cause of anxiety?
o cognitive-behavioral o counseling o biofeedback techniques- o meditation o herbal products - pharmacotherapy if interferes with ADLs
what are CNS depressants used for?
anxiety and sleep disorders
what are the 2 categories for CNS depressants?
benzodiazepines and nonbenzodiazepines
what are the effects of CNS depressants?
depression ranges from relaxation to sleep
what are CNS depressants also known as?
sedatives and hypnotics
what are the 3 characteristics that classify it as a sedative?
o relaxation, calmness, and ↓ anxiety
o lower doses
o taken during the day
what are the 3 characteristics that classify it as a hypnotic?
o sleep
o induce sleep at higher doses
o taken at night
what are the 3 characteristics of physical dependence?
- altered physical condition d/t repeated substance use
- body becomes accustomed to the abused substance
- withdrawal symptoms when agent discontinued
what are the 4 characteristics of psychological dependence?
- no obvious physical signs of discomfort when agent is stopped
- overwhelming desire to continue drug-seeking
- high doses usually taken for a prolonged period
- may persist for months or years
what are the 2 forms of lorazepam?
IV and PO
what is the main indication for lorazepam?
general anxiety disorder (anxiolytic)
what are the off-label uses for lorazepam?
insomnia, seizures, alcohol, withdrawal sxs
what is the action of lorazepam?
binds to GABA receptors and intensifies GABA effects
what are the adverse effects for PO lorazepam? IV?
dizziness, daytime drowsiness, confusion, paradoxical
excitation
o IV – ↑ risk of respiratory depression
what is the D-D interaction for lorazepam?
↑ CNS depression w/ other CNS depressants
what is important to remember about stopping lorazepam?
slow tapering to avoid withdrawal sxs
what is the antidote for lorazepam?
flumazenil
what is temazepam used for?
short-term therapy of insomnia < 4 weeks
what are 4 characteristics of temazepam?
- possible risk of physical and/or psychological
dependence - AEs similar to other benzodiazepines
- may cause complex sleep-related behaviors
- long half-life, more likely to cause daytime sedation
what are the 2 non-benzo?
zolpidem (CR), eszopicione
what are the indications for non-benzo?
o ↓ sleep-onset time and of nighttime awakenings
o improves the length and quality of sleep
o need 7-8 hrs. of sleep
what is the action for non benzo?
binds to GABA receptors
what are the adverse effects of non-benzo?
daytime drowsiness, dizziness, hallucinations, HA,
behavioral changes (sleep-driving), hangover
o eszopiclone – no frequent AES
o risk of rebound insomnia
what are 8 geriatric considerations?
- medication-related sleep problems
- accumulates in the system
- determine lowest effective dose
- drugs may cause excessive drowsiness or dizziness – ↑ risk of falls and injury
- safety precautions
Home modifications:
o remove throw rugs from walking areas
o no doubling up on doses if first dose is ineffective
