Psychopharm Test 3 Flashcards
What does the Supra Charismatic Nucleus do?
PPM of the brain - located in hypothalamus it is responsible for influencing the sleep/wake cycle.
It increases the release of GABA and other neurotransmitters so you can fall asleep
How does Adenosine effect sleep
Adenosine increases in your body the longer you are awake and as it increases it mildly depresses the body and promotes sleep.
What is coffee considered?
Adenosine antagonist; it prevents the effects of adenosine and helps you stay awake.
What is the pineal gland responsible for releasing?
Melatonin - melatonin levels increase in evening and help you fall asleep.
How does the Ascending Reticular Activating System work?
network of nerves in the brain that regulates consciousness and when we sleep. During deep sleep the activity in RAS is reduced. During REM sleep the activity is almost as active as when we are awake
Damage or blockage of the ARAS can lead to sleep disturbances and difficulty staying awake. Like comas,
How does histamine effect sleep
Histamine is a neurotransmitter found in Tuberomammillary nucleus and it keeps you awake. Less histamine = you are tired; antihistamines = decrease histamine and make you drowsy.
How does Orexin/Hypocretin effect sleep
Located in perifornical area, it mediates arousal and alertness in the body (helps keep you awake). In the case of sleep, blocking orexins can help to combat insomnia (help you sleep), while too little orexin can cause narcolepsy.
What is initial insomnia?
How do you treat it?
Inability/difficulty falling alseep (d/t neuropathic/musculoskeletal pain & certain meds)
Tx = Melatonin or Histamine Antagonist (aka antihistamine) - ex. would be diphenhydramine or Vistaril (hydroxyzine pamoate)
What is middle insomnia?
How do you treat it?
waking durig the night and not being able to fall back asleep.
*Can be d/t daytime fatigue, muscle spasm, nocturia etc.
Tx - Eszopixlone (Lunesta) and Zolpidem (Ambien) They both have longer half lives which is good for patients who need 6-8 more hours of sleep.
Hypnotics with half-lives that are short, but not ultra-short (approximately 6 hours: zolpidem CR, eszopiclone, and perhaps low doses of trazodone or doxepin), may provide rapid onset of action and plasma levels above the minimally effective concentration only for the duration of a normal night’s sleep.
What is terminal insomnia?
How do you treat it?
May be d/t mental illness or lack of exposure to daylight;
Tx - treat the underlying cause such as depression or anxiety
** Mirtazapine (atypical antidepressant/seritonergic hypnotic)
Where is the “off” setting or sleep promoter of the sleep/wake cycle located?
ventrolateral preoptic nucleus (VLPO) of the hypothalamus
When the VLPO is active and GABA is released to the TMN, the sleep promoter is on, and the wake promoter is inhibited.
Inhibiting GABA activity can promote wakefulness.
Where is the wake promotor located?
is localized within the tuberomammillary nucleus (TMN) of the hypothalamus. Two key neurotransmitters regulate the sleep/wake switch: histamine from the TMN and GABA from the VLPO.
A 75-year-old man in good physical shape is having sleep problems. He wakes up at 4am and, although he tries to stay awake in the evening to prevent this early rising, he usually falls asleep right after dinner, often before 7pm. Which of the following treatment options may be most beneficial for this patient?
Early morning melatonin
Late afternoon/Evening light
Why are benzos used for sleep?
act on the CNS to enhance the effects of GABA (helps increase it) which induces sleep
Name examples of benzos for sleep that are GABA-A positive allosteric modulators (PAMs)
Flurazepam
Quazepam
Estazolam
Trazolam
Are benzos considered a 1st or 2nd line treatment for sleep disorders?
2nd line therapy - this is because they cause long-term problems such as loss of efficacy over time (tolerance) and withdrawal sx including rebound insomnia
