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NURS 7310 > Sleep Agents > Flashcards

Sleep Agents Flashcards

1
Q

What are the restorative purposes of sleep?

A

Energy conservation, immune function, body repair, glymphatic system

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2
Q

What is the information processing purposes of sleep?

A

Development, neurogenesis, memory consolidation, pruning

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3
Q

Stage one also called the drowsy period is

A

so light most people when awoken from this stage will say that they were not asleep

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4
Q

Stage two has

A

sleep spindles (periodic bursts of activity resulting from interactions between the thalamus and the cortex

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5
Q

Stage 3 nd 4 are called slow weave sleep and

A

are the deepest stages of sleep characterized by the development of delta waves

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6
Q

REM sleep is

A

remarkably like that of the awake state but the body or at least the major muscles are paralyzed

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7
Q

Non-REM sleep is characterized by

A

limited eye movement and a decrease in muscle tone and heart rate, metabolic rate and body temp decrease

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8
Q

REM sleep is characterized by

A

rapid, darting movements of the eyes along with paralysis of most major muscle groups. heart and respirations increase to almost the level found when awake.

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9
Q

REM latency

A

the time to the first occurrence of REM

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10
Q

The lose of the ability to induce muscle paralysis

A

REM sleep behavior disorder

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11
Q

Describe non-REM dreams

A

thoughts or person solving problems

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12
Q

REM dreams

A

illogic, bizarre, and even hallucinatory

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13
Q

Define sleep walking

A

Occurs during the first stage 4 non REM period of the night. The person will have open eyes, avoid obstacles, and have cognition clouded with no memory of the event. Best practice is to gently guide the sleepwalker back to bed.

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14
Q

Define Night terrors

A

Extreme terror and an inability to be awakened. Usually in children between ages 4 and 7 and develops in the deep stages of non-REM sleep.

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15
Q

Where is the Suprachiasmatic Nucleus located?

A

anterior hyupothalamus

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16
Q

What does the Suprachiasmatic Nucleus do?

A

It regulates circadian rhythms using solar cues from the retina

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17
Q

Without solar cue inputs how long is the Suprachiasmatic Nucleus cycle?

A

26 hours

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18
Q

Why are CLOCK BMAL1, PER, and CRY significant to sleep cycle?

A

They are believed to drive the 24 hour cycling of SCN

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19
Q

This specific group of neurons project to the thalamus and are responsible for awake and REM

A

Cholinergic

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20
Q

These four neurons project to the hypothalamus and cerebral cortex and are active during awake cycles.

A

Noradrenergic, dopaminergic, serotonergic, and histaminergic

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21
Q

This neurotransmitter is a key one in regulating wakefulness and is the ultimate target of many wake promoting drugs and sleep promoting drugs.

A

histamine

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22
Q

Which receptor is best known as the target of antihistamines

A

postysnaptic histamine 1 (H1) receptor

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23
Q

Stimulating the H1 receptor is likely to cause

A

wakefulness, normal alertness, and procognitive actions

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24
Q

Blocking H1 receptors is likely to cause

A

sedation, drowsiness or sleep

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25
Q

This receptor is best known for its action in gastric acid secretion and is the target of several anti-ulcer drugs and also exists in the brain

A

Histamine 2 (H2) receptors

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26
Q

This histamine receptor is still under research as a way of blocking this receptor allowing the release of histamine to act at H1 receptors

A

H3

27
Q

The sleep/wake switch is a set of circuits located in the

A

hypothalamus

28
Q

The on switch is known as the wake promoter and is localized within the

A

tuberomammillary nucleus (TMN)

29
Q

The off switch is known as the sleep promoter and is localized within the

A

ventrolateral preoptic (VLPO) nucleus of the hypothalamus

30
Q

This key neurotransmitter in the sleep/wake switch is from the TMN

A

histamine

31
Q

This key neurotransmitter in the sleep/wake switch is from the VLPO

A

GABA

32
Q

How does the neurotransmitter GABA affect sleep/wake cycles?

A

It inhibits wakefulness

33
Q

What two neurons act as regulators of the sleep/wake switch

A

Orexin and melatonin

34
Q

What neuron do those with narcolepsy have less of?

A

Orexin

35
Q

What is the diurnal variation of depression?

A

worse in the morning

36
Q

What is one of the most common complaints among patients with mood disorders?

A

Insomnia

37
Q

How does effective treatment affect insomnia in those with a mood disorder

A

insomnia resolves

38
Q

An effective, although short-lived antidepressant is

A

sleep deprivation

39
Q

What gland secretes melatonin and is called both a clock and a calendar?

A

melatonin

40
Q

Based on recent research on melatonin in those with SAD what does it suggest as the reason?

A

neural circuits that mediate season change may be impaired

41
Q

In those with bipolar a lack of sleep can precede

A

a manic episode

42
Q

Sedative-Hypnotic drugs include benzodiazepines, barbiturates and Z drugs all of which act at

A

GABA A receptors to enhance the action of GABA

43
Q

When are benzodiazepines used for insomnia

A

second line hypnotics

44
Q

Which benzodiazepines are utilized for insomnia

A

flurazepam, quazepam, triazolam, estazolam, temazepam

45
Q

Why are barbiturates rarely used to treat insomnia now?

A

tolerance, dependence, high abuse potential, multiple drug interactions, fatal with an overdose

46
Q

What barbiturates are approved to treat insomnia?

A

thiopental, secobarbital, phenobarbital

47
Q

Barbiturates interact poorly with the antifungal

A

griseofulvin

48
Q

Barbiturates interact poorly with the antibiotics

A

rifampicin and rifabutin

49
Q

Barbiturates interact poorly with antileptics such as

A

carbamazepine, eslicarbazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, topiramate

50
Q

What are the signs of acute toxicity in barbiturates?

A

respiratory depression, coma, pinpoint pupils

51
Q

How do you treat Barbiturate toxicity?

A

maintain body heat, support blood pressure, activated charcoal to remove barbiturate from the body, maintain adequate oxygen

52
Q

What are the three Z drugs to treat insomnia?

A

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

53
Q

What are the main side effects of Zolpidem (Ambien)

A

daytime drowsiness and dizziness

54
Q

What are the main side effects of Eszopiclone (Lunesta)

A

bitter aftertaste, headache, somnolence, dizziness, and dry mouth

55
Q

What are the main side effects of Zaleplon (Sonata)

A

headaches, nausea, drowsiness, dizziness, myalgia, and abdominal pain

56
Q

Which antidepressant is used at lower doses as a very effective hypnotic?

A

Trazadone

57
Q

What are the OTC antihistamines commonly used to help with insomnia?

A

Diphenhydramine and Doxylamine

58
Q

What are the adverse effects of antihistamines for insomonia?

A

less effective, tolerance develops quickly, daytime drowsiness and anticholinergic effects

59
Q

For those who suffer from initial insomnia and not sleep maintenance what is a good complementary therapy as well as prescription drug?

A

Melatonin OTC

Ramelteon (Rozerem) prescription

60
Q

What is the first line treatment in those who have insomnia due to restless leg syndrome?

A

Dopamine agonists such as ropinirole and pramipexole

61
Q

What is the second line treatment in those who have insomnia due to restless leg syndrome?

A

alpha-2-delta ligands such as gabapentin or pregabalin

62
Q

What is the only Orexin Antagonist that is FDA approved for insomnia in adults?

A

Lemborexant (Dayvigo)

63
Q

Modafinil and Armodafinil are both

A

hypersomnia and wake promoting agents

64
Q

What stimulants are there that are wake-promoting agents?

A

Methylphenidate (Ritalin, Concerta ER), Amphetamine, Caffeine, Gamma-hyroxybutyrate (Xyrem)

NURS 7310 (15 decks)

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