Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Drug Action III > Sleep Disorder (Physiology/Pharm) - Block 3 > Flashcards

Sleep Disorder (Physiology/Pharm) - Block 3 Flashcards

1
Q

What is sleep?

A

Regulated set of behavioral and physiological states during which many processes vital to health and well-being take place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is sleep important?

A

Maintians optimal physical health, menthal and emotional functioning, and cognitive performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is REM sleep?

A

Low amplitude, high frequency desynchronous EEG
* Dreaming, rapid eye movements and muscular paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is non REM sleep?

A

All stages of sleep except REM sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is slow wave sleep?

A

Non-REM sleep characterized by synchronized EEG activity during deeper stages of sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the characteristics of REM?

A
  1. Narrative dreams
  2. Muscle atonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is muscle atonia?

A

Motor cortex is active but descending motor pathways are paralyzed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the stages o sleep cycles?

A

Stage 1: Lightest stage of NREM, drowsy sleep stage can be easily disrupted
Stage 2: Memory consolidation and synaptic pruning occur
Stage 3/4: Deep NREM sleep, most restorative stage of sleep
REM: Dreaming stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What waves are associated with stage 1 sleep?

A

Theta waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What waves are associated with stage 2?

A

Sleep spindles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the waves assoiated with stage 3 sleep?

A

Delta waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What neurotransmitters are associated with wakefulness?

A

NE, DA, Ach, H, 5HT, orexin (hypocrein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the neurotransmitters associated with sleep?

A

GABA, Ach, Adenosine, Melatonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is insomnia?

A
  1. Problems initiating sleep
  2. Problems staying aseep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common cause of insomnia?

A

Stress
Hormonal imbalances
Pschological disorders
Chronic illnesses
Substance abuse and meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are sx of insomnia during the night?

A

Tossing and turning, thinking, worrying
Inability to fall asleep and stay asleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are sx of insomnia the next day?

A

Inability to remember things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

WHat are the major sleep disorders?

A

Dyssomnias
Parasomnias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the difference between dyssomnias and parasomnias?

A

D: difficulties in amount, quality, or timing of sleep (most common)
P: abnormal behavioral and physiological events that occur during sleep (nightmares, walking, talking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the types of dyssomnias?

A

Circadian Rhythm Sleep Disorders: jet lag and shift work
Intrinsic sleep disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is circadian rhythm sleep disorders?

A

Inability to synchronize circadian sleep-wake pattern with the sleep-wake schedule of the surrounding environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the types of Circadian Rhythm Sleep Disorders?

A

Jet lag: corssing multiple time zones
Shift work: sleep problems associated with night shift work or changing shifts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are types of phases shift syndromes?

A

Advanced: early sleep onset and early awakening
Delayed: late sleep onset and late awakening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is sleep interuppted in patients with Breathing Related Sleep Disorders?

A

Chronic or habitual snoring, upper airways resistance syndrome, obstructive sleep apnea or obesity hypoventilation syndrome -> excessive sleepiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the tx for breathing related sleep disorders?

A
  1. CPAP
  2. Mechanical devices to reposition tongue or jaw
  3. Meds to stimulate breathing
  4. Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is RLS?

A

Unpleasant sensations in the legs and an uncontrollable urge to move wehn resting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are tx for RLS?

A

Dopamine agonists: Ropinirole (Requip), Pramipexole (Mirapex), Rotigotine (Neupro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Periodic Limb Movement Disorder? Tx?

A

Legs kick or jerk during nighttime sleep
Dopamine agonists: Ropinirole (Requip), Pramipexole (Mirapex), Rotigotine (Neupro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are examples of parasomnia disorders?

A

Arousal disorders: Confusional Arousals, Somnambulism, sleep terrors
Sleep wake transition disorders: nocturnal leg cramps, rhythmic movement disorder, sleeptalking
Parasomnias Usually Associated with REM Sleep: Nightmares, sleep paralysis, REM sleep behavior disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A physiological state of impaired cognitive and sensory-motor performance after waking?

A

Confusional Arousals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Sleepwalking in children and adults?

A

Somnambulism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the sx of sleep walking?

A
  1. During NREM
  2. Rising from bed and walking
  3. Blank stare
  4. Disorientation and amnesia upon awakening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the difference between night terrors and nightmares?

A

Terrors: NREM sleep
Mares: REM sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is REM sleep behavior disorder?

A

During REM sleep, the CNS motor function is normally paralyzed
* patient act out dreams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is narcolepsy?

A

Uncontrollable need to sleep during the day (excessive daytime sleepiness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is cataplexy?

A

Sudden loss of muscle tone associated with intense emotions and the sudden onset of REM sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the unability to move or speak?

A

Sleep paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the imagined sensations or hallucinations as a person is falling asleep?

A

Hypnagogic hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the difference between NT1 and 2?

A

NT1: low levels of orexin or hypocretin in CSF and/or cataplexy sx, shortened time entering REM on MSLT
NT2: No cataplexy or low levels of hypocretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the tests used to diagnose narcolepsy?

A

Multiple sleep latency test (MSLT)
Polysomnography (PSG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Prevalence rate of adult ADHD?

A

4.4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How many children are affected by ADHD in the US?

A

6.1 million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the causes of ADHD?

A

Heterogeneous neurobehavioral disorder:
1. Neuroanatomic/chemical: children with low birth weight
2. Genetics: parental ADHD
3. CNS insult: prenatal drug, nicotine or alcohol exposure
4. Environment: Patients with psychosocial adversity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the genetic basis of ADHD?

A
  1. Twin studies
  2. Family studies
  3. Adoption studies
  4. Molecular genetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the subtypes of ADHD?

A
  1. ADHD predominately inattentive
  2. ADHD predomnbiately hyperactivity/impulsivity
  3. ADHD combined
47
Q

What are the sx associated with ADHD diagnosis?

A
  1. Persistant and more severe
  2. Impairment
  3. Present in 2 or more settings
48
Q

What is the main tx for sleep problems?

A

Improve sleep hygiene

49
Q

What are classes of drugs approved for insomnia?

A
  1. Benzodiazepine hypnotics CIV
  2. Nonbenzodiazepine hypnotics CIV
  3. Orexin receptor antagonists CIV
  4. Selective melatonin receptor agonist

Other: Antihistamines, Antidepresants, Antipsychotics

50
Q

Types of benzo hypnotics?

A

Temazepam (Restoril)
Flurazepam (Dalmane)
Triazolam (Halcion)
Estazolam (Prosom)
Quazepam (Doral)

51
Q

Types of non-benzo hypnotics?

A

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

52
Q

Types of oxerin receptor antagonists?

A

Suvorexant (Belsomra)
Daridorexant (Quviviq)
Lemborexant (Dayvigo)

53
Q

Types of slective melatonin receptor agonist?

A

Ramelteon (Rozerem)
Tasimelteon (Hetlioz)

54
Q

Types of antihistamines for insomnia?

A

Diphenhydramine
Doxylamine

55
Q

Types of antidepressants for insomnia?

A

Trazadone
Mirtazipine
Amitriptyline

56
Q

How is the med tx guideline to treat insomnia?

A
  1. Lowest effective
  2. Shortest duration necessary
  3. DC med gradually to avoid rebound insomnia
  4. Use agents with the shortest half-lives to minimize daytime sedation
57
Q

What is the MOA of BZDs?

A
  1. Enhance GABA activation and chloride conduction of the GABA-chloride ionophore
  2. Facilitating GABA binding and increasing the frequency
58
Q

Distinguish the characteristics of sedative benzos?

A

Flurazepam (Dalmane): LA
Temazepam (Restoril): Mid-acting
Triazolam (Halcion): fast onset

59
Q

Flurazepam

Onset, MOA, Indication

A

Dalmane
Onset: LA, long half-life
Indication: facilitates sleep onset and increases sleep duration - Quazepam (Doral) similar
ADR: No rebound insomnia, but active metabolites may cause daytime sedation

60
Q

Temazepam

Onset, Indication

A

Restoril
Onset: Mid acting benzo, short term used (7-10 days)
Indication: facilitates sleep onset and increases sleep duration - Estazolam (Prosom)

61
Q

Triazolam

Onset, Indication

A

ONset: fast-onset
Indication: Decreases time needed to fall asleep, recommended to lessen the rebound insomnia associated with its DC

62
Q

Cautions/ADRs of using Benzos?

A
  1. Tolerance
  2. Respiratory depression
  3. High risk for abuse and are controlled substances IV
  4. Patients should not be prescribed benzodiazepines if currently taking any opioid products
  5. Daytime sedation
  6. Cognitive impairment
63
Q

MOA of non-benzo hypnotics?

A

Acts on the Benzodiazepine Receptor (sub-type of the GABA-A receptor (α1 GABA-A)

64
Q

What are indications of non benzo hypnotics?

A
  1. Sleep onset only: Zolpidem (Ambien), Zaleplon (Sonata)
  2. Sleep onset and sleep maintenance: Zolpidem ER (Ambien ER), Eszopiclone (Lunesta)
65
Q

What non-benzos are used for short-term tx of insomnia?

A

Zolpidem (Ambien) and Zaleplon (Sonata)

66
Q

What non-benzo does not have a FDA restriction on duration of usage?

A

Eszopiclone (Lunesta)

67
Q

Zolpidem

Onset, Indication, ADR

A

Ambien
Onset: Fast (30 min), rapid elimination (3hrs)
Indication: Sleep maintenace
ADR: Some people using this medicine have engaged in activity while not fully awake and later had no memory of it

68
Q

Zaleplon

Onset, Indications, ADR

A

Onset: Fast onset 5-15 min; Rapid elimination t1/2 = 1-1.5 hrs
Indication: For trouble falling asleep and maintaining sleep
ADR: Visual disturbances, No memory of activity

69
Q

Eszopiclone

Indication

A

Indication: Approved for longer than 35 days

70
Q

Suvorexant

MOA, Inidication

A

MOA: specific Orexin receptor antagonist
* Blocks the binding of wake-promoting neuropeptides orexin A and orexin B to orexin receptors OX1R and OX2R, suppressing the “wake drive”

Indication: sleep onset/maintenance insomnia

71
Q

Daridorexant (Quviviq)

MOA, ADR

A

Quviviq
MOA: Orexin Receptor Antagonists
ADR: Daytime somnolence, fatigue, HA
* Hypnagogic hallucinatiokns
* Cataplex
* complex sleep behaviors

72
Q

Lemborexant

MOA, ADR

A

MOA: Orexin Receptor Antagonists
ADR: Daytime somnolence, fatigue, HA
* Hypnagogic hallucinatiokns
* Cataplex
* complex sleep behaviors

73
Q

What is pineal hormone that regulates sleep-wake cycles and promotes sleep?

A

Melatonin

74
Q

Ramelteon

MOA, indication

A

MOA: Selective Melatonin Receptor Agonist: targets MT1 and MT2 receptors in hypothalamus
Indication: Reduces sleep-onset latency and increases sleep periods

75
Q

Scheduled drug class for Selective Melatonin Receptor Agonist?

A

Nonscheduled

76
Q

Tasimelteon

MOA, Inidication

A

MOA: Selective Melatonin Receptor Agonist for MT1 and MT2
Indication: Non-24 is a circadian rhythm sleep disorder

77
Q

What histamine receptors are blocked by antihistamine?

A

H1 receptors

78
Q

Antihistamines are strongly recommneded for chronic and elderly use?

A

False, due to anticholinergic effects

79
Q

Anticholinergic ADRs?

A

Decreased cognitive function (delirium), dry mouth, constipation, urinary retention, increased intraocular pressure

80
Q

What is an antidepressant that doesn’t suprress REM?

A

Trazodone (Desyrel)

81
Q

Trazodone

MOA, ADR

A

MOA: Serotonin receptor antagonist and 5HT reuptake inhibitor
ADR: priapism in men and clitoral engorgement in women, serotonin syndrome

82
Q

What are the non-approved antidepressants for insomnia?

A

TCA
1. Doxepin: strong histamine blocker
2. Amitriptyline / Nortriptyline: Acts at a multitude of serotonergic, histamine and cholinergic sites in the CNS

Mirtazipine: Adrenergic α2, serotonin 5-HT2A and 5-HT2C, and histamine H1 receptor antagonists

83
Q

What are the medications for narcolepsy?

A
  1. Psychostimulants
  2. NDRI
  3. H3 receptor antagonists
  4. Sodium oxybate
  5. Antidepressant (off-label)
84
Q

Types of psychostimulants?

A

Modafinil (Provigil), Armodafinil (Nuvigil), Methylphenidate

85
Q

Types of NDRI?

A

Solriamfetol (Sunosi)

86
Q

Types of Histamine H3 receptor antagonist?

A

Pitolisant (Wakix)

87
Q

Psychostimulants

Indication, ADR

A

Indication: Promote wakefulness and may selectively inhibit REM sleep mechanisms
ADR: anxiety, insomnia, anorexia, GI upset, tachycardia

88
Q

Modafinil

MOA, Indication

A

Provigil
MOA: reuptake inhibitors of dopamine
Indication: narcolepsy or shift work sleep disorders

89
Q

Methylphenidate

MOA

A

MOA: CNS stimulant that blocks reuptake of NE and Dopamine
Indication: Improves attention and decrease distractibility

90
Q

What isomer of methylphenidate binds to DAT?

A

d-methylphenidate

91
Q

Amphetamines

MOA, PK, ADR

A

MOA: Ca++ independent release of neurotransmitter
* Weak competitive re-uptake inhibitor and MOA inhibitor

PK: Well absorbed orally, freely penetrates into brain
ADR: HTN, tachycardia. dependence, acute psychosis with overdose

92
Q

Describe the MOA of amphetamines?

A
93
Q

Examples of amphetamine-like stimulants?

A

Desoxyn (methamphatamine)
Dexedrine, Dexedrine Spansule, Dextrostat (Dextroamphetamine)
Adderall, Adderall XR (Amphetamine / Dextroamphetamine)
Vyvanse (Lisdexamfetamine) - prodrug

94
Q

What are the ADRs of stimulants?

A
  1. Insomnia
  2. ANorexia
  3. Weight loss
95
Q

Sodium Oxybate

MOA, Inidcation

A

MOA: CNS depressant
Inidcation: narcolepsy with cataplexy and improves nighttime sleepiness

96
Q

What is the difference among the brands of oxybates?

A

Xyrem: sodium salt of oxybate
Xywave: calcium, mag, potassium, low sodium oxybates
Zyrem and Xywav must be taken in two divided doses, one at bedtime and another about 2.5 - 4 hours later

97
Q

What is the ER sodium oxybate product?

A

Lumryz: ER PO suspension QPM

98
Q

ADRs of oxybates?

A
  1. CNS depression, nausea, bed-wetting and worsening of sleepwalking
  2. Abuse and Misuse Potential (CIII): gamma-hydroxybutyrate (GHB) salts
  3. Restricted access programs: XYWAV, XYREM and LUMRYZ REMS
99
Q

Solriamfetol

MOA, INdication, ADR

A

Sunosi
MOA: NDRI
Inidication: Excessive sleepiness (narcolepsy and sleep apnea)
ADR: HA, anorexia, insomnia
* Serious: Increased BP and HR, psychiatric symptoms

100
Q

Pitolisant

MOA

A

Wakix
MOA: Histamine-3 (H3) receptor antagonist
ADR: insomnia, N/Ax

101
Q

What is the function of H3 receptors?

A

autoreceptors found on presynaptic terminals that regulate histamine synthesis and release

102
Q

Indications of SSRI/SNRI for narcolepsy?

A

Suppresses REM sleep

103
Q

Indications of TCA for narcolepsy?

A

cataplexy

104
Q

What is the effectiveness of psychostimulants in ADHD?

A

Not paradoxical:
1. Increase attention span
2. Increase goal-oriented behavior
3. Increase ability to concentrate and focus
4. Reduce impulsivity

105
Q

Describe the neurotransmittors related to ADHD?

A

DOpamine: Striatal - Prefrontal
* Enhances signal
* Imporves attention

NE: Prefrontal
* Dampens noise

106
Q

What are the methylphenidate formulations for ADHD?

A
  1. Ritalin (Immediate Release)
  2. Ritalin SR/LA (sustained release)
  3. Metadate ER/CD (extended release)
  4. Methylin & ER (extended release)
  5. Concerta (osmotic release)
  6. Daytrana (Transdermal)
  7. Quillivant XR (extended release liquid, new)
  8. Generics in immediate and extended release forms
  9. Focalin & XR (Dexmethylphenidate HCl, isomer of methylphenidate with a longer duration of action)
107
Q

What are the types of Amphetamine and amphetamine-like stimulants for ADHD?

A
  1. Methamphetamine (Desoxyn)
  2. Dextroamphetamine (Dexedrine)
  3. Amphetamine and Dextroamphetamine (Adderall)
  4. Lisdexamfetamine dimesylate (Vyvanse)
108
Q

Azstarys

MOA

A

Dexmethylphenidate / Serdexmethylphenidate
MOA: CNS stimulant

109
Q

Non-stimulant medications of ADHD?

A

Atomoxetine (Strattera)
Clonidine (Kapvay)
Guanfacine (Intuniv)

110
Q

Atomoxetine

MOA, Indication, ADR

A

Strattera
MOA: norepinephrine reuptake inhibitor (not scheduled)
Indication: minority of children typically respond to atomoxetine
ADR: N/dyspepsia, sleep disturbances, suicidal thoughts

111
Q

Clonidine

MOA, Inidcation, ADR

A

Kapvay
MOA: stimulation of α-2 receptors in the CNS
Indication: Not as effective for distractibility and attention span
ADR: sleepinessm low BP, dry mouth

112
Q

Guanfacine

A

Intuniv
MOA: stimulation of α-2 receptors in the CNS
Indication: Not as effective for distractibility and attention span
ADR: sleepinessm low BP, dry mouth

113
Q

How long does it take for clonidine and guanfacine to have optimal effect?

A

Takes 4-5 weeks to reach full efficacy

114
Q

How long does it take atomoxetine to have full effect?

A

6–8 weeks

Drug Action III (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions