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Dynamics II > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What are the effects of a sedative drug

A
  1. decreases activity
  2. calming effect
  3. moderates excitement
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2
Q

What is a hypnotic drug?

A
  1. produces drowsiness
  2. imitates the natural sleep pattern
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3
Q

What is insomnia?

A

sleep disorder; you have difficulty falling or staying asleep

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4
Q

What are the three different types of insomnia?

A
  1. Transient insomnia
  2. Acute insomnia
  3. Chronic insomnia
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5
Q

What is transient insomnia?

A

a type of insomnia that can be brought on by many things and usually lasts for a few days

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6
Q

What is acute insomnia?

A

a type of insomnia that is caused by many types of stresses or a traumatic event and this usually lasts for a few days or weeks

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7
Q

What is chronic insomnia?

A

a type of insomnia that is caused by an underlying disorder and can last from months to years

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8
Q

How many stages of sleep are there?

A

5 stages

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9
Q

What is stage is REM sleep in?

A

Stage 5

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10
Q

Where does non-REM sleep occur?

A

Stages 1 - 4

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11
Q

What is Stage 1 sleep?

A

light sleep, muscle activity slows, slight muscle twitching

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12
Q

What is Stage 2 sleep?

A

slight decrease in body temperature, breathing and heart rate slows

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13
Q

What is Stage 3 sleep?

A

deep sleep begins, brain generates delta waves

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14
Q

What is Stage 4 sleep?

A

deep sleep begins; delta waves are produced; limited muscle activity

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15
Q

What is Stage 5 sleep?

A

REM sleep; dreaming occurs; muscles relax and heart rate increases; breathing is rapid and shallow

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16
Q

What are the ideal hypnotic pharmacokinetic properties?

A
  • rapid absorption
  • no active metabolites
  • optimal half- life
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17
Q

What are the ideal hypnotic pharmacokinetic effects?

A
  • rapid onset of action
  • other mechanisms besides CNS depression
  • sleep maintenance
  • improved daytime function
  • no “hangover effect” in the morning
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18
Q

Why were barbiturates replaced as the mainstay treatment to induce sleep with BZDs? (4 reasons)

A
  1. induce tolerance
  2. physical dependence
  3. severe withdrawal symptoms
  4. induce drug-metabolizing enzymes
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19
Q

What is the onset of action of barbiturates?

A

20 - 60 minutes

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20
Q

What is the duration of action of barbiturates?

A

15 - 50 hours

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21
Q

What are two examples of barbiturates?

A

pentobarbital, amobarbital

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22
Q

What is the CNS effect of barbiturates?

A

induced coma with toxic doses

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23
Q

What is the mechanism of action of barbiturates?

A

bind to GABA (a) receptors and then potentiate GABA actions which causes a prolonged entry of chloride through the chloride channel in the GABA receptor

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24
Q

What is the mechanism of action of benzodiazepines?

A

enhances the GABA induced ionic currents by causing hyper-polarization and causing increased inhibitory effects

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25
Q

What are the actions of benzodiazepines?

A
  1. sedative-hypnotic
  2. muscle relaxant
  3. anxiolytic
  4. anticonvulsant
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26
Q

Do benzodiazepines have a general anesthetic effect?

A

No

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27
Q

As the dosage of benzodiazepines increases what happens?

A

hypnosis then leads to unconsciousness

28
Q

How do benzodiazepines affect sleep?

A

benzodiazepines decrease the amount of time that it takes for you to fall asleep, which will increase the amount of time that you are asleep

29
Q

What is an FDA approved drug that helps with insomnia?

A

Temazepam (Restoril)

30
Q

What is the effect that benzodiazpines have at hypnotic doses?

A
  • no effect on respiration
  • no effect on cardiovascular effects
  • obstructive sleep apnea
31
Q

What is the effect that benzodiazepines have at anesthetic doses?

A
  • slight depression of alveolar ventilation
  • decreases blood pressure and increases heart rate
32
Q

What type of drugs are the first line therapy for insomnia?

A

“Z-drugs”

33
Q

Do “Z-drugs” have a high or low potential for abuse?

A

low potential for abuse

34
Q

What is the effect that Z-drugs have on benzodiazepines?

A

agonistic effects at the benzodiazepine site on the GABA receptor

35
Q

What class of drugs are ideal for elderly patients?

A

Z-drugs

36
Q

What are the advantages of using Z-drugs? (6)

A
  • no rebound insomnia
  • less hangover
  • no withdrawal
  • no active metabolites
  • less effect on the sleep cycle
  • dependency is only expected after long term use
37
Q

What is the mechanism of action for Zaleplon (Sonata)?

A

agonist at GABA receptors (alpha-1 receptor unit)

38
Q

What is the sleep onset of Zaleplon (Sonata)

A

1 hour

39
Q

When is the ideal time that you would need to take Zaleplon (Sonata)

A

directly at bedtime or before bedtime

40
Q

Is Zolpidem (Ambien)for long term or short term treatment of insomnia?

A

short term treatment of insomnia

41
Q

When would you have to adjust the dose of Zolpidem (Ambien)

A

for elderly patients and cirrhosis patients

42
Q

What drug has a sex-gap?

A

Zolpidam

43
Q

What formulations does Zolpidem come in?

A

Controlled and Immediate release

44
Q

Does Ambien emulate normal sleep cycle?

A

yes

45
Q

Is Eszopiclone (Lunesta) for short term or long term treatment of insomnia?

A

long term

46
Q

What are some side effects of Eszopiclone (Lunesta)?

A

may cause abnormal thinking, behavior, aggression, agitation and hallucinations

47
Q

What is the mechanism of action for antihistamines?

A

Histamine Receptor Antagonists

48
Q

What are two examples of antihistamines?

A

Diphenhydraminen (Zyquil) and Doxylamine

49
Q

What is a side effect of antihistamine use?

A

dry mouth, dry eyes, urinary retention, blurred vision, and constipation

50
Q

What is the mechanism of action for Doxepin (Silenor)?

A

H1-receptor (Higher affinity)

51
Q

What is Doxepin (Silenor)?

A

tricyclic antidepressant that has antihistamine effects

52
Q

Doxepin (Silenor) improves sleep maintenance, but not ______?

A

latency

53
Q

What do you need to be cautious of when taking Doxepin (Silenor)?

A

do not use when taking MAO inhibitor in the past 14 days

54
Q

What drug is an orexin receptor antagonist?

A

Suvorexant

55
Q

What is the indication for Suvorexant?

A

it treats difficulty in falling or staying asleep

56
Q

What is the mechanism of action for Suvorexant?

A

Highly selective dual antagonist for orexin receptors OX1R and OX2R

57
Q

What is the main difference between Orexin Receptor Antagonist and other drugs that treat sleep disorders?

A

it does not disrupt cognition

58
Q

What is melatonin?

A

Hormone produced naturally by the pineal gland in response to darkness; helps manage sleep and wake cycles

59
Q

What is the mechanism of action of melatonin?

A

MT1and MT2receptor agonist

60
Q

Where is melatonin likely the most effective?

A

delayed sleep phase syndrome

61
Q

What can melatonin also be used for even though it is not FDA approved?

A

dietary supplement

62
Q

What is the mechanism of action for Ramelteon (Rozerem)?

A

melatonin receptor agonist that has a high affinity for M1 and M2

63
Q

What is Ramelteon (Rozerem)?

A

Synthetic melatonin analog

64
Q

What are the advantages of Ramelteon (Rozerem)? (4)

A
  1. no rebound insomnia
  2. no CNS depression
  3. no abuse potential, tolerance, or withdrawal
65
Q

You are the medication specialist as part of an interprofessional team at a local hospital. A.D. is a 79-year old female who was diagnosed with Parkinson’s disease 2 years ago. She complains about having difficulty falling asleep. You are asked for a therapeutic recommendation. Patient currently takes lovastatin and a MAO inhibitor. Which of the following medications would be useful for A.D.?

A

Eszopiclone

Dynamics II (6 decks)

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