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NeuroPsych > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

Stages of Sleep

A

Falling asleep
Light sleep
Deep sleep

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2
Q

How long is the NREM-REM cycle?

A

70-120 minutes and we do it 4-6x a night

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3
Q

What neurotransmitters promote sleep?

A

GABA
Melatonin
Adenosine

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4
Q

Dyssomnias

A

1˚ sleep disorders
1˚ insomnia
Breathing related sleep disorder
Unspecified

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5
Q

Parasomnias

A

Strange behavior while asleep

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6
Q

1˚ Insomnia Dx Criteria

A 
Difficulty with the following for ≥1 month:
Sleep onset
Sleep maintenance
Waking too early
Poor sleep quality
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7
Q

Risk Factors for Insomnia

A

Women

Age - quality decreases

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8
Q

What is the difference between acute and chronic 1˚ insomnia

A

4 weeks is the turning point

Before then, give PRN sleep aids and improve sleep hygiene

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9
Q

When is pharm therapy reserved for insomnia?

A

After adequate trials of non-pharm measures

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10
Q

Major Sedative/Hypnotic Counseling Pts

A 
Empty stomach
No pregnancy
Careful in depression, lung, liver or heart dys
Try for 2-4 weeks and re-eval
Taper/CBT when d/cing
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11
Q

BZDs MOA

A

GABA Agonists

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12
Q

Is there tolerance with BZDs?

A

Potential
Most are effective for up to 2-4 weeks
Intermittent dosing reduces likelihood of tolerance

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13
Q

BZDs in Elderly

A

Not recommended

If used - give 1/2 to 1/3 normal adult dose of SHORT ACTING BZDs

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14
Q

Shortest and Longest Onset BZD

A

Shortest: triazolam and estazolam
Longest: flurazepam

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15
Q

Shortest and Longest Acting BZD

A

Shortest: triazolam
Longest: Flurazepam (active metabolite)

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16
Q

BZD Withdrawal

A

Rebound sx w/in hours to days
Can cause delirium
Especially high dose

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17
Q

BZDRAs

A

BZD Receptor Agonists

Bind BZD receptor on GABA

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18
Q

Advantages of BZDRAs

A

Stage 3 preserved
Sedative effects only
Less dependence/tolerance

19
Q

Ambien Counseling Points

A

Diarrhea may resolve in 2 weeks

Use up to 35 days

20
Q

Dosing Considerations with BZDRAs

A

Women, >65, and liver probs = lower dose

21
Q

Intermezzo

A

IR SL zolpidem

PRN when wake up and still have at least 4 hours of sleep left

22
Q

Zaleplon

A

Sonata
Max 30 days
Only for onset
High doses (while effective for increasing total sleep time) are not recommended

23
Q

Temazepam Brand

A

Restoril

24
Q

Triazolam Brand

A

Halcion

25
Q

Flurazepam Brand

A

Dalmane

26
Q

Eszopiclone

A

S-enantiomer

Lunesta

27
Q

BZDRA Counseling Pts

A

Empty stomach right before bed

28
Q

Shortest onset BZDRA

A

Sonata

29
Q

Shortest and Longest Acting BZDRA

A

Shortest: Sonata
Longest: Lunesta

30
Q

Melatonin Receptor Agonist

A

Ramelteon (Rozerem)

31
Q

Melatonin

A

Secreted by pineal gland - less with age
Sleep/wake cycle
Agonism = sleep

32
Q

Weird Lunesta Dosing

A

Onset: 1mg
Maintenance: 2mg

33
Q

Rozerem

A

CI with fluvoxamine (1A2)

Empty stomach right before bed

34
Q

TCA Approved for Sleep

A

Doxepin (Silenor)
Suicide potential
Anti-Ach AEs - H1 antagonist
w/in 30 min of bed empty stomach

35
Q

Off-Label Use for Insomnia

A 
Trazodone
Mirtazapine
SSRIs
TCAs
SGAs
36
Q

Sleep bruxism

A

Teeth grinding

37
Q

OTC options

A 
Benadryl
Valerian
Melatonin
Kava
5-HT
38
Q

Central Sleep Apnea

A

No airflow due to no ventilation

Male, DM, CHF, old age, stroke

39
Q

Obstructive Sleep Apnea

A

No airflow, despite ventilation

40
Q

Consequences of OSA

A

Heart complications and increased mortality

41
Q

Screening tool for OSA

A 
ISNORED
Insomnia
Snoring
Nighttime awakenings
Obesity
Restorative sleep? 
Excessive sleepiness in day
Drugs affecting sleep
42
Q

Drugs for OSA

A

Change drugs promoting weight gain/CNS depression
Nothing approved
Modafinil for daytime sleepiness if using CPAP

43
Q

Restless Leg Syndrome

A

Risk - women, PD
1˚ and 2˚ - due to low Fe, pregnancy, kidney failure
Avoid stimulants or DA blockers

44
Q

RLS Treatment

A

DA Agonists
Ropinirole
Pramipexole
Gabapentin ER - prodrug

NeuroPsych (13 decks)

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