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Pharm 3 Shea > Sleep Wake > Flashcards

Sleep Wake Flashcards

1
Q

Which location of the brain and which neurotransmitter are associated w/ sleep-wake disorders?

A

Cannot be localized to area of brain or neurotransmitter

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2
Q

Numerous neurotransmitters mediate NREM sleep including ____ and _____.

A
  • y-aminobutyric acid (GABA)
  • adenosine
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3
Q

REM sleep is turned on by ________.

A

Cholinergic cells

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4
Q

REM sleep turned off by _________.

A

Noradrengeric cells

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5
Q

What 2 things facilitate arousal and wakefullness?

A
  • Ascending reticular activating system
  • Posterior hypothalamus
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6
Q

An increase in ____ has an alerting effect

A decrease in ____ promotes sleepiness

A

Dopamine

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7
Q
  • Neurochemicals involved in wakefullness include _______ and _______ in the cortex

and

  • ______ and ______ such as substance P and corticotropin releasing factor in the hypothalamus.
A
  • norepinephrine & acetylcholine
  • histamine & neuropeptides
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8
Q
  • Which age group has difficulty falling asleep?
  • Which 2 age groups have middle of the night awakening or early morning awakening?
  • 40% of individuals w/ insomnia also have concurrent ____ _____. along w/ anxiety, depression, or substance abuse.
A
  • Young adults
  • Middle aged and elderly adults
  • Psychiatric disorder
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9
Q

Significant percentrage of those w/ insomnia use _____ or ____ to self treat.

A
  • Nonprescription drugs
  • Alcohol
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10
Q

Complaint of transient / short term insomnia is usually due to what?

A

Recent stressors

  • separation
  • death in family
  • job change
  • college exams
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11
Q

Chronic insomnia is frequently comorbid w/ ____ or ______.

A
  • psychiatric or medication conditions
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12
Q

3 common etiologies of insomnia

A
  • Situational (work/financial stress)
  • Medical (cardiovascular, respiratory, endocrine)
  • Pscyhiatric (mood disorders, anxiety disorders, substance abuse)
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13
Q

What drugs interfere w/ REM sleep?

A
  • Anticonvulsants
  • Central adrengergic blockers
  • Diuretics
  • Selective serotonin reuptake inhibitors
  • Steroids
  • Stimulants
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14
Q

What is the goal of drug therapy for insomnia?

A

Lowest possible dose for shortest possible time period

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15
Q

2 types of medications for insomnia

A

Sedation & Hypnotic

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16
Q
  • Effective sedative (anxiolytic) agent should reduce anxiety and exert a calming effect
A

Sedation meds for insomnia

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17
Q

Hypnotic drug should produce drowsiness and encourage the onset & maintenance of a state of sleep

A

Hypnotic meds for insomnia

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18
Q

3 clinical uses of Sedative-Hypnotics

A
  • Relief of anxiety
  • Insomnia
  • For control of ethanol or other sedative hypnotic withdrawal states
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19
Q

Which sedative-hypnotics lead to coma/death?

A

Barbiturates / alcohol

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20
Q

Which sedative-hypnoticc drugs have a ceiling effect and does not work for surgical anesthesia

(no coma/death)

A

Benzodiazepines

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21
Q

Absorption/Distribution of which drug?

  • lipid soluble (crosses BBB)
  • absorbed well from GI tract
  • good distribution to brain
A

Sedative-Hypnotic drugs for Insomnia

22
Q

Metabolism/Excretion of which drug?

  • Metabolized before elimination from body
  • mainly by hepatic enzymes
  • active and inactive metabolites
A

Sedative-Hypnotic Drugs for Insomnia

23
Q

What is the most commonly used tx for insomnia?

A

Benzodiazepines

24
Q

What are the 3 “newer” non-benzodiazepines GABA agonists which possess only sedative properties?

A
  • Eszopiclone
  • Zaleplon
  • Zolpidem
25
Q

What type of drugs are these?

  • Estazolam
  • Flurazepam
  • Quazepam
  • Temazepam
  • Triazolam
A

Benzodiazepines

(most common used tx for insomnia)

26
Q

Traditional benzodiazepines have which 4 properties?

A
  • Sedative
  • Anxiolytic
  • Muscle relaxant
  • Anticonvulsant properties
27
Q

Which benzodiazepine is a “true hypnotic?”

A

Flurazepam

28
Q

Which benzodiazepine can lead to homicidal ideation?

A

Triazolam

29
Q

The receptors for benzodiazepines are located in which 3 areas of the brain?

A
  • Thalamus
  • Limbic structures
  • Cerebral cortex
30
Q
  • Binding of benzodiazepines facilitates the inhibitory actions of _____.
  • What does BZDRA stand for?
A
  • GABA
  • Benzodiazepine receptor agonists
31
Q

What should you prescribe for:

  • Acute anxiety states
  • Panic attacks
  • Generalized anxiety disorder
  • Insomnia
  • Skeletal muscle relaxation
  • Seizure disorders
A

Benzodiazepines

32
Q

PK of which drug?

  • Hepatic metabolism
  • Active metabolites
  • Additive CNS depression w/ many drugs
  • Half lives: 2-4 hrs
A

Benzodiazepines

33
Q

3 toxicities of Benzodiazepines

A
  • Extension of CNS depressant actions
  • Tolerance
  • Dependence liability
34
Q

Which benzo was the 1st benzo on the market and was drug of choice for alcohol withdrawal?

A

Chlordiazepoxide

35
Q

Which benzo is the “active metabolite?”

A

Oxazepam

36
Q

Which benzo has active metabolites and erratic bioavailability from IM injection

A

Diazepam

37
Q

Which benzo has active metabolites w/ long half lives?

A

Flurazepam

38
Q

Which 3 benzos have no active metabolites?

A
  • Lorazepam
  • Oxazepam
  • Zolpidem
39
Q

BZDRA adverse drug events

High doses w/ long/intermediate elimination half lives have a greater potential to:

  • produce daytime sedation
  • psychomotor incoordination
  • cognitive deficits
  • half lives are shortened or prolonged in older patients?
A

Prolonged

40
Q
  • Most traditional benzodiazepines maintain hypnotic efficacy for ___ month.
  • Tolerance can develop w/ time. How many days?
A
  • 1
  • 10-14 days
41
Q

2 effects from BZDRA ADEs

A
  • Anterograde amnesia
  • Rebound insomnia
42
Q
  • What has been reported the most w/ use of BZDRAs?
  • And is more likely to occur w/ short acting agents
A

Anterograde amnesia

(impairment of memory and recall of events occurring after the dose is taken has been reported with most )

43
Q

Increased wakefulness beyond baseline amounts that last for a few nights after abrupt discontinuation

A

Rebound insomnia

44
Q

How can you prevent / minimize rebound insomnia and avoid adverse effects on memory w/ use of BZDRAs?

A

Use lowest effective dose

45
Q

The FDA requires BZDRA labeling to include a caution regarding what 3 things?

A
  • anaphylaxis
  • facial angioedema
  • complex sleep behaviors (sleep driving, phone calls, sleep eating)
46
Q

What is the most common type of drug interaction w/ sedative-hypnotics?

A

CNS depression

47
Q

What are the 5 “interacting substances” w/ sedative-hypnotics?

A
  • Alcohol
  • Antihistamines
  • Antipsychotics
  • Opioid analgesics
  • Tricyclic antidepressants
48
Q

Overdose on BZDRAs / sedative-hypnotics can result in what 2 things?

A
  • severe respiratory depression
  • cardiovascular depression
49
Q

Potentially lethal effects of BZDRAs are more likely to occur w/ what 3 substances as compared to benzodiazepines or newer hypnotics such as zolpidem?

A
  • alcohol
  • barbiturates
  • carbamates
50
Q

_____ may reverse CNS depressant effects of benzodiazepines, eszopiclone, zolpidem, & zaleplon

A

Flumazenil

51
Q

_____ is a reversing agent for BZDRAs

A

Flumazenil

52
Q

What are the 3 effects/toxicities of Flumazenil?

A
  • Agitation
  • Confusion
  • Possible withdrawal syndrome

Pharm 3 Shea (17 decks)

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