Sleep Wake- SG 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

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

Numerous neurotransmitters mediate NREM sleep including ____ and _____.

A
  • y-aminobutyric acid (GABA)
  • adenosine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

REM sleep is turned on by ________.

A

Cholinergic cells

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

REM sleep turned off by _________.

A

Noradrengeric cells

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

What 2 things facilitate arousal and wakefullness?

A
  • Ascending reticular activating system
  • Posterior hypothalamus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

An increase in ____ has an alerting effect

A decrease in ____ promotes sleepiness

A

Dopamine

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

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

A
  • Nonprescription drugs
  • Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

Recent stressors

  • separation
  • death in family
  • job change
  • college exams
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chronic insomnia is frequently comorbid w/ ____ or ______.

A
  • psychiatric or medication conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 common etiologies of insomnia

A
  • Situational (work/financial stress)
  • Medical (cardiovascular, respiratory, endocrine)
  • Pscyhiatric (mood disorders, anxiety disorders, substance abuse)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What drugs interfere w/ REM sleep?

A
  • Anticonvulsants
  • Central adrengergic blockers
  • Diuretics
  • Selective serotonin reuptake inhibitors
  • Steroids
  • Stimulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the goal of drug therapy for insomnia?

A

Lowest possible dose for shortest possible time period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 types of medications for insomnia

A

Sedation & Hypnotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • Effective sedative (anxiolytic) agent should reduce anxiety and exert a calming effect
A

Sedation meds for insomnia

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

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

A

Hypnotic meds for insomnia

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

3 clinical uses of Sedative-Hypnotics

A
  • Relief of anxiety
  • Insomnia
  • For control of ethanol or other sedative hypnotic withdrawal states
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which sedative-hypnotics lead to coma/death?

A

Barbiturates / alcohol

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

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

(no coma/death)

A

Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
**What type of drugs are these?** * Estazolam * Flurazepam * Quazepam * Temazepam * Triazolam
**Benzodiazepines** | (most common used tx for insomnia)
26
Traditional benzodiazepines have which 4 properties?
* Sedative * Anxiolytic * Muscle relaxant * Anticonvulsant properties
27
Which benzodiazepine is a "true hypnotic?"
Flurazepam
28
Which benzodiazepine can lead to homicidal ideation?
Triazolam
29
The receptors for benzodiazepines are located in which 3 areas of the brain?
* Thalamus * Limbic structures * Cerebral cortex
30
* Binding of benzodiazepines facilitates the inhibitory actions of \_\_\_\_\_. * What does BZDRA stand for?
* GABA * Benzodiazepine receptor agonists
31
**What should you prescribe for:** * Acute anxiety states * Panic attacks * Generalized anxiety disorder * Insomnia * Skeletal muscle relaxation * Seizure disorders
Benzodiazepines
32
**PK of which drug?** * Hepatic metabolism * Active metabolites * Additive CNS depression w/ many drugs * **Half lives:** 2-4 hrs
Benzodiazepines
33
3 toxicities of Benzodiazepines
* Extension of CNS depressant actions * Tolerance * Dependence liability
34
Which benzo was the 1st benzo on the market and was drug of choice for alcohol withdrawal?
Chlordiazepoxide
35
Which benzo is the "active metabolite?"
Oxazepam
36
Which benzo has active metabolites and erratic bioavailability from IM injection
Diazepam
37
Which benzo has active metabolites w/ long half lives?
Flurazepam
38
Which 3 benzos have no active metabolites?
* Lorazepam * Oxazepam * Zolpidem
39
**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?_
Prolonged
40
* Most traditional benzodiazepines maintain hypnotic efficacy for ___ month. * Tolerance can develop w/ time. How many days?
* 1 * 10-14 days
41
2 effects from BZDRA ADEs
* Anterograde amnesia * Rebound insomnia
42
* What has been reported the most w/ use of BZDRAs? * And is more likely to occur w/ short acting agents
**Anterograde amnesia** (impairment of memory and recall of events occurring after the dose is taken has been reported with most )
43
Increased wakefulness beyond baseline amounts that last for a few nights after abrupt discontinuation
Rebound insomnia
44
How can you prevent / minimize rebound insomnia and avoid adverse effects on memory w/ use of BZDRAs?
Use lowest effective dose
45
The FDA requires BZDRA labeling to include a caution regarding what 3 things?
* **anaphylaxis** * **facial angioedema** * **complex sleep behaviors** (sleep driving, phone calls, sleep eating)
46
What is the most common type of drug interaction w/ sedative-hypnotics?
CNS depression
47
What are the 5 "interacting substances" w/ sedative-hypnotics?
* Alcohol * Antihistamines * Antipsychotics * Opioid analgesics * Tricyclic antidepressants
48
Overdose on BZDRAs / sedative-hypnotics can result in what 2 things?
* severe respiratory depression * cardiovascular depression
49
Potentially lethal effects of BZDRAs are more likely to occur w/ what 3 substances as compared to benzodiazepines or newer hypnotics such as zolpidem?
* alcohol * barbiturates * carbamates
50
\_\_\_\_\_ may reverse CNS depressant effects of benzodiazepines, eszopiclone, zolpidem, & zaleplon
Flumazenil
51
\_\_\_\_\_ is a reversing agent for BZDRAs
Flumazenil
52
What are the 3 effects/toxicities of Flumazenil?
* Agitation * Confusion * Possible withdrawal syndrome