Unit 4: Sleep and Insomnia

Question 1

L1: Which “Z” drug is best used as a sleep aid in the middle of the night, since it does not reduce nocturnal awakenings?

Answer 1

Zaleplon

Question 2

L1: Which “Z” drug is the most widely prescribed hypnotic agent?

Answer 2

Zolpidem

Question 3

L1: Which stage of sleep? Decreased muscle tone, increased BP/HR/RR

Answer 3

REM

Question 4

L1: Which stage of sleep? Delta wave (very slow) EEG), deepest level of sleep

Answer 4

3 and 4

Question 5

L1: Which stage of sleep? EEG looks awake but arousal threshold is elevated

Answer 5

REM

Question 6

L1: Which stage of sleep? Light sleep, slower EEG

Answer 6

2

Question 7

L1: Which stage of sleep? May be involved in synaptic pruning and tuning

Answer 7

3 and 4

Question 8

L1: Which stage of sleep? Transition phase, EEG appears like wakefulness

Answer 8

1

Question 9

L1: Which stage of sleep? When dreams and somnambulism occur

Answer 9

3 and 4

Question 10

L2: ________: sleepiness waxes and wanes as according to signals in the suprachiasmatic nuclei

Answer 10

Circadian altering system

Question 11

L2: ________: the longer we are awake, the sleepier we get; mediated by adenosine

Answer 11

Homeostatic Drive

Question 12

L2: Name the status on/off of the following neurotransmitter during wakefulness and NREM sleep. Orexin

Answer 12

Active, off

Question 13

L2: Name the status on/off of the following neurotransmitter during wakefulness and REM sleep. DA

Answer 13

Active, off

Question 14

L2: Name the status on/off of the following neurotransmitter during wakefulness, NREM sleep, and REM sleep. 5HT

Answer 14

Active, reduced, off

Question 15

L2: Name the status on/off of the following neurotransmitter during wakefulness, NREM sleep, and REM sleep. ACh

Answer 15

Active, off, active/very active

Question 16

L2: Name the status on/off of the following neurotransmitter during wakefulness, NREM sleep, and REM sleep. GABA

Answer 16

Off, active, reduced

Question 17

L2: Name the status on/off of the following neurotransmitter during wakefulness, NREM sleep, and REM sleep. Histamine

Answer 17

Active, reduced, off

Question 18

L2: Name the status on/off of the following neurotransmitter during wakefulness, NREM sleep, and REM sleep. NE

Answer 18

Active, reduced, off

Question 19

L2: Place the “Z” drugs in order of increasing half-life.

Answer 19

Zaleplon, Zolpidem, Esziopiclone

Question 20

L2: Place the following Benzodiazepines in order of increasing half-life: flurazepam, temazepam, triazolam

Answer 20

Triazolam, Temazepam, Flurazepam

Question 21

L2: Which agent for insomnia has agonist, antagonist, and reuptake inhibition actions on 5HT neurons?

Answer 21

Trazodone

Question 22

L2: Which agent for insomnia is an agonist at MT1 and MT2 melatonin receptors in the suprachiasmatic nucleus of the hypothalamus?

Answer 22

Ramelteon

Question 23

L2: Which agent for insomnia is an antagonist at H1 histamine receptors and muscarinic receptors?

Answer 23

Diphenhydramine

Question 24

L2: Which agent is a 5HT +/- NE reuptake inhibitor, histamine antagonist, and cholinergic antagonist?

Answer 24

Amitriptyline

Question 25

L2: Which agent is an antidepressant used for insomnia, especially in patients prone to substance abuse?

Answer 25

Trazodone

Question 26

L2: Which BDZ used in treatment of insomnia can lead to rebound insomnia upon withdrawal?

Answer 26

Triazolam

Question 27

L2: Which BDZ used in treatment of insomnia has the highest risk of daytime sedation, especially among elderly patients?

Answer 27

Flurazepam

Question 28

L2: Which BDZ used in treatment of insomnia has the least depression of REM sleep?

Answer 28

Flurazepam

Question 29

L2: Which brain structure? Ascending cortical activation, switch between SWS and REM

Answer 29

Brainstem

Question 30

L2: Which brain structure? Circadian clock that modulates alterness, core body temperature, and melatonin secretion

Answer 30

Suprachiasmatic Nucleus

Question 31

L2: Which brain structure? Location where adenosine accumulates during wakefulness and decreases during sleep

Answer 31

Basal forebrain

Question 32

L2: Which brain structure? Responsible for generating slow wave sleep

Answer 32

Thalamus

Question 33

L2: Which brain structure? Sleep/wake switch

Answer 33

Hypothalamus