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PRE-REG-Thuri > NERVOUS SYSTEM - SLEEP DISORDERS + SUBSTANCE DEPENDENCE > Flashcards

NERVOUS SYSTEM - SLEEP DISORDERS + SUBSTANCE DEPENDENCE Flashcards

1
Q

What is insomnia?

A

Sleeping problem

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2
Q

List 4 symptoms of insomina?

A

difficulty sleeping

difficulty staying asleep

early morning awaking

poor sleep quality

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3
Q

What is transient insomnia caused by?

A

Environmental factors (use 1-2 doses of short-acting hypnotic - midazolam)

e.g. jet lag

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4
Q

What is short-term insomnia caused by?

A

Emotional or serious illness

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5
Q

How to treat short-term insomnia?

A

Use short-term hypnotic intermittent (use for <3 weeks)

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6
Q

What is chronic insomnia caused by?

A

Psychiatric or physical illness- treat the underlying cause.

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7
Q

List the 3 types of insomnia?

A

Transient

Short-term

Chronic

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8
Q

What 2 classes of drugs are given for insomnia?

A

Z drugs

Benzodiazepines

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9
Q

List 2 Z drugs used in insomnia?

A

Zopiclone

Zolpidem

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10
Q

What drug schedule are Z drugs?

A

CD4 part 1

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11
Q

List Benzos used in insomnia? (8)

A

Nitrazepam

Flurazepam

Diazepam

Temazepam

Lorazepam

Loprazolam

Lormetazepam

Oxazepam

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12
Q

Are zopiclone + zolpidem short or long acting?

A

Short acting

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13
Q

What Z drug causes taste disturbances

A

Zopiclone

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14
Q

What Z drug causes GI disturbances?

A

Zolpidem

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15
Q

What is 1 counselling point to tell the patient regarding zolpidem and driving?

A

Drowsiness may still persist the next day - leave 8 hours before driving.

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16
Q

What Benzo is commonly used in dental procedures + preferred?

A

Diazepam

Lorazepam

Temazepam - preferred

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17
Q

What 2 benzos help with insomnia linked to anxiety?

A

Lorazepam

Oxazepam

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18
Q

What 2 Z drugs are short-acting?

A

Zopiclone + Zolpidem

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19
Q

Who should benzos + Z drugs be avoided in?

A

Elderly - risk of falls

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20
Q

What is MOA of Z drugs?

A

Acts on benzodiazepine sites on GABA receptors + increases GABA binding.

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21
Q

What is indication of Z drugs?

A

Severe insomnia -SHORT TERM

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22
Q

What 3 benzos are long acting?

A

Diazepam

Flurazepam

Nitrazepam

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23
Q

What 5 benzos are SHORT acting?

A

Temazepam

Lorazepam

Loprazolam

Lormetazepam

Oxazepam

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24
Q

What effect is more prominent in long-acting benzodiazepines?

A

Hangover effect

Anxiolytic effect during day (diazepam single dose at night).

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25
Q

What are 3 SEs of Z -drugs?

A

Daytime sleepiness

Respiratory depression

Dependence + tolerance

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26
Q

What does label say for Z-drugs?

A

this medicine makes you feel sleepy. If you still feel sleepy the next day, do not drive or use tools/ machines.

Do not drink alcohol.

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27
Q

What can happen if a benzo is given with opioid?

A

CNS depression effect- monitor when starting, new dose

28
Q

If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, when to monitor methadone?

A

2 weeks of initiation as CNS depression effect delayed

29
Q

What other patient counselling should be given regarding respiratory depression?

A

Report signs of slow and shallow breathing, sedation + blue lips

30
Q

What are some cautions surrounding dependence on Z drugs?

A

Substance misuse + MH disorder

31
Q

What class drugs can interact with Z drugs + increase CNS depression / sedation?

A

-Alcohol, opioids, sedating antihistamines, Antipsychotics, Benzos, (CNS depressant)

-Azole antifungals, Macrolides, Diltiazem + verapamil (enzyme inhibitors)

32
Q

What drug types/enzyme —- can interact with Z drugs to increase CNS depression?

A

CNS depressants

Enzyme inhibitors - increase toxicity of Z drug = sedation

33
Q

What is narcolepsy?

A

Excessive sleepiness in the daytime + may also suddenly fall asleep during any activity.

34
Q

What is 1st line management of narcolepsy?

A

Modafinil

35
Q

What is alcoholism?

A

Strong, uncontrollable desire to drink.

36
Q

What are 2 1st line drug treatments for alcohol withdrawal symptoms?

A

Chlordiazepoxide

OR

Diazepam

37
Q

What drug can help alcohol with-drawal patient with seizures?

A

Lorazepam

38
Q

What drug can help alcohol withdrawal patient with delirium tremens?

A

Oral lorazepam

39
Q

What drug can help alcohol with-drawal patient with persistant delirium tremens OR if declines?

A

Parenteral Lorazepam

OR

Haloperidol

40
Q

What is 1st line treatment for alcohol dependence?

A

Acamprostate OR naltexone + psychological therapy

41
Q

What drug is used to reduce the alcohol consumption in patient with alcohol dependence with high risk of drinking ?

A

Nalmefene

42
Q

What drug is used to help treat Wernicke’s Encephalopathy?

A

Thiamine

43
Q

What is nicotine dependence?

A

Nicotine which is present in tobacco is addictive and smoking causes lung cancer + COPD.

44
Q

What is the most effective approach in stopping smoking?

A

Abrupt quiting

Cessation aids + behavioural support

45
Q

What are 2 drug treatments to help stop smoking?

A

Varenicline

Long + short acting NRT.

46
Q

What are examples of short acting NRT?

A

Gum, Lozenge, Nasal + oral spray, sublingual tablet, inhalator.

(helps with urge to smoke + prevent cravings).

47
Q

What are examples of long acting NRT?

A

patch - for strong cravings on waking

48
Q

What are 2 durations of the patch?

A

16 hours

24 hours

49
Q

What is an SNRI drug which is also used for smoking cessation?

A

Bupropion

50
Q

What is an MHRA warning regarding the use of bupropion and serotonergic drugs?

A

Increased risk of serotonin syndrome

51
Q

What patient counselling can be given to the SNRI Bupropion?

A

Report any worsening of depression, suicidal behaviour.

52
Q

What 2 drugs are given for opioid dependence?

A

Methadone

Buprenorphine

53
Q

What is duration of dose for opioid dependence drugs?

A

OD

54
Q

What is a SE of methadone?

A

QT prolongation

55
Q

What is a SE of buprenorphine?

A

Precipitates withdrawal - take 1st dose on withdrawal signs.

56
Q

describe half life of methadone?

A

Long half life

57
Q

What is more sedating; methadone or buprenoprhine?

A

Methadone

58
Q

What to do if they miss 3 days of methadone?

A

Cannot give- overdose risk

59
Q

What to do if they miss 5 days of methadone?

A

risk of misuse - cannot give.

60
Q

Which opioid dependence drug has a lower risk of overdose?

A

Buprenorphine

61
Q

What 3 conditions to avoid varenicline in ?

A

CVD

Epilepsy

Psychiatric illness

62
Q

What 3 conditions to avoid bupropion in?

A

Eating disorders

seizures

psychiatric illness

63
Q

What NRT to use if pregnant?

A

16 hour patch if pregnant or nightmares +

short term reliever - e.g. gum, lozenges

64
Q

What is max supply for opioid dependance treatment?

A

14 days - FP10MDA FORM

65
Q

How many missed does of methadone means refer back?

A

3 or more missed doses

66
Q

Can treatment for opioid dependence carry on when pregnant?

A

YES

PRE-REG-Thuri (44 decks)

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