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Neuro 4 Mine > Sleep > Flashcards

Sleep Flashcards

1
Q

Benzodiazepines

A
  • target a1, a2-a5
  • promote sleep, lessen anxiety
  • most likely to produce memory disturbances such as anterograde amnesia
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2
Q

In what stage of sleep do night terrors occur?

A

Stage 3

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3
Q

Z Drugs

A
  • target a1

- promote sleep

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4
Q

Zolpidem

A
  • ambien , ambien CR
  • Z drug used for sleep
  • targets a1
  • non-BDZ BDZ agonist
  • reduces sleep latency
  • reduces nocturnal awakenings
  • reduces insomnia associated with middle of the night awakening
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5
Q

Alpha 1 Target

A
  • agonist: BDZs, Z drugs
  • location: cortex
  • actions: sleep, anticonvulsant, amnesia, additive CNS depression
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6
Q

A2-A5 Targets

A
  • agonist: BDZs
  • location: limbic, brain stem
  • actions: anxiolytic, myorelaxant, tolerance, dependence, addiction
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7
Q

“Hangover effect” is increased with drugs with:

A

-longer half life

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8
Q

Triazolam Pharmacokinetcs

A
  • Halcion
  • BDZ agonist
  • rapid oral absorption
  • short 1/2 life, less daytime sedation
  • rebound insomnia next day due to rapid elimination
  • use cautiously in elderly- dose reduction
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9
Q

Temazepam Pharmacokinetics

A
  • Restoril
  • BDZ agonist
  • slow absorption- minimal effect on sleep latency
  • intermediate 1/2 life (9-13 hrs)
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10
Q

Flurazepam Pharmacokinetics

A
  • Dalmane
  • BDZ agonist
  • long t1/2 and active metabolite, low tolerance
  • can accumulate in elderly
  • impaired hepatic clearance
  • daytime sedation (hangover)/overdosage
  • less tolerance development than other BDZs
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11
Q

Zolpidem and Zaleplon Pharmacokinetics

A
  • rapid oral absorption
  • shortest durations of action and 1/2 lives
  • zolpidem eliminated more slowly in females- dose recommendation halved to prevent daytime hangover
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12
Q

Eszopiclone Pharmacokinetics

A
  • Lunesta
  • structurally different from zolpidem or zaleplon with longer 1/2 life
  • Z drug
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13
Q

BDZ Adverse Reactions

A
  • daytime sedation and performance impairment
  • anterograde amnesia
  • rebound insomnia
  • psychologic and physiologic dependence
  • overall very safe
  • fatal overdose very rare unless taken in combo with EtOH
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14
Q

Z Drug Adverse Reactions

A
  • safety similar to BDZs
  • rarely bizarre behavioral disturbances
  • tolerance, dependence, withdrawal possible, but less than with BDZs
  • overall very sage\
  • fatal overdose very rare unless taken in combo with EtOH
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15
Q

Zaleplon Effectiveness

A
  • effective for:
  • dec. time to sleep onset
  • NOT for reducing nocturnal awakenings
  • BUT is suitable to aid sleep onset for middle of night nocturnal awakenings
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16
Q

Eszopiclone Effectiveness

A
  • lunesta
  • effective for:
  • sleep maintenance (longest half life)
  • safe for long term use
  • Z drug
17
Q

Triazolam

A

-rapid oral absorption

18
Q

Trazedone

A
  • mixed 5HT reuptake blocker and receptor antagonist
  • dec. REM sleep
  • ADR: oversedation, orthostasis (a1 block), priapism
  • Role: antidepressant- very sedating and improves sleep continuity
  • no concerns with tolerance or dependence
19
Q

Ramelteon

A
  • Melatonin Receptor Agonist (MT1 induces sleepiness)
  • ADRs: dissiness, somnolence, fatigue, nausea
  • Role: useful to reduce sleep latency
20
Q

Melatonin

A
  • dietary supplement

- may be best for jet lag

21
Q

Diphenhydramine

A
  • benadryl
  • antagonist at CNS histamine H1 and muscarinic receptors
  • most likely to cause anticholinergic effects (no pee, see, spit shit)
  • ADRs: generally minimal, BUT antimuscarinic actions can be troublesome, esp in elderly
  • Role: minimally effective, generally not recommended long term, can see tolerance after >10 days use
22
Q

Treatment for Slow Wave Sleep

A

-trazedone

23
Q

Adjunctive Sleep Treatment

A
  • melatonin

- diphenhydramine

24
Q

1st Line Tx of Sleep Onset

A
  • zaleplon
  • zolpidem
  • ramelteon
25
Q

1st Line Tx for Sleep Onset and Sleep Maintenance

A
  • zolpidem CR

- eszopiclone

26
Q

What causes homeostatic drive in sleep loss?

A

-likely adenosine buildup

27
Q

REM Sleep

A
  • in charge of development and memory
  • rapid eye movements
  • most dreams
  • active brain, paralyzed body
  • suppressed with EtOH
28
Q

Non-REM Sleep

A
  • in charge of brain and body regeneration
  • stages N1, N2, N3 (SWS)
  • sleep walking, night terrors occurs during SWS
29
Q

Chronic jet lag, shift work, and sleep deprivation cause atrophy of:

A

-hippocampus

30
Q

Epworth Sleepiness Scale

A
  • helps sort out sleepy from fatigued
  • high score= excessive daytime sleepiness
  • low epworth= fatigue
31
Q

Lowest core body temp:

A

-is 2-3 hours before spontaneous wake time

32
Q

Tx for Circadian Problems

A
  • exposure to light

- melatonin

33
Q

Delayed Sleep Phase Syndrome

A
  • night owls
  • insomnia when trying to sleep at socially appropriate time
  • like to stay up late
34
Q

Advanced Sleep Phase Syndrome

A
  • early birds

- like to wake up early

Neuro 4 Mine (14 decks)

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