Day 2 - Neuro3 Sleep/LOC Flashcards Preview

Step 2 DIT Rapid Review > Day 2 - Neuro3 Sleep/LOC > Flashcards

Flashcards in Day 2 - Neuro3 Sleep/LOC Deck (14):
1

Sleep patterns depressed v. elderly

Depressed - decreased sleep slow wave (less stage 3 and 4), more REM, decreased REM latency (hitting REM early on); Elderly - opposite in terms of REM - less REM & increased REM latency, also have decreased slow wave (less stage 3 and 4)

2

Nightmares vs. Night terrors

Nightmares - REM sleep, patients appear to wake up & actually awake; Night terrors - not during REM but slow wave, deep (stage 3 or 4) sleep, appear to wake up but not really awake, elevated autonomic (tachycardic, diaphoretic)

3

Pickwickian syndrome

Obesity hypoventilation syndrome, characterized by hypersomnolence (not breathing/sleeping well at night), excessive daytime sleepiness, dyspnea, hypoxemia, resulting in cyanosis, polycythemia, & plethora as well as pHTN (Right heart failure may also result & cause edema)

4

Dx narcolepsy criteria

(1) Cataplexy (sudden loss of muscle tone, diagnostic when present) (2) Other causes of excessive daytime sleepiness r/o'd - Overnight polysomnogram r/o OSA & periodic limb movement, r/o sedating meds, multiple sleep latency test (narcolepsy 45 opportunities to nap every 2 hrs, fall asleep in less than 8 min, may also be present in chronic sleep deprivation)

5

Tx Narcolepsy

Avoid sedating meds (e.g., alcohol, benzos, anticonvulsants); Scheduled naps 1-2x day for 10-20 min; Stimulants - Modafenil (Provigil) is first-line, may use ADHD stimulants; Support group; In case of cataplexy, Venlafaxine, Fluoxetin, or Amoxetine

6

Tx insomnia

(1) Melatonin - naturally secreted by pineal gland to help w/ circadian rhythms, warn patients may have vivid dreams, safe for 3 mo. (2) Valerian - herb, may be placebo effect (3) Antihistamines - diphenhydramine (Tylenol PM), doxylamine, assoc. w/ poor sleep quality, not for long-term use, anticholinergic side effect so avoid in elderly and/or demented patients (4) Trazodone - antidepressant, increase REM sleep, small risk of priapism, small dose may be used for just insomnia w/o depression (5) TCAs - Amitriptyline, Doxepin, antidepressants, small risk of arrhythmias (may get EKG prior to use), anticholinergic s/e so avoid in elderly/demented - Nortriptyline less than Amitriptyline (6) Long-acting benzos - Temazepam, Lorazepam, Clonazepam, Diazepam, Chlordiaxepoxide, only short-term no more than 35 days, decrease slow wave/deep sleep (7) Zolpidem (Ambien), Zaleplon (Sonata) - work at benzo receptor, short-term, rebound insomnia when d/c, depressed pt need something to sleep before antidepressant starts working in 2-4 weeks - may use thse (8) Eszopiclone (Lunesta) - long-term (9) Ramelteon (Rozerem) - non-addictive, melatonin receptors, NOT w/ liver disease (metabolized by liver)

7

Restless leg syndrome p/w

Sensation of unpleasant paresthesias compels patient to have voluntary but spontaneous, continuous movements that temporarily relieve sensation; Discomfort works at rest, evening, & during sleep; Described as sensation of ants or spiders being in or on calf muscles;

8

Cause of restless leg syndrome

Usually primary idiopathic, but may result from iron def, ESRD, diabetic neuropathy, Parkinson's, pregnancy, rheumatic diseases, varicose veins, or caffeine intake

9

Tx restless leg syndrome

Dopamine agonists - Levidopa/Carbidopa, Pramipexole, Ropinirole (like Parkinson's Disease); Iron replacment, Avoid caffeine; Benzo, Gabapentin, or last line, Opioid if refractory to dopamine agonists

10

Causes of syncope

Decreased cerebral perfusion: (1) Reflex syncope - vasovagal (emotional stress, trauma, pain, site of blood, prolonged standing) or situational (micturition, defecation, coughing, GI stimulation) (2) Carotid sinus hypersensitivity - head turning, shaving, tight collar; Cardiogenic - exertion, palpations, chest pain, or SOB; Orthostatic - stand up bp drops, dx tilt test or bp orthostatics; Cerebrovascular - prolonged loss of consciousness, seizures, neuro defects; No cause found in at least 20%

11

W/U syncope

History; Tilt test or orthostatics; R/o seizure: H & P, history of seizures, prodrome/de javu/aura, postical confusion, tongue lacerations; Syncope - prodrome of lightheadness, history of prolonged standing, non-specific brief limb jerking and urinary incontinence also; CBC, lytes, glucose (hypoglycemia), volume status, pulse ox, EKG (r/o arrhythmias, cardiac cause), meds; R/o carotid sinus hypersensitivity via massage (not do if known carotid artery disease); Consider: Serial cardiac enzymes, serial EKGs, echo (especially if murmur, exertion related, or history of heart disease), cardiac stress (especially if older), b/l carotid duplex, holter monitor, CT head

12

DDx LOC

AEIOU TIPS: Alcohol, Epilepsy/Environment (e.g., hypo/hyperthermia), Insulin (too much or little), Opioids/Overdose, Uremia, Trauma, Infx, Psychogenic, Stroke

13

Empiric tx for LOC

Check glucose, may give glucose for presumed hypoglycemia; Thiamine prior to glucose; Naloxone for presumed opioid ovedose.

14

Thiamine given before glucose infusion to alcoholics w/ hypoglycemia

Glucose w/o thiamine can exacerbate damage to mamillary bodies and worsen wernicke encephalopathy

Decks in Step 2 DIT Rapid Review Class (111):