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PHAR 253 - Therapeutics (2) > Insomnia > Flashcards

Insomnia Flashcards

1
Q

What is SL (sleep latency)

A

time to get to sleep following bedtime

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2
Q

What is WASO (Wake after sleep onset)?

A

sum of wake times from sleep onset to final awakaning

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3
Q

What is TIB

A

time from bedtime to getting out of bed

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4
Q

What is TST?

A

total sleep time = TIB-SL-WASO

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5
Q

What is sleep efficiency percent?

A

SE= TST/TIB x 100

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6
Q

What stage of sleep does most sleep occur?

A

stage 2

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7
Q

What sleep stage is it hardest to wake up from?

A

stage 3

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8
Q

What stage of sleep do we dream?

A

stage 4 or REM sleep

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9
Q

Generally How many times does does sleep cycle through?

A

4-5 cycles

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10
Q

WHat are some wake promoting neurotransmitters?

A

Glutamate, Acetylocholine, dopamine, Nor E, 5Ht, his

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11
Q

What is some sleep promoting neurotransmitters?

A

GABA, Melatonin, glycine, adenosine

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12
Q

What structure promotes wakefulness?

A

RAS

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13
Q

What are some major things to be diagnosed insomnia for DSM 5?

A

difficulty initiating sleep or maintaining or non restorative,
and impairment of daytime= cognitive, tired, mood
at least 3 x per week for at least 3 months
hard even though opportunity to sleep

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14
Q

What is the definition of insomnia?

A

SL of > 30 min, efficiency of < 85%, less than 6 hours of total sleep for > 3 days a week for 3 months

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15
Q

When is it acute insomnia?

A

1 month

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16
Q

What is sub chronic insomnia?

A

1-3 months

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17
Q

What is persistent insomnia?

A

> 3 months

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18
Q

What is primary insomnia?

A

no causation

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19
Q

What is secondary insomnia?

A

caused by medical condition or s/e

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20
Q

What would hyperthyroidism cause for sleep?

A

insomnia

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21
Q

What is some other conditions other than insomnia that it could be?

A

obstructive sleep apnoea
restless leg syndrome
narcolepsy- sleep in daytime
circadian rythym syndrome- sleep at wrong time
parasomnia

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22
Q

What can stimulate narcolepsy sleeping during day?

A

laughing

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23
Q

What is parasomnia?

A

unpleasant experiences with sleep that stops you from sleeping

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24
Q

What test can we use to see if it is sleep apnoea?

A

STOP-BANG

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25
What is the general insomnia assessment?
Epworth sleepiness scale SLEEP DIARY Insomnia severity scale
26
For AIS what is mild moderate and sever insomnia score?
mild= 6-9 mod= 10-15 severe= 16-24
27
Which gender struggles more with sleep?
females
28
How does age relate to sleep?
older= worse sleep
29
What percentage of people meet criteria for insomnia?
6-10%
30
How does old make sleep worse?
delayed onset, less REM, wake up more
31
Why would women have worse sleep?
lots of hormonal changes
32
What comorbidities is very common with insomnia?
depression anxiety, congestive heart failure
33
What are some risk factors for poor sleep?
stress, age, female, Comorbidities, shift work, lower status
34
What meds could make sleep hard?
diuretic= pee statin= muscle pain prednisone, levodopa, stims, venlafaxine, fluvoxamine
35
Les than how many hours increases risk of obesity?
<5 hours
36
Why can lack of sleep cause obesity?
lower leptin levels
37
What is our primary goal of therapy for insomnia?
increase sleep quality, lower daytime impairments
38
What are some general secondary goals of therapy?
Sl <30 min WASO <30 min lower awakening >6 total hours
39
What is the best way to treat insomnia?
treat underlying cause first/ psychological
40
How does CBT help?
lower SL and WASO and lower severity NOT TST
41
What component of CBT is the most important?
sleep restriction
42
What are some good sleep hygiene?
don't stay too long in bed, schedule, exercise, get out of bed if can't sleep, comfortable, no stims, dark, no screens
43
What are the components of CBT?
cognitive=misconceptions stim control=only go to bed sleepy, don't do none sleep things in bed sleep restriction sleep hygiene relaxation
44
How do you plan sleep restriction?
set wake time set a bedtime
45
How long to use benzes and z drugs?
LESS than 4 weeks
46
How much do the drugs GENERALLY improve sleep?
25 min SL decrease of 10 min and lower awakenings
47
Why is drug therapy not very good?
not super helpful and NNH high
48
How do benzos and z drugs work?
bind to GABA which inhibits CNS and calms you
49
What are some benzos?
PAM's and am's
50
What are the short acting benzos
end in am
51
What side effects are we worried about with midazolam?
amnesia and withdrawal and dependency
52
Why are we worried with older people with these drugs?
falls and accidents
53
DO we want a short, medium or long acting benzo?
medium
54
What are the medium benzos?
LOT lorazepam, oxazepam, temazepam clonazepam
55
Which is better eszopiclone vs zopiclone?
maybe better efficiency in eszopiclone but the same everywhere else
56
How many awakenings will you have if on z drug or benzo?
1 less
57
Can you have alcohol while on benzos and z drugs?
fuck no
58
IS antihistamines good? And what are we concerned about
no, tolerance in 4 days
59
S/E of antihistamines?
anticholinergic
60
What value does melatonin have?
8 minute improvement of SL
61
What is rationale behind melatonin?
levels decline as we age
62
Where is melatonin produced?
pineal and is increased in dark
63
Is TCA's an option?
increase TST, SL, efficiency, lower awake but not much benefit
64
Who is a no for TCA?
old people
65
S/E of TCA
anticholinergic, BPH, hypotension, arrythmias, epilepsy
66
When may we use TCA?
if they have depression too
67
What is MOA of doxepin?
H1 may help older with quality, time, efficiency NO for SL
68
S/E of doxepin?
anticholinergic
69
What must be said if giving doxepin?
no within 3 hours of meal and next day drowsy
70
MOA of trazodone
weak 5 HT reuptake inhibitor
71
What is a positive of trazodone?
lower risk of morning hangover and tolerance
72
Is trazodone worth it?
very limited evidence
73
What is con of mirtazepine?
weight gain
74
What is pro of mirtazepine?
can get less sedation etc higher doses
75
Should we use mirtazepine and quetiapine JUST for insomnia?
noooooo
76
What are the drugs that work on orexin receptor antagonist?
end in orexant
77
What are some s/e that are more uncommon for orexin drugs?
weird dreams, sleep paralysis, mood changes, suicide
78
What is a pro with orexin drugs?
no rebound insomnia
79
Which is better orexin or z drugs?
orexin
80
When should the patient maybe be informed of deprescribing benzos?
>65 recent hospitalization long term car falls substance use
81
How do you deprescribe these agents?
taper- with long acting, by 5 mg of diazepam no refills so they must see someone
82
Which is better for tappering benzo or z drug?
neither
83
When is tapering required?
>8 weeks
84
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PHAR 253 - Therapeutics (2) (8 decks)

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