insomnia Flashcards
(85 cards)
1
Q
What is the optimal sleep duration for most adults to maintain good health?
A
7-9 hours per 24-hour period.
2
Q
What adverse outcomes are associated with short sleep duration?
A
Increased mortality.
3
Q
What factors control the body’s circadian rhythm?
A
Both internal and external factors.
4
Q
Which neurotransmitters promote wakefulness?
A
- Norepinephrine
- Acetylcholine
- Histamine
- Orexin
- Serotonin
5
Q
Which neurotransmitters promote sleep?
A
- GABA
- Adenosine
- Melatonin
6
Q
What are the two categories of sleep?
A
- Rapid Eye Movement (REM)
- Non-REM
7
Q
What tools are used to measure sleep parameters?
A
- Electroencephalograms
- Electro-oculograms
- Electromyograms
8
Q
How long does it typically take to pass from wakefulness to sleep?
A
About 45 minutes.
9
Q
How often is the sleep cycle repeated during a night?
A
Four to six times.
10
Q
What changes in sleep patterns occur with age?
A
- Less delta sleep (N3)
- Less REM sleep
- More nocturnal awakenings
- More total wake time at night
11
Q
What is the prevalence of insomnia in the adult population?
A
35%-50%.
12
Q
What are common risk factors for insomnia?
A
- Increasing age
- Female sex
- Comorbid disorders
- Shift work
- Unemployment
- Lower socioeconomic status
13
Q
What are the three types of insomnia as defined by DSM-5?
A
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Early morning awakening
14
Q
What is the minimum frequency of sleep difficulties for a diagnosis of insomnia?
A
At least 3 nights of the week.
15
Q
What is the recommended initial treatment duration for insomnia?
A
2-4 weeks.
16
Q
What is the purpose of cognitive behavioral therapy (CBT) in insomnia management?
A
Nonpharmacologic management of insomnia.
17
Q
What class of medications is primarily used for insomnia?
A
Benzodiazepines.
18
Q
What are the three classifications of benzodiazepines based on half-life?
A
- Short acting (less than 6 hours)
- Intermediate acting (6-24 hours)
- Long acting (more than 24 hours)
19
Q
What are common problems associated with benzodiazepines?
A
- Tolerance
- Dependence
- Residual daytime sedation
- Rebound insomnia
- Anterograde amnesia
20
Q
What is the half-life of Eszopiclone?
A
6 hours.
21
Q
What is the primary indication for Zaleplon?
A
Short-term treatment of insomnia.
22
Q
What is the role of orexin receptor antagonists in insomnia treatment?
A
Decrease sleep latency and promote sleep maintenance.
23
Q
What is the CAGE questionnaire used for?
A
Screening for alcohol use disorder.
24
Q
What is the first-line treatment for alcohol withdrawal symptoms?
A
Benzodiazepines.
25
What are the characteristic symptoms of acute alcohol withdrawal?
* Anxiety
* Insomnia
* Nausea
* Tachycardia
* Tremors
26
What is the goal of treatment for substance use disorder (SUD)?
Remission of the disorder, leading toward lasting recovery.
27
What is the recommended approach for treating SUD?
Patient-centered with shared decision-making, motivational interviewing, and harm reduction strategies.
28
What are common comorbid conditions with insomnia?
* Anxiety disorders
* Mood disorders
* Psychotic disorders
* Dementia
* Attention deficit disorder
* Personality disorders
29
What should be included in the evaluation of insomnia?
Assessment of medical and psychiatric status.
30
What medications should be avoided in patients with respiratory disorders?
Agents that can depress respiration.
31
What is the prevalence of insomnia in older adult patients?
As high as 40%.
32
What is a common consequence of long-term use of hypnotic medications?
Regular follow-ups every 6 months.
33
What is one of the guidelines for treating chronic insomnia according to the American Academy of Sleep Medicine?
Recommends against trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, valerian.
34
What should guide the treatment level for acute alcohol withdrawal?
An accurate history regarding amount, duration, and past withdrawal symptoms.
35
What is considered first-line treatment for alcohol withdrawal symptoms?
Benzodiazepines.
36
List some benzodiazepines that carry FDA indications for treating alcohol withdrawal.
* Chlordiazepoxide
* Clorazepate
* Diazepam
* Oxazepam
37
Why are long-half-life benzodiazepines preferred in some cases?
They minimize the potential for breakthrough symptoms.
38
Which benzodiazepines are preferred for older adults or patients with liver disease?
Lorazepam or oxazepam.
39
What is the CIWA-Ar scale used for?
To assess the severity of alcohol withdrawal symptoms.
40
What is the score range of the CIWA-Ar scale?
0-67.
41
At what CIWA-Ar score is treatment typically initiated?
Greater than 8-10.
42
What should be administered to all patients to prevent Wernicke-Korsakoff syndrome?
Thiamine.
43
How should thiamine be administered in severe cases?
Intramuscularly/intravenously.
44
What is the recommended dosage of thiamine for severe cases?
100-250 mg daily for 3-5 days, followed by 100 mg by mouth three times daily for 1 week.
45
What should be given before glucose to prevent complications?
Thiamine.
46
Name some antiseizure medications that can be used adjunctively in alcohol withdrawal.
* Carbamazepine
* Gabapentin
* Valproic acid
47
What is Acamprosate (Campral) used for?
To reduce cravings in alcohol use disorder.
48
What is a key precaution for prescribing Naltrexone?
Monitor liver function tests periodically.
49
What is the mechanism of action of Disulfiram (Antabuse)?
Blocks acetaldehyde dehydrogenase.
50
What symptoms can occur if alcohol is consumed while taking Disulfiram?
Nausea, vomiting, flushing, headache.
51
What is a common sign of opioid intoxication?
Miosis.
52
What scale is commonly used to monitor opioid withdrawal severity?
Clinical Opiate Withdrawal Scale (COWS).
53
What is the maximum score on the COWS?
48.
54
What is the first-line treatment for severe opioid withdrawal?
Buprenorphine or methadone.
55
What type of receptor does Methadone act on?
Mu-opioid receptor.
56
What is a significant risk associated with Methadone?
Fatal respiratory depression.
57
What makes Buprenorphine different from full agonists?
It is a partial agonist at the mu-opioid receptor.
58
What is the ceiling effect in Buprenorphine?
It provides less effect with increasing doses.
59
What are the dosage forms for Buprenorphine?
* Sublingual tablets (Subutex)
* Buccal film (Bunavail)
* Sublingual film (Suboxone)
* Sublingual tablet (Zubsolv)
* Implantable subdermal device (Probuphine)
* ER injection (Sublocade)
60
What is required before administering Naltrexone?
Patient must be completely off opioids for 7-10 days.
61
What is Lofexidine used for?
Treatment of opioid withdrawal.
62
What are the adverse health effects reduced by smoking cessation?
* Reproductive health outcomes
* Cardiovascular diseases
* COPD
* Cancer
63
What percentage of adults smoked cigarettes in 2020 according to the CDC?
12.5%.
64
What is the average number of attempts necessary for a patient to quit smoking successfully?
Seven attempts.
65
What are the five A's in assessing willingness to quit smoking?
* Ask about tobacco use
* Advise to quit
* Assess willingness to attempt to quit
* Assist in quit attempt
* Arrange for follow-up
66
List the pharmacologic agents available for smoking cessation.
* Nicotine replacement therapy (5 types)
* Non-nicotine agents (2 types)
67
What is the recommended starting dose of nicotine patch for heavy smokers?
21 mg/day.
68
How should nicotine gum be used?
Chewed until a 'peppery' taste develops, then parked between the cheek and gum.
69
How many lozenges should be used at the beginning of nicotine therapy?
At least 9 lozenges.
70
What is the recommended dose for nicotine nasal spray?
0.5 mg delivered to each nostril.
71
What should be avoided 15 minutes before using nicotine products?
Acidic beverages.
72
What is the recommended dose of the nasal spray for nicotine replacement therapy?
0.5 mg delivered to each nostril, with one or two doses used hourly, up to five doses
## Footnote
Maximum of 40 doses in 24 hours; at least eight doses should be used at the start of therapy.
73
What is the recommended length of therapy for the nasal spray?
3-6 months, with tapering
## Footnote
Risk of dependency is higher than with other forms of nicotine replacement.
74
What percentage of patients may experience nasal irritation when using the nasal spray?
Up to 94%
## Footnote
Nasal irritation can last as long as 8 weeks into therapy.
75
What should be avoided when using the nasal spray to reduce the risk of nasal irritation?
Inhaling, sniffing, and swallowing
## Footnote
These actions can increase nasal irritation.
76
Can nicotine patches be used with other dosage forms of nicotine replacement therapy?
Yes, nicotine patches can be used with as-needed dosage forms
## Footnote
This combination can increase the chances of quitting.
77
What is the treatment of choice for pregnant women trying to quit smoking?
Nonpharmacologic methods
## Footnote
Pharmacologic therapies are generally avoided.
78
When should Bupropion SR be initiated before the quit date?
7 days before the quit date
## Footnote
Treatment should last for at least 8 weeks but can continue for up to 6 months.
79
What is Varenicline and what is its function?
A nicotine receptor partial agonist that blocks the effects of nicotine from smoking
## Footnote
It should be started 1 week before the quit day.
80
How long should Varenicline be continued after the quit date?
A total of 12 weeks
## Footnote
If successful at quitting, it can be continued for another 12 weeks.
81
What warning about Varenicline was removed in 2016?
The black boxed warning about neuropsychiatric symptoms
## Footnote
This change reflects new safety information.
82
What are some other agents used for smoking cessation besides Varenicline?
* Clonidine
* Nortriptyline
## Footnote
These may be considered for patients who do not succeed with first-line therapies.
83
What should be done for patients who were unsuccessful with one form of pharmacologic therapy?
They should be tried on a different method
## Footnote
This approach may improve the chances of quitting.
84
What are the strong recommendations made by the American Thoracic Society for tobacco-dependent adults?
* Varenicline is recommended over a nicotine patch
* Varenicline is recommended over bupropion
* Varenicline plus a nicotine patch is recommended over varenicline alone
* Varenicline is recommended over electronic cigarettes
* Start varenicline treatment for patients not ready to quit
## Footnote
These recommendations aim to optimize smoking cessation outcomes.
85
What are the conditional recommendations for tobacco-dependent adults with comorbid psychiatric conditions?
* Varenicline is recommended over a nicotine patch
* Extended-duration therapy with varenicline is recommended over standard-duration therapy
## Footnote
These recommendations are tailored to specific patient populations.
