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45 Cards in this Set
- Front
- Back
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what is a fever |
36.5-37.5C 98-100F |
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what part of the brain control body temperature |
hypothalamus as protoglandin e2 goes up fever goes up |
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when tx of fever necessary? |
preexisting cardiac impairment pulmonary impairment CNS impairment
children when febrile or non febrile sz |
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OTC drugs for fever |
aspirin- contraindicated in children, has effect on plts
NSAID- effect on plts, more effective then APAP
APAP |
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dose for aspriin |
325-650 mg q4-6h up to 4g/d |
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dose for NSAID |
Ibuprofen adult: 200-400mg q4-6h PRN reduction of fever child: 5mg/kg/dose q6-8h (10mg/kg/dose if >39C) |
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APA dose |
adult: 325-650mg q4-6h PRN for reduction of fever child: 10-15mg/kg/dose q4-6h |
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what are nonpharmacologic strategies for insomnia |
stimulus control therapy sleep restriction relaxation training paradoxical intention sleep hygiene education congnitive therapy
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what are the 4 goals for insomnia
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-Identify prominent insomnia sx -Identify comord causes of insomnia -remove or mitigate comordbies cause of insomnia -minimize duration of insomnia sx to prevent acute episodes form becoming chronic |
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what are the different categories of drugs |
non-benzos benzos melatonin receptor agonists orexin receptor antaonists OTC drugs |
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what the non-benzos |
zolpidem (Ambien) zaleplon (Sonata) eszopiclone (Lunesta) |
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cautions and long term use of non-benzos |
caution with hepatic/renal impairment and watch for w/d
long term use: eszopiclone and XL zolpidem |
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ADR of non-benzos |
drowsiness, fatigue, confusion residual daytime sedatino or amnesia reported obsessive ideas sleep eating OD looks like benzos and tx same (Flumazenil)
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dose for non-benzes |
Zolpidem 10mg T qhs PRN relief of insomnia
5mg for elderly and women |
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what are the benzos |
estazolam (ProSom) flurazepam (Dalmane) quazepam (Doral) temazepam (restoril) trazolam (halcoin) |
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effects of benzos |
decreased sleep latency decreased awakenings REM sleep usually shortened total sleep time increase- "Deep, refreshing sleep"
effects ON stages of sleep
watch dependence and abuse and w/d- taper for months |
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ADR of benzos |
hypnotic doses little to NO effect on: respiration, cardiac func, impaired hepatic func.
CNS effects: light-headless, impairment of mental and motor func, confusion, anterograde amnesia |
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contraindicators for benzos |
obstrx sleep apnea- worsens sleep related breathing disorders |
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rx for benzo |
Temazepam 15mg T qhs PRN relief of insomnia |
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what are the melatonin receptor agonists |
ramelteon (Rozarem) tasimelteon (Hetlioz) |
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ADR of melatonin receptors agonist |
hypnotics: dizziness, sleepiness, fatigue MT3 effects: decr testosterone incr prolactin disruption of reproductive hormonal regulation: decr libido, disruption of menses |
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chronic circadian rhythm sleep disorder
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sighted- body insists that the day is longer then 24h and refuses to adjust the external light dark cycle
blind- SCN is not cued each day to synchronize the circadian rhythm to 24-h social day |
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rx for melatonin receptor agonist |
Rozerem 8mg T 30m before bed PRN relief of insomnia |
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what is the orexin receptor antagonist |
suvorexant (Belsomra) |
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caution using orexin receptor antagonist in what pts |
depression hx of drug dependence abnl kidney func CYP3A4 |
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ADR of orexin receptor antagonist |
drowsiness HA abnl dreams
REM sleep effects -sleep paralysis -mild cataplexy |
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rx for orexin receptor antagonist |
Belsomra 10mg qd within 30m of bedtime |
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what are the OTC sleep aids |
diphenhydramine (Nytol) doxylamine (NiteTime Sleep Aid) |
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ADR of OTC sleep aids |
long half lives = morning hangover
muscarinic effects: dry mouth, dry eyes, urinary retention, constipation, blurred vision, delirium
general CNS depression: affects driving performance, lower sz threshold in epilepsy |
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what are other drugs can you use for sleep aids? |
antidepressants (Trazodone) Melatonin Valerian |
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what drug can be used to tx OSA |
NONE need CPAP |
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what drugs do you want to avoid in narcolepsy |
benzos opiates antipsychotics alcohol |
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what nonpharm therapy can you do to tx narcolepsy/shift work |
avoid naps and sleep deprivation psychosocial assistance |
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what drugs are eugeroics |
amphetmaines (Dexedrine) methylphenidate (Ritalin) modafinil (Provigil) armodafinal (Nuvigil) |
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MOA of eugeroics |
increase CAT and dopamine |
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who don't you want to use eugeroics in? |
cardiac pts: angian, ischemia, MI, LVH psych pts: psychosis or bipolar children
monitor elderly and hepatic func |
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ADR of eugeroics |
HA GI: appetite decrease, abd pain, nausea CNS: nervousness, dizziness, anxiety, insomnia SJS
CYP3A4 |
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dose for eugeroics |
Modafinil (Provigil) 200mg qd morning |
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what is tx for cataplexy |
REM sleep-suppression drugs: NE or SSRI (venlafaxine, fluoxetine, atomoxetine)
sodium oxybate |
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what is the sodium oxybate |
gamma hydroxybutyrate (GHB) |
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nonpharm tx of RLS |
moderate regular exercise leg massage including pneumatic compression heat application mental alerting activities at times of rest or boredom avoid aggravating factors |
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what are the dopamine agonists for RLS |
ropinirole (Requip) pramipexole (Mirapex) rotigotine (Neupro) |
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caution with dopamine agonists in pts with what conditions |
dyskinesisa psychotic pts liver/kidney func |
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ADR of dopamine agonists |
impulse control disorders HA dizziness daytime sleepiness GI: nausea and vomiting |
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dose for dopamine agonists |
Ropinirole 1mg T qd 1-3h before bedtime |
