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30 Cards in this Set
- Front
- Back
insomnia self treatment
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alcohol
diphenhydramine doxylamine metalonin natural product valeria, kavakava |
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alcohol treatment
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- low sleep latency
- up total sleep time - fragment sleep - low quality |
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otc treatment
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- up sleep maintenance
- up total sleep time - no effect on sl - anti chole AE - tolerance |
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melatonin treatment
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- low sl
- regular rhythm not fda regulated SE fatigue, dz, ha contraindication pragnance, cvd, immuno suppress |
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natural product treatment
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- no data for efficacy
- valerian: late onset livertoxic delirium - kavakava livertoxic - l trytophan death |
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treatment of acute insomnia
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- remove underlying cause
- use short time - 4-6wk - sleep hygeine |
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sleep hygeine
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- no nap
- routine time - no everning exercise - no stimulants - prepare to sleep - good bedroom |
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chronic insomnia treatment
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- find and treat 2ndary causes
- start non phar 1st - start intermittent shorterm (2-3dprn) - reassess - may go to sleep study |
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non pharmaco tx
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cognitive bahavioural tx
(cbt) - affect as med for shorterm - last >6mo |
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for sleep onset bzd
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bzd
- short acting: triazolam - inter acting estazolam temazolam |
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sleep onset bzra
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bzd recetor agonist
- zaleplon - zolpidem (pregnancy) - eszopiclone |
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sleep onset other med
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remalteon
doxepin |
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insomnia maintenance
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- bzd
- bzra (no zaleplon) - doxepin |
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shorterm insomnia guideline with bzra
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- non phar tx 1st
- short hypnotic - cheapest one - switch if AE - dont switch if no response |
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insomnia in elderly and children
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- trial elderly: bzra better bzd
- no trial on children |
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bzd short acting and AE
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short acting
- memory - amnesia - withdraw 24hr - rebound 1-2 days - tolerance 1-2wks |
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bzd long acting and AE
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- respiratory depress
- hangover effect - withdraw 3-8days - tolerance 1-3mi |
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parasomnia problem
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- sleep walk
- sleep eating - sleep driving - memory loss |
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parasomnia drug link
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zolpidem - interaction w valproic acid
zaleplon overdose short acting bzd alcohol |
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FDA label regulation
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- behaviour change
- anaphylaxis |
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other drug use
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trazodone
< 2wks |
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patient education
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medication relate
- avoid fatty meal - take before sleep - use intermittent only - drug interaction |
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rhythm disorder tx
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melatonin
FDA for blindness delay sleep phase advance sleep phase (not for elderly) jet lag shilf switch |
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rhythm disorder non phar tx
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light
sleep hygeine |
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sleep apnea non phar tx
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mild
- position moderate / severe - Cpap - weight loss - surgery if cpap doesnt work |
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sleep apnea phar tx
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- no cns depressant
- modafinil - bzra w cpap - topical nasal corticosteroid |
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NOT RECOMMENDED FOR SLEEP APNEA
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- PROTRIPTYLINE
- AMINOPHYLLINE - THEOPHYLINE - ESTROGEN - OXYGEN - NASAL DICONGESTANT |
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rls and rlmd tx
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iron 325bid
levodopa dopamin agonist - ropinirole (liver cl) - pramipexole (renal cl) |
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rls/plmd 2nd line
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- opioid
- bzd, bzra - anticonvulsant - life time modify |
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narcolepsy drug
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- modafinil
- dextroamphetamine - oxybate for cataplexy central pharmacy only or tca, ssri |