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39 Cards in this Set
- Front
- Back
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what stage is the majority of sleep spent
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stage 2
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what stage(s) of sleep are the restorative stage
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stage 3
stage 4 |
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what are the dysomnias
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insomnia
narcolepsy obstructive sleep apnea circadian rhythm disorders |
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Primary sleep disorder: at least 2 of the following for at least a month
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difficulty initiating sleep > 30 mins
difficulty maintaining sleep > 30 mins early morning awakenings poor sleep efficacy (spend time in bed but not a lot of it is spent sleeping) impairment of social, occupational, or other areas of functioning |
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what drugs can induce insomnia
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stimulants
antidepressants decongestants diuretics corticosteroids antihypertensives |
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what are the nonpharmacologic treatments for insomnia
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sleep hygiene education
stimulus control |
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what are the tips for sleep hygiene educations
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don't exercise too close to bed stime
avoid stimulants too close to bedtime maintain regular sleep schedule comfortable sleep environment |
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what is done for stimulus control
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avoid napping
avoid forcing sleep use bedroom only for sleeping go to bed only when tired |
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what is the efficacy of BZD
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shorten onset of sleep
prolong stage 2 sleep prolong total sleep time LACK EVIDENCE OF LONG TERM USE |
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what are the BZD used to treat sleep
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triazolam
temazopam estazolam flurazepam quazepam |
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which of the following BZD are short acting, long acting, and intermediate acting
triazolam quazepam estazolam temazopam flurazepam |
short: triazolam
intermediate: temazopam, estazolam long: flurazepam, quazepam |
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when would BZD be considered for treatment of secondary sleep disorders
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when also used for long term treatment of anxiety
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why would you not use BZD in eldery
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due to risk of fall
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what are the AE of BZD
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residual daytime sedation
anterograde amnesia dependence/withdrawal tolerance |
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which BZD don't have DDI with CYP3A4 inhibitors
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lorazepam
oxazepam temazepam |
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you should avoid using BZD with what agents
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CNS depressants (ex. antihistamines)
alcohol |
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what drugs improve stage 3 and 4 of sleep
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Non BZD Z hypnotics
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what drugs improve stage 2 of sleep
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BZD hypnotics
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what is the efficacy of Non BZD Z hypnotics
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improve sleep quality
reduce time to onset of sleep reduce # of awakenings |
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what are the Non BZD Z hypnotics
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zolpidem
zolpidem CR lunesta zaleplon |
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what Non BZD Z hypnotic has the longest duration
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lunesta
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which Non BZD Z hypnotic can't be used for sleep maintanence
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Zaleplon short duration of action
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what is the main SE of Zolpidem, Eszopiclone
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Zolpidem - parasomnias
Eszopiclone - metalic taste, dry mouth |
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what is the main difference between Non BZD and BZD hypnotics
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Non BZD hypnotics
-no tolerance -no dependence -less chance for withdrawal NONE WITH ZALEPLON |
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what is the Melatonin Rc agonist drug and how is it metabolized
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ramelteon
liver metabolism |
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what is the efficacy of Ramelteon
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shortens delay to sleep onset
increases total sleep time |
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what are the AE of Ramelteon
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somnolence
sore throat HA |
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what are the antihistamines used to treat sleep disorders
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diphenhydramine
doxylamine hydroxyzine |
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what are the AE of antihistamines
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residual morning sedation
anticholinergic effect dizziness tolerance |
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what drugs should be avoided in the elderly
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BZD hypnotics
antihistamines |
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what is the issue with using Alcohol to treat sleep disorders
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decreases onset to sleep
promotes sleep disturbances promotes sleep apnea |
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what are the antidepressants used for sleep disorders (must also have depression)
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mirtazepine
trazadone amitriptyline doxepin |
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what are the AE of antidepressants
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weight gain
suicidal ideation anticholinergic effects |
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what are the antipsychotics to treat sleep disorders (must also have psychotic issue)
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quetiapine
olanzapine |
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what are the anticonvulsants to treat sleep disorders (must also have seizures)
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tiagabine
pregabalin |
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what are the circadian rhythm disorders
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jet lag
shift work |
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what can be done to treat jet lag
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melatonin
short acting sleep aid (triazolam, zaleplon) |
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what can be done to treat sleep apnea
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weight loss
stop smoking/drinking lay on back while sleep CPAP surgery |
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patients with narcolepsy experience excessive daytime sleepiness what can be given to treat this
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modafanil
armodafanil |
