Term
| what are the 3 symptoms that at least 1 is needed for insomnia |
|
Definition
difficulty initating sleep
difficulty maintaing sleep
early morning wake and cant return to sleep |
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|
Term
| for insomnia sleep disturbances occur _ nights per week |
|
Definition
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|
Term
| for insomnia, sleep problems had to be apparent for how mnay months |
|
Definition
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|
Term
| T/F- insomnia is where you have sleep problems when don't have adequate oppourtiny for sleep? |
|
Definition
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|
Term
| can you have insomnia if it occurs during another sleep disorder? |
|
Definition
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|
Term
| when is insomnia episodic |
|
Definition
| symptoms last 1 month but less than 3 |
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|
Term
| when is insomnia persistent? |
|
Definition
| last longer than 3 months |
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|
Term
| when is insomnia recurrent |
|
Definition
| two or more episodes wihtin 1 yr |
|
|
Term
| look at slide 4 for medicla causes of sleep distrubance |
|
Definition
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|
Term
| what are the psychiatric causes of sleep distrubrance-4 |
|
Definition
anxiety
depression
bipolar
alholol/substances |
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|
Term
| what are some drugs that cause sleep disturbance? (look on pg 5 to see the rest) -4 |
|
Definition
alcohol
diuretics
theophylline
thyroid hormones |
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|
Term
for diagnosis of insomnia pt shoudl keep a?
what other things are done?-2 |
|
Definition
sleep log
PE, psychiatric eval |
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|
Term
| look on slide 5 for non pharm methods for insomnia- what are 4? |
|
Definition
dont force sleep
try to avoid naps
exercise
avoid lrg amnt of liuquids at bedtime |
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|
Term
| majority of time use long/short term treatment for insomnia |
|
Definition
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|
Term
| the bad thing about many insomnia drugs is- |
|
Definition
|
|
Term
| what are the 3 antidepressants for insomnia |
|
Definition
| trazadone, mirtzapine, TCAs |
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|
Term
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Definition
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|
Term
what is reccomendation for taking doxepin
why? |
|
Definition
dont take within 3 hrs of meal
bc will delay and increase daytime sedation |
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|
Term
which antidepressant should be used in elderly?
why? |
|
Definition
|
|
Term
| whihc med is often used for antidepressant induced insomnia? |
|
Definition
|
|
Term
| which class of meds is only used for episodic insomnia? |
|
Definition
|
|
Term
| melatonin is useful for -2 |
|
Definition
|
|
Term
| when is melatonin reccomended for insomnia? |
|
Definition
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|
Term
| which med as ER formulation can be used to help disct BDZ therapy |
|
Definition
|
|
Term
whihc med isnt approved by FDA?
why? |
|
Definition
|
|
Term
| whihc med class is only approved for short term use for insomnia? |
|
Definition
|
|
Term
|
Definition
# of awakenings
latency for sleep onset |
|
|
Term
| what are the most important things about BDZs-2 |
|
Definition
|
|
Term
|
Definition
| cns depression, tolerance, amnesia |
|
|
Term
| what 2 meds can cause complex sleep bhaviors-def? examples-3 |
|
Definition
BZD, non BZD hypnotics
dirivng, sex, eating |
|
|
Term
| meds that act on CYP _ cna affect BDZs |
|
Definition
|
|
Term
| when on BDZ counsel pt to avoid- |
|
Definition
|
|
Term
| for BDZs what do you do for elderly |
|
Definition
|
|
Term
| contrainidcations for BDZs-4 |
|
Definition
| hepatic impair, sleep apnea, substance abus, preggo |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the short acting BZD |
|
Definition
|
|
Term
| what are the intermediate BZDs-2 |
|
Definition
|
|
Term
| what are the long lasting BZDs |
|
Definition
|
|
Term
| which non BZD hypnotic are approved just for short term use |
|
Definition
|
|
Term
| which non BDZ hypnotic is approves for long and short term |
|
Definition
|
|
Term
| tolerance and withdrawal for non BDZ hypnotics? |
|
Definition
|
|
Term
| non BZDs are substrates of what CYP? |
|
Definition
|
|
Term
| what do you avoid while on non BZD hypnotics |
|
Definition
|
|
Term
| counsel pt when taking non BZD hyponitc- |
|
Definition
|
|
Term
| how does ADEs and changing sleep structure compare for non BZDs |
|
Definition
| better ADEs, doesnt change structure |
|
|
Term
| what are contrainidcaitons for non BZD hypnotics-2 |
|
Definition
| hepatic impair, sleep apnea |
|
|
Term
| can you use non BZDs with preggos? |
|
Definition
|
|
Term
| what is the only non BZD that just decreases latency and doesnt also increase sleep time? |
|
Definition
|
|
Term
on avg- are non BZDs quikc/long acting
and how long is duration |
|
Definition
|
|
Term
| non BZD hypnotics are what type of controlled substances- |
|
Definition
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|
Term
| ramelteon takes how long to see effects |
|
Definition
|
|
Term
| what is the melatonin agonist? |
|
Definition
|
|
Term
| ramelteon is metab by what? |
|
Definition
|
|
Term
| counsel pt when taking ramelteon-2 |
|
Definition
dont take with high fatty meal
take 30 min before bedtime |
|
|
Term
|
Definition
| daytime sedation, headache, increased prolactin |
|
|
Term
| can you use ramelteon for preggo? |
|
Definition
|
|
Term
| with insomnia- what are the first 2 things to try |
|
Definition
treat underlying porblem
try non pharmacological |
|
|
Term
| what are the first line agents for insomnia?-2 |
|
Definition
| BZDs and non BZD hypnitcs |
|
|
Term
| what is 2nd line therapy for insomnia? |
|
Definition
|
|
Term
| what is 3rd line therapy fr insomnia? |
|
Definition
| sedating antidepressants- can use earlier if pt has depression too |
|
|
Term
what combination therapies are available?-2
when are they used? |
|
Definition
BZd/non BZD + sedating antidepressant
ramelteon + sedating antidepressant
last |
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