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Exam 2
Lecture 12
65
Anatomy
7th Grade
09/30/2013

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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
Term
for insomnia sleep disturbances occur _ nights per week
Definition
3
Term
for insomnia, sleep problems had to be apparent for how mnay months
Definition
3
Term
T/F- insomnia is where you have sleep problems when don't have adequate oppourtiny for sleep?
Definition
NO
Term
can you have insomnia if it occurs during another sleep disorder?
Definition
no
Term
when is insomnia episodic
Definition
symptoms last 1 month but less than 3
Term
when is insomnia persistent?
Definition
last longer than 3 months
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
Term
what are the psychiatric causes of sleep distrubrance-4
Definition
anxiety
depression
bipolar
alholol/substances
Term
what are some drugs that cause sleep disturbance? (look on pg 5 to see the rest) -4
Definition
alcohol
diuretics
theophylline
thyroid hormones
Term
for diagnosis of insomnia pt shoudl keep a?
what other things are done?-2
Definition
sleep log
PE, psychiatric eval
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
Term
majority of time use long/short term treatment for insomnia
Definition
short
Term
the bad thing about many insomnia drugs is-
Definition
have ADE as insomnia
Term
what are the 3 antidepressants for insomnia
Definition
trazadone, mirtzapine, TCAs
Term
what is doxepin?
Definition
anitdepressant
Term
what is reccomendation for taking doxepin
why?
Definition
dont take within 3 hrs of meal
bc will delay and increase daytime sedation
Term
which antidepressant should be used in elderly?
why?
Definition
trazadone
bc of BDZ ADEs
Term
whihc med is often used for antidepressant induced insomnia?
Definition
trazadone
Term
which class of meds is only used for episodic insomnia?
Definition
antihistamines
Term
melatonin is useful for -2
Definition
elderly
jet lag
Term
when is melatonin reccomended for insomnia?
Definition
if REM disorder
Term
which med as ER formulation can be used to help disct BDZ therapy
Definition
melatonin
Term
whihc med isnt approved by FDA?
why?
Definition
melatonin
diatary supp.
Term
whihc med class is only approved for short term use for insomnia?
Definition
BDZs
Term
BDZ reduce what-2
Definition
# of awakenings
latency for sleep onset
Term
what are the most important things about BDZs-2
Definition
onset and duraiton
Term
ADEs of BDZs-3
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
3A4
Term
when on BDZ counsel pt to avoid-
Definition
alcohol/CNS depressants
Term
for BDZs what do you do for elderly
Definition
lower dose
Term
contrainidcations for BDZs-4
Definition
hepatic impair, sleep apnea, substance abus, preggo
Term
onset for: triazolam
Definition
1 hr
Term
onset for: temezapem
Definition
1.5 hrs
Term
onset for: estrazolam
Definition
2 hours
Term
onset for: flurazapem
Definition
1 hour
Term
onset for: quazepam
Definition
2 hours
Term
what is the short acting BZD
Definition
triazolam
Term
what are the intermediate BZDs-2
Definition
temezapmam
estrazolam
Term
what are the long lasting BZDs
Definition
flurazapem
quazepam
Term
which non BZD hypnotic are approved just for short term use
Definition
zolpidem
zaleplon
Term
which non BDZ hypnotic is approves for long and short term
Definition
eszopiclone
Term
tolerance and withdrawal for non BDZ hypnotics?
Definition
not as bad as BZDs
Term
non BZDs are substrates of what CYP?
Definition
3A4
Term
what do you avoid while on non BZD hypnotics
Definition
alcohol/depressants
Term
counsel pt when taking non BZD hyponitc-
Definition
take on empty stomach
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
yes- category C
Term
what is the only non BZD that just decreases latency and doesnt also increase sleep time?
Definition
zaleplon
Term
on avg- are non BZDs quikc/long acting
and how long is duration
Definition
quick
~6-8 hrs
Term
non BZD hypnotics are what type of controlled substances-
Definition
IV
Term
ramelteon takes how long to see effects
Definition
3 weeks
Term
what is the melatonin agonist?
Definition
ramelteon
Term
ramelteon is metab by what?
Definition
1A2
Term
counsel pt when taking ramelteon-2
Definition
dont take with high fatty meal
take 30 min before bedtime
Term
ADes of ramleteon-3
Definition
daytime sedation, headache, increased prolactin
Term
can you use ramelteon for preggo?
Definition
yes- category C tho
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
ramleteon
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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