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NE2 Insomnia

Deleted user 11 questions Updated 11 Oct 2019

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Questions in this quiz (11)

  1. 1Sleep Hygiene: ASLEEP
    • Avoid [blank_start]alcohol, caffeine and nicotine[blank_end]
    • [blank_start]Sleep (and sex)[blank_end] should be the only use of the bed
    • Leave [blank_start]laptops, TVs and paperwork[blank_end] out of the bedroom
    • [blank_start]Exercise[blank_end] regularly and be outdoors during the day
    • Early rising - avoid [blank_start]sleeping in and daytime naps[blank_end]
    • Plan for bedtime
    1. Aalcohol, caffeine and nicotine
    2. BSleep (and sex)
    3. Claptops, TVs and paperwork
    4. DExercise
    5. Esleeping in and daytime naps
  2. 2Lack of sleep
    • Irritability
    • [blank_start]Daytime[blank_end] sleepiness
    • [blank_start]Low[blank_end] energy/motivation
    • Physical discomfort
    • Impaired [blank_start]cognitive function[blank_end]
    1. ADaytime
    2. BLow
    3. Ccognitive function
  3. 3Insomnia - “Repeated inability to initiate and maintain sleep.”
    - Transient, [blank_start]2-3[blank_end] days - likely cause [blank_start]acute[blank_end] situational or environmental stress (shift work, jet lag)
    - Short term, <[blank_start]3[blank_end] weeks - likely cause [blank_start]ongoing[blank_end] personal stress
    - Long term, >3 weeks - likely causes psychiatric illness, behavioural, medical reasons
    1. A2-3
    2. B3
    3. Cacute
    4. Dongoing
  4. 4Neurotransmitter effects:
    1. Cortical arousal regulated by - (match NT to location)
    [blank_start]Noradrenaline[blank_end] (locus coeruleus)
    [blank_start]Cholinergic[blank_end] pathways (brainstem)
    [blank_start]Histamine[blank_end] (tuberomamillary nucleus)
    [blank_start]Serotonin[blank_end] (raphe nucleus)

    2. Promote wakefulness: orexins/hypocretins ([blank_start]peptide neurotransmitters[blank_end])

    3. Sleep induced by: [blank_start]GABA, melatonin and galanin[blank_end]
    1. ANoradrenaline
    2. BCholinergic
    3. CHistamine
    4. DSerotonin
    5. Epeptide neurotransmitters
    6. FGABA, melatonin and galanin
  5. 5GABA
    - Gamma-aminobutyric acid, major inhibitory neurotransmitter, decreases [blank_start]neuronal excitability[blank_end] and therefore CNS function
    - Drugs potentiating GABA [blank_start]transmission[blank_end]
    1. Hypnotic ([blank_start]sleep inducing[blank_end] properties)
    2. Sedative (moderating excitement and [blank_start]calming[blank_end])
    3. [blank_start]Anxiolytic[blank_end] (anxiety-relieving)
    1. Aneuronal excitability
    2. Btransmission:
    3. Csleep inducing
    4. Dcalming
    5. EAnxiolytic
  6. 6Drag and drop pharmacotherapies people take for insomnia into the right boxes.Image for question 6
    1. ADietary supplements
    2. BOTC/sleep aids
    3. CSedating medications
    4. DInsomnia meds
  7. 7Benzodiazepine receptor agonists e.g. [blank_start]triazolam, temazepam[blank_end].
    Indicated for acute insomnia.
    • Dose related [blank_start]hypnotic[blank_end] effects
    • Facilitate [blank_start]onset and duration[blank_end] of sleep
    • Alter NREM:REM
    • [blank_start]Rebound[blank_end] insomnia
    • Caution in pulmonary/respiratory disease: [blank_start]respiratory and CV[blank_end] depression risk.
    1. Atriazolam, temazepam
    2. Bhypnotic
    3. Conset and duration
    4. DRebound
    5. Erespiratory and CV
  8. 8Pharmacodynamics of benzos:
    - [blank_start]Positive allosteric[blank_end] modulator of GABA(A) R (most [blank_start]abundant[blank_end] R in CNS)
    - ‘[blank_start]tonic[blank_end]’ inhibition
    - [blank_start]hyper[blank_end]polarisation via Cl-
    - makes excitation [blank_start]less[blank_end] likely

    Pharmacokinetics of benzos:
    - Potency: hydrophobicity
    - Plasma protein [blank_start]binding[blank_end] (less free drug concentration).. so less potency in vivo
    - E.g.: [blank_start]Diazepam[blank_end] - rapid onset, long acting, vs [blank_start]midazolam[blank_end] rapid onset, short acting, temazepam and triazolam very [blank_start]short[blank_end] half life, nitrazepam [blank_start]long[blank_end] half life
    - Caution: increased potency with low [blank_start]albumin[blank_end] (e.g. haemodilution, liver dysfunction)
    - Metabolised by CYP3A4 (Caution: impaired [blank_start]hepatic[blank_end] function)
    1. APositive allosteric
    2. Babundant
    3. Ctonic
    4. Dhyper
    5. Eless
    6. Fbinding
    7. GDiazepam
    8. Hmidazolam
    9. Ishort
    10. Jlong
    11. Kalbumin
    12. Lhepatic
  9. 9Non-benzodiazepine hypnotics: zalepon, zolpidem, zopiclone
    • [blank_start]Different[blank_end] chemical class, similar mechanism
    • Postsynaptic GABA(A) Rs - binding site [blank_start]distinct[blank_end] from benzo site
    • Increased [blank_start]Cl- influx[blank_end] causes hyperpolarisation
    • Rapidly [blank_start]absorbed[blank_end], metabolized by liver
    • Short t1/2 ~ [blank_start]1-6[blank_end]h

    Unwanted effects: Incoordination, drowsiness, dizziness, confusion, amnesia
    1. ADifferent
    2. Bdistinct
    3. CCl- influx
    4. Dabsorbed
    5. E1-6
  10. 10Benzos and Zs have problems as short term and long-term therapy:
    [blank_start]Sedation, drowsiness, muscle relaxation[blank_end] - affects driving, machinery operation, [blank_start]falls[blank_end] in elderly
    [blank_start]Abusable[blank_end] (rapid onset, short duration, high potency) and dependence risks.
    1. ASedation, drowsiness, muscle relaxation
    2. Bfalls
    3. CAbusable

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User has deleted their subject information Quiz on NE2 Insomnia, created by Deleted user on 11/10/2019.
Author
Deleted user
Language
English
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105
History
Created on 11 Oct 2019 · updated on 11 Oct 2019
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