Chapter 11: Sleep Disorders & ADHD Treatment

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Questions and Answers

What characterizes Stage 1 of sleep?

  • Dreaming occurs and brain activity is high
  • Easily awakened with possible sudden contractions of the limbs (correct)
  • Deep sleep with disorientation upon awakening
  • Eye movements stop and brain activity increases

How much sleep do teenagers typically require?

  • 8 to 9 hours (correct)
  • 9 to 10 hours
  • 7 to 8 hours
  • 5 to 6 hours

What is a common sign of sleep deprivation?

  • Awakening without feeling disoriented
  • Difficulty falling asleep within 15 minutes
  • Drowsy feeling during the day (correct)
  • Feeling refreshed after 4 hours of sleep

Which factor is associated with contributing to sleep deficiency?

<p>Chronic illnesses (B)</p> Signup and view all the answers

What device is used as a non-pharmacologic measure for sleep apnea?

<p>CPAP device (A)</p> Signup and view all the answers

What is the primary external cue that influences circadian rhythms?

<p>Sunlight (A)</p> Signup and view all the answers

Which of the following is a function of sleep?

<p>Healthy functioning of the immune system (B)</p> Signup and view all the answers

Which neurotransmitter is known to induce sleepiness?

<p>Melatonin (C)</p> Signup and view all the answers

What is the term for sleep cycles characterized by rapid eye movements?

<p>REM sleep (B)</p> Signup and view all the answers

What is rebound hypersomnia?

<p>Excessive sleeping after sleep deprivation (A)</p> Signup and view all the answers

Which of the following symptoms is commonly associated with sleep deprivation?

<p>Impaired memory (B)</p> Signup and view all the answers

What type of medication is typically used to treat insomnia?

<p>Hypnotics (B)</p> Signup and view all the answers

Which of the following is NOT a reason why sleep is deemed necessary?

<p>Increased social media interaction (A)</p> Signup and view all the answers

What is the defining characteristic of long-term insomnia?

<p>Lasts longer than 3 weeks (A)</p> Signup and view all the answers

Which of the following medications is an example of a benzodiazepine used to treat insomnia?

<p>Temazepam (A)</p> Signup and view all the answers

Which of the following statements about insomnia is incorrect?

<p>Long-term insomnia lasts less than 3 weeks. (C)</p> Signup and view all the answers

What is the primary mechanism of action for imidazopyridines and cyclopyrrolone derivatives?

<p>They modulate the GABAA receptor chloride channel. (C)</p> Signup and view all the answers

Which drug is classified as an OTC option for short-term relief of insomnia?

<p>Diphenhydramine (A)</p> Signup and view all the answers

Benzodiazepines used for insomnia have what notable safety characteristic compared to barbiturates?

<p>More desirable safety profile (C)</p> Signup and view all the answers

Which of the following sleep disorders is characterized by sudden episodes of falling asleep?

<p>Narcolepsy (B)</p> Signup and view all the answers

What class of medications generally has the suffixes '-epam' and '-olam'?

<p>Benzodiazepines (B)</p> Signup and view all the answers

What is the primary mechanism of action believed to be utilized by modafinil and armodafinil?

<p>Stimulation of alpha1-adrenergic receptor sites (D)</p> Signup and view all the answers

Which of the following is NOT listed as an adverse effect of modafinil?

<p>Weight gain (A)</p> Signup and view all the answers

Which of the following factors is considered an environmental risk factor for ADHD?

<p>Food additives (B)</p> Signup and view all the answers

What is one of the warning labels associated with modafinil?

<p>May decrease effect of oral contraceptives (D)</p> Signup and view all the answers

Which subtype of ADHD is characterized primarily by impulsiveness and hyperactivity?

<p>Hyperactive-impulsive (C)</p> Signup and view all the answers

In how many subtypes is ADHD classified?

<p>Three (C)</p> Signup and view all the answers

Which of the following is a commonly held misconception regarding the etiology of ADHD?

<p>It is solely genetic (A)</p> Signup and view all the answers

Which of these substances during pregnancy has been implicated as a risk factor for ADHD?

<p>Cigarette smoke (B)</p> Signup and view all the answers

What is the primary purpose of pharmacotherapy in ADHD treatment?

<p>To control and manage symptoms (C)</p> Signup and view all the answers

Which of the following is a characteristic of amphetamines when treating ADHD?

<p>They improve focus in individuals with ADHD (A)</p> Signup and view all the answers

What mechanism of action do amphetamines NOT utilize in ADHD treatment?

<p>Blocking norepinephrine receptors (B)</p> Signup and view all the answers

Which of the following drugs is a nonamphetamine stimulant used for ADHD?

<p>Atomoxetine (Strattera®) (B)</p> Signup and view all the answers

What is a common adverse effect associated with the use of stimulant medications for ADHD?

<p>Decreased appetite (D)</p> Signup and view all the answers

What important warning label is associated with stimulant medications for ADHD?

<p>May be habit-forming (A)</p> Signup and view all the answers

Which of the following statements about guanfacine (Intuniv XR®) is true regarding its use in ADHD?

<p>Its mechanism of action in ADHD is unknown (D)</p> Signup and view all the answers

What notable effect do amphetamines have in individuals with ADHD?

<p>They enhance alertness and responsiveness (B)</p> Signup and view all the answers

What is one of the adverse effects specifically associated with zaleplon?

<p>Photosensitivity (C)</p> Signup and view all the answers

Which herb is known to help with sleep and has been used for over 2000 years?

<p>Valerian root (D)</p> Signup and view all the answers

What should be avoided close to bedtime to help treat insomnia?

<p>Stimulants (C)</p> Signup and view all the answers

How long should daily exercise be performed to help with insomnia?

<p>20 to 30 minutes (C)</p> Signup and view all the answers

What is a common warning about benzodiazepines?

<p>They may cause drowsiness (B)</p> Signup and view all the answers

Which stimulant is used to treat narcolepsy and is classified as a nonamphetamine?

<p>Modafinil (D)</p> Signup and view all the answers

What is a recommended action if you cannot fall asleep within a certain time after going to bed?

<p>Engage in a nonstimulating activity (C)</p> Signup and view all the answers

Which of the following is NOT an adverse effect of imidazopyridines and cyclopyrrolone derivatives?

<p>Stomach cramps (A)</p> Signup and view all the answers

Flashcards

Sleep's Importance

Sleep is crucial for a healthy immune system, nervous system, emotional/social well-being, physical & mental skills, and memory.

Sleep Cycle Influence

Circadian rhythms, influenced by sunlight, affect the sleep cycle.

Melatonin's Role

Melatonin, a hormone from the pineal gland, regulates sleepiness and body functions; the pineal gland uses sunlight

Hypnotic

A drug that promotes sleep.

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Insomnia

Difficulty falling asleep or staying asleep.

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Non-REM Sleep

A stage of sleep that occurs before REM sleep.

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REM Sleep

The stage of sleep associated with dreaming.

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Sleep Disorders

Medical conditions affecting the sleep cycle and quality.

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Deep Sleep Stages

Stages 3 and 4 of sleep are characterized by deep unconsciousness, making it difficult to awaken. The individual may feel disoriented if they are woken.

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Sleep Apnea

A condition where breathing repeatedly stops and starts during sleep. Symptoms include loud snoring and excessive daytime sleepiness.

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Sleep Deprivation Signs

Two common signs of sleep deprivation: falling asleep within 5 minutes of lying down, and feeling drowsy during the day.

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Caffeine Effect

Consuming caffeine (like in coffee, tea, or cola) can negatively affect sleep due to its stimulating effect.

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What are the most common sleep disorders?

The most common sleep disorders are insomnia, restless legs syndrome, sleep apnea, and narcolepsy.

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Restless Legs Syndrome

A sleep disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations.

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Ropinirole & Pramipexole

Medications used to treat Restless Legs Syndrome.

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Narcolepsy

A sleep disorder characterized by excessive daytime sleepiness and sudden attacks of sleep.

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Transient Insomnia

Insomnia that lasts less than 7 days.

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Short-Term Insomnia

Insomnia that lasts up to 3 weeks.

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Long-Term Insomnia

Insomnia that lasts longer than 3 weeks.

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Modafinil's MOA

The exact mechanism of action is unknown, but modafinil is believed to stimulate alpha1-adrenergic receptor sites.

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Amphetamine & Methylphenidate

These stimulants are classified as sympathomimetics and are used to treat narcolepsy.

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Modafinil: Adverse Effects

Common side effects of modafinil include stimulation, insomnia, tolerance, and dependence.

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Modafinil: Warning Labels

Important warnings include avoiding alcohol, potential decrease in oral contraceptive effectiveness, and habit formation.

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ADHD Etiology

The exact cause of ADHD is unknown, but there is evidence supporting a genetic component and environmental factors.

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ADHD Medications

Medications used for ADHD treatment are categorized by their mechanism of action including stimulants, non-stimulants, and other therapies.

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ADHD Symptoms

Common ADHD symptoms include: hyperactivity, impulsiveness, inattention, and difficulty focusing.

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ADHD Subtypes

ADHD is classified into three subtypes: hyperactive-impulsive, predominantly inattentive, and combined type.

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ADHD treatment

There's no cure for ADHD, only ways to manage symptoms. This includes medication (like amphetamines) and behavioral therapy.

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Amphetamines for ADHD

Amphetamines like Adderall® decrease hyperactivity and improve focus in people with ADHD.

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Non-amphetamine stimulant

Atomoxetine (Strattera®) is a non-amphetamine stimulant that helps ADHD by inhibiting norepinephrine reuptake.

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Amphetamine MOA

Amphetamines have three actions: release norepinephrine, block monoamine oxidase, and release dopamine.

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Norepinephrine effects

Increased norepinephrine stimulation leads to alertness, responsiveness, wakefulness, and reduced fatigue.

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Guanfacine for ADHD

Guanfacine (Intuniv XR®) is a non-stimulant ADHD treatment, working as a selective alpha2A-adrenergic receptor agonist.

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Common ADHD drug side effects

These include decreased appetite, nausea, stomach ache, anxiety, irritability, insomnia, increased heart rate, palpitations, arrhythmia, dizziness, and tremor.

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Amphetamine syndrome

This is a drug-induced psychosis caused by amphetamine use.

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Imidazopyridines & Cyclopyrrolone Derivatives

A class of drugs used to treat insomnia, including zaleplon, eszopiclone, and zopiclone. They work by enhancing the effects of GABA, a neurotransmitter that promotes sleep.

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Side Effects of Imidazopyridines & Cyclopyrrolones

These drugs can cause sedation, dizziness, tolerance, dependence, photosensitivity (zaleplon only), and a bitter or metallic taste (eszopiclone and zopiclone only).

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Valerian Root

A herbal treatment for insomnia, it has been used for over 2000 years. Its mechanism of action is not fully understood, but it may promote relaxation and sleepiness.

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Melatonin's Function

A hormone produced in the pineal gland, melatonin regulates sleep-wake cycles, acting as a signal to the body that it's time to sleep. The pineal gland is sensitive to light changes.

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Avoid Stimulants Before Bed

To improve sleep, avoid caffeinated drinks, tea, chocolate, fortified water, energy drinks, and OTC decongestants several hours before bedtime.

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Screen Devices Before Bed

Limit the use of electronic devices like smartphones, tablets, and laptops before bed. The blue light emitted from these screens can suppress melatonin production and make it harder to fall asleep.

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Modafinil (Alertec®)

A nonamphetamine stimulant used to treat narcolepsy and sleep apnea. Its exact mechanism of action is unknown, but it is believed to stimulate alpha1-adrenergic receptor sites.

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Benzodiazepines: Warning Labels

Benzodiazepines, a class of drugs used to treat anxiety and insomnia, are known to cause drowsiness, impair driving ability, interact negatively with alcohol, and be habit-forming.

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Study Notes

Chapter 11: Treatment of Sleep Disorders and Attention-Deficit Hyperactivity Disorder

  • Sleep Disorders and Medications Used to Treat Them:
    • Learn terminology associated with sleep disorders and ADHD
    • Discuss why sleep is necessary
    • Describe the phases of a normal sleep cycle
    • Describe symptoms associated with sleep deprivation
    • Describe different types of sleep disorders
    • Describe the function of neurotransmitters related to sleep
    • Classify medications used to treat sleep disorders
    • Describe the mechanism of action for each class of drugs used to treat sleep disorders
    • Identify warning labels and precautionary messages associated with medications used to treat sleep disorders

Key Terms

  • Hypnotic
  • Insomnia
  • Melatonin
  • Non-REM sleep
  • Rapid eye movement (REM) sleep
  • Rebound hypersomnia
  • Sedative
  • Stimulant

Overview

  • Sleep is vital for a healthy body and encompasses a variety of functions including immune system health, nervous system health, emotional and social functioning, physical and mental agility, and memory improvement

The Sleep Cycle

  • The sleep cycle is influenced by circadian rhythms, which are biological changes influenced by daylight
  • The pineal gland plays a critical role in releasing melatonin, which promotes drowsiness and regulates body temperature and hormone secretion

Five Stages of Sleep

  • Stage 1: Easily awakened, limb movements may occur
  • Stage 2: Eye movements stop, brain activity decreases
  • Stage 3 & 4: Deep sleep, difficult to awaken, disorientation upon waking
  • REM (Rapid Eye Movement): Dreaming occurs

Sufficient Sleep Varies

  • Sleep needs vary between 5 and 16 hours per day depending on age
    • Infants may need up to 16 hours
    • Teenagers often need 9 hours
    • Adults need 5-8 hours
    • Seniors may sleep less than young adults

Sleep Deprivation

  • Signs include daytime drowsiness, falling asleep quickly, and factors like sleep apnea, restless leg syndrome, caffeine consumption, prescriptions, and chronic illnesses

Sleep Disorders

  • Common disorders include insomnia, restless legs syndrome, Ropinirole, , Pramipexole, sleep apnea, and narcolepsy

Insomnia

  • Categorized by duration: transient (less than 7 days), short-term (up to 3 weeks), and long-term (more than 3 weeks)

Treatment of Sleep Disorders

  • Prescription drugs, such as benzodiazepines and other sedative-hypnotics, are used to treat insomnia.

Benzodiazepines Used in The Treatment of Insomnia

  • Common names end in "-epam" or "-olam"
  • Reduce neuronal excitability by opening calcium channels
  • More desirable safety profile than barbiturates

Miscellaneous Drugs Used for Insomnia

  • Zaleplon, zolpidem, eszopiclone, zopiclone, diphenhydramine, and doxylamine are other common medications to treat insomnia

MOA of Imidazopyridines and Cyclopyrrolone Derivatives

  • Act on benzodiazepine receptors subtype v-1
  • Modulate GABA receptors, chloride channel, to reduce neuronal excitability

Imidazopyridines and Cyclopyrrolone Derivatives Adverse Effects

  • Side effects include sedation, dizziness, tolerance/dependence, photosensitivity, and bitter/metallic taste

Herbal Treatments for Insomnia

  • Herbal treatments such as melatonin and valerian root are used
  • Melatonin: hormone produced by the pineal gland, sensitive to light changes
  • Valerian root: dates back over 2000 years

Non-pharmacological Treatment of Insomnia

  • Avoid stimulants close to bedtime (eg., caffeine, colas, tea, highly caffeinated beverages)
  • Establish a regular sleep schedule
  • Avoid daytime naps
  • Create a comfortable sleep environment free of noise and light
  • Reduce use of electronics before bed

Non-pharmacological Treatment of Insomnia (cont'd)

  • Don't go to bed hungry
  • Exercise 20-30 minutes daily (5-6 hours before sleep)
  • If you can't fall asleep, get up and do something relaxing for 10-15 minutes before trying again.

Benzodiazepines: Warning Labels

  • May cause drowsiness, impair driving ability
  • Avoid alcohol consumption
  • Can be habit-forming

Pharmacotherapy for Narcolepsy

  • Stimulants are used to treat narcolepsy
  • Modafinil: a non-amphetamine stimulant believed to stimulate alpha1-adrenergic receptor sites
  • Modafinil can treat sleep apnea as well
  • Amphetamine and methylphenidate are also used

MOA of Drugs Used to Treat Narcolepsy

  • Modafinil and armodafinil stimulate alpha1-adrenergic receptor sites
  • Amphetamine and methylphenidate are sympathomimetics

Modafinil: Adverse Effects

  • Stimulation, insomnia, tolerance, and dependence

Modafinil: Warning Labels

  • Avoid alcohol
  • May decrease effect of oral contraceptives
  • May be habit-forming

Attention-Deficit Hyperactivity Disorder and Medications Used to Treat It

  • Describe etiology (cause) of ADHD
  • Classify ADHD medications
  • Discuss mechanism of action for each class of ADHD medications
  • Identify warning labels and precautions
  • Identify significant look-alike or sound-alike drug issues

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Most common childhood behavioral disorder
  • Symptoms include hyperactivity, restlessness, impulsiveness, inattention, distractibility, forgetfulness, and inability to complete tasks
  • Three subtypes of ADHD: hyperactive-impulsive, predominantly inattentive, and combined type

Environmental and Nutritional Risk Factors for ADHD

  • Genetic component (up to 25% of children with ADHD have a relative affected by it too)
  • Cigarette smoke and alcohol consumption during pregnancy
  • High lead levels (from lead-based paint or gasoline)
  • Food additives and sugar consumption might exacerbate ADHD symptoms

Look-Alike/Sound-Alike Drugs

  • Adderall® and Inderal®
  • Ritalin®, Ritalin® SR

Treatment of ADHD

  • No cure, only treatment of symptoms with pharmacotherapy and behavioral therapy is possible
  • Drug treatment can involve amphetamines and non-amphetamines.
  • Amphetamines affect individuals with ADHD differently than people without ADHD. They decrease hyperactivity and improve focus

Drugs Used in the Treatment of ADHD

  • Adderall (mixed salts of amphetamine)
  • Dexedrine (dextroamphetamine)
  • Focalin (dexmethylphenidate)
  • Biphentin/Concerta/Ritalin (methylphenidate)
  • Vyvanse (lisdexamfetamine)
  • Atomoxetine (Strattera): non-amphetamines stimulant and inhibits the reuptake of norepinephrine

MOA of Amphetamines

  • Stimulates the release of norepinephrine and dopamine
  • Increases stimulation of adrenergic receptors (resulting in increased alertness and responsiveness, and wakefulness)
  • Decreases feelings of tiredness or fatigue

Adverse Effects of Amphetamines

  • Decreased appetite, nausea, stomach ache, anxiety, irritability, insomnia, increased heart rate, palpitations, arrhythmia, dizziness, tremor, and amphetamine syndrome (a drug-induced psychosis).

Warning Labels for Amphetamines

  • Take with food
  • Can be habit-forming
  • Swallow whole; crushed/chewed formulations may be dangerous

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