Podcast
Questions and Answers
What characterizes Stage 1 of sleep?
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?
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?
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?
Which factor is associated with contributing to sleep deficiency?
What device is used as a non-pharmacologic measure for sleep apnea?
What device is used as a non-pharmacologic measure for sleep apnea?
What is the primary external cue that influences circadian rhythms?
What is the primary external cue that influences circadian rhythms?
Which of the following is a function of sleep?
Which of the following is a function of sleep?
Which neurotransmitter is known to induce sleepiness?
Which neurotransmitter is known to induce sleepiness?
What is the term for sleep cycles characterized by rapid eye movements?
What is the term for sleep cycles characterized by rapid eye movements?
What is rebound hypersomnia?
What is rebound hypersomnia?
Which of the following symptoms is commonly associated with sleep deprivation?
Which of the following symptoms is commonly associated with sleep deprivation?
What type of medication is typically used to treat insomnia?
What type of medication is typically used to treat insomnia?
Which of the following is NOT a reason why sleep is deemed necessary?
Which of the following is NOT a reason why sleep is deemed necessary?
What is the defining characteristic of long-term insomnia?
What is the defining characteristic of long-term insomnia?
Which of the following medications is an example of a benzodiazepine used to treat insomnia?
Which of the following medications is an example of a benzodiazepine used to treat insomnia?
Which of the following statements about insomnia is incorrect?
Which of the following statements about insomnia is incorrect?
What is the primary mechanism of action for imidazopyridines and cyclopyrrolone derivatives?
What is the primary mechanism of action for imidazopyridines and cyclopyrrolone derivatives?
Which drug is classified as an OTC option for short-term relief of insomnia?
Which drug is classified as an OTC option for short-term relief of insomnia?
Benzodiazepines used for insomnia have what notable safety characteristic compared to barbiturates?
Benzodiazepines used for insomnia have what notable safety characteristic compared to barbiturates?
Which of the following sleep disorders is characterized by sudden episodes of falling asleep?
Which of the following sleep disorders is characterized by sudden episodes of falling asleep?
What class of medications generally has the suffixes '-epam' and '-olam'?
What class of medications generally has the suffixes '-epam' and '-olam'?
What is the primary mechanism of action believed to be utilized by modafinil and armodafinil?
What is the primary mechanism of action believed to be utilized by modafinil and armodafinil?
Which of the following is NOT listed as an adverse effect of modafinil?
Which of the following is NOT listed as an adverse effect of modafinil?
Which of the following factors is considered an environmental risk factor for ADHD?
Which of the following factors is considered an environmental risk factor for ADHD?
What is one of the warning labels associated with modafinil?
What is one of the warning labels associated with modafinil?
Which subtype of ADHD is characterized primarily by impulsiveness and hyperactivity?
Which subtype of ADHD is characterized primarily by impulsiveness and hyperactivity?
In how many subtypes is ADHD classified?
In how many subtypes is ADHD classified?
Which of the following is a commonly held misconception regarding the etiology of ADHD?
Which of the following is a commonly held misconception regarding the etiology of ADHD?
Which of these substances during pregnancy has been implicated as a risk factor for ADHD?
Which of these substances during pregnancy has been implicated as a risk factor for ADHD?
What is the primary purpose of pharmacotherapy in ADHD treatment?
What is the primary purpose of pharmacotherapy in ADHD treatment?
Which of the following is a characteristic of amphetamines when treating ADHD?
Which of the following is a characteristic of amphetamines when treating ADHD?
What mechanism of action do amphetamines NOT utilize in ADHD treatment?
What mechanism of action do amphetamines NOT utilize in ADHD treatment?
Which of the following drugs is a nonamphetamine stimulant used for ADHD?
Which of the following drugs is a nonamphetamine stimulant used for ADHD?
What is a common adverse effect associated with the use of stimulant medications for ADHD?
What is a common adverse effect associated with the use of stimulant medications for ADHD?
What important warning label is associated with stimulant medications for ADHD?
What important warning label is associated with stimulant medications for ADHD?
Which of the following statements about guanfacine (Intuniv XR®) is true regarding its use in ADHD?
Which of the following statements about guanfacine (Intuniv XR®) is true regarding its use in ADHD?
What notable effect do amphetamines have in individuals with ADHD?
What notable effect do amphetamines have in individuals with ADHD?
What is one of the adverse effects specifically associated with zaleplon?
What is one of the adverse effects specifically associated with zaleplon?
Which herb is known to help with sleep and has been used for over 2000 years?
Which herb is known to help with sleep and has been used for over 2000 years?
What should be avoided close to bedtime to help treat insomnia?
What should be avoided close to bedtime to help treat insomnia?
How long should daily exercise be performed to help with insomnia?
How long should daily exercise be performed to help with insomnia?
What is a common warning about benzodiazepines?
What is a common warning about benzodiazepines?
Which stimulant is used to treat narcolepsy and is classified as a nonamphetamine?
Which stimulant is used to treat narcolepsy and is classified as a nonamphetamine?
What is a recommended action if you cannot fall asleep within a certain time after going to bed?
What is a recommended action if you cannot fall asleep within a certain time after going to bed?
Which of the following is NOT an adverse effect of imidazopyridines and cyclopyrrolone derivatives?
Which of the following is NOT an adverse effect of imidazopyridines and cyclopyrrolone derivatives?
Flashcards
Sleep's Importance
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
Sleep Cycle Influence
Circadian rhythms, influenced by sunlight, affect the sleep cycle.
Melatonin's Role
Melatonin's Role
Melatonin, a hormone from the pineal gland, regulates sleepiness and body functions; the pineal gland uses sunlight
Hypnotic
Hypnotic
A drug that promotes sleep.
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Insomnia
Insomnia
Difficulty falling asleep or staying asleep.
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Non-REM Sleep
Non-REM Sleep
A stage of sleep that occurs before REM sleep.
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REM Sleep
REM Sleep
The stage of sleep associated with dreaming.
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Sleep Disorders
Sleep Disorders
Medical conditions affecting the sleep cycle and quality.
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Deep Sleep Stages
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
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
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
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?
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
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
Ropinirole & Pramipexole
Medications used to treat Restless Legs Syndrome.
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Narcolepsy
Narcolepsy
A sleep disorder characterized by excessive daytime sleepiness and sudden attacks of sleep.
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Transient Insomnia
Transient Insomnia
Insomnia that lasts less than 7 days.
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Short-Term Insomnia
Short-Term Insomnia
Insomnia that lasts up to 3 weeks.
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Long-Term Insomnia
Long-Term Insomnia
Insomnia that lasts longer than 3 weeks.
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Modafinil's MOA
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
Amphetamine & Methylphenidate
These stimulants are classified as sympathomimetics and are used to treat narcolepsy.
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Modafinil: Adverse Effects
Modafinil: Adverse Effects
Common side effects of modafinil include stimulation, insomnia, tolerance, and dependence.
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Modafinil: Warning Labels
Modafinil: Warning Labels
Important warnings include avoiding alcohol, potential decrease in oral contraceptive effectiveness, and habit formation.
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ADHD Etiology
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
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
ADHD Symptoms
Common ADHD symptoms include: hyperactivity, impulsiveness, inattention, and difficulty focusing.
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ADHD Subtypes
ADHD Subtypes
ADHD is classified into three subtypes: hyperactive-impulsive, predominantly inattentive, and combined type.
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ADHD treatment
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 for ADHD
Amphetamines like Adderall® decrease hyperactivity and improve focus in people with ADHD.
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Non-amphetamine stimulant
Non-amphetamine stimulant
Atomoxetine (Strattera®) is a non-amphetamine stimulant that helps ADHD by inhibiting norepinephrine reuptake.
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Amphetamine MOA
Amphetamine MOA
Amphetamines have three actions: release norepinephrine, block monoamine oxidase, and release dopamine.
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Norepinephrine effects
Norepinephrine effects
Increased norepinephrine stimulation leads to alertness, responsiveness, wakefulness, and reduced fatigue.
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Guanfacine for ADHD
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
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
Amphetamine syndrome
This is a drug-induced psychosis caused by amphetamine use.
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Imidazopyridines & Cyclopyrrolone Derivatives
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
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
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
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
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
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®)
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: 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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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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