Nursing Practice: Insomnia and Sedatives
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Questions and Answers

What should the NP monitor for in patients taking non-stiumulant or Z-drugs?

  • Suicidal ideation (correct)
  • Sleep quality
  • Dependence
  • Next-day drowsiness

    • Which drug class is not considered 1st line treatment for insomnia due to its potential for misuse?

  • Antihistamines
  • Melatonin
  • Z-drugs
  • Benzodiazepines (correct)

    • All of the following are other risk factors for ADHD EXCEPT?

  • Inconsistent parenting practice
  • Phychosocial stress
  • Adverse childhood environment
  • Multiple siblings (correct)

    • Why should extended-release (ER) formulas be avoided?

    <p>They increase the risk of next-day drowsiness</p> Signup and view all the answers

    What should be avoided in older adults when prescribing hypnotics?

    <p>All of the above</p> Signup and view all the answers

    What is recommended as an alternative to z-drugs in older adults?

    <p>Melatonin</p> Signup and view all the answers

    Why does Ritalin have a low risk for adverse effects?

    <p>Because it blocks DA &amp; NE NTMs</p> Signup and view all the answers

    All of the following meds block the reuptake of DA & NE because they are inhibitors EXCEPT?

    <p>Vyvanse</p> Signup and view all the answers

    All of the following coexisting conditions are common causes of insomnia EXCEPT?

    <p>COPD, bronchitis, sleep apnea</p> Signup and view all the answers

    What percentage of clients with major depressive disorder have insomnia?

    <p>60-90%</p> Signup and view all the answers

    What medication is more potent than Ritalin?

    <p>Dexmehtylphenidate (Focalin)</p> Signup and view all the answers

    What type of medication is Ropinirole (Requip)?

    <p>Dopamine receptor agonist</p> Signup and view all the answers

    What is primary insomnia associated with?

    <p>None of the above</p> Signup and view all the answers

    What is the difference between primary insomnia and psychiatric insomnia?

    <p>Primary insomnia is not associated with psychiatric conditions</p> Signup and view all the answers

    What stimulant should be avoided when an MAOI has been taken in the past 14 days?

    <p>Amphetamine (Adzenys)</p> Signup and view all the answers

    What stimulant is the most abused and diverted drug?

    <p>Dextroamphetamine (Adderall)</p> Signup and view all the answers

    What is the primary reason to prescribe Z-drugs for PRN use?

    <p>Due to the potential for abuse and dependence</p> Signup and view all the answers

    What is the effect of higher doses or extended use sleep meds on next-day drowsiness?

    <p>It increases the risk</p> Signup and view all the answers

    What are the potential adverse effects of Z-drug medication?

    <p>All of the above</p> Signup and view all the answers

    What is the proportion of clients older than 65 years who have persistent insomnia?

    <p>1/3</p> Signup and view all the answers

    What are common characteristics of insomnia according to the American Psychiatric Association?

    <p>all of the above</p> Signup and view all the answers

    What stimulant is least abused or diverted and is considered a prodrug?

    <p>Lisdexamfetamine (Vyvanse)</p> Signup and view all the answers

    What is a common trigger for insomnia?

    <p>Acute stress</p> Signup and view all the answers

    What is the proportion of adults who experience chronic insomnia?

    <p>10%</p> Signup and view all the answers

    Which type of firing is associated with reward, feeling of euphoria, and abuse potential?

    <p>Phasic firing</p> Signup and view all the answers

    What type of stimulants have a higher risk of abuse due to it's effect of rapidly increasing phasic firing of DA &NE?

    <p>Immediate-release stimulants</p> Signup and view all the answers

    What is the effect of extended-release formulations on NE and DA signals that leads to gradual & sustained increases?

    <p>They amplify tonic firing</p> Signup and view all the answers

    What is the mechanism by which extended-release formulations reduce abuse potential?

    <p>By occupying the NE transporter in the prefrontal cortex that enhances tonic firing</p> Signup and view all the answers

    Why does atomoxetine lack abuse potential?

    <p>It increases DA levels in the PFC, but not in the nucleus accumbens</p> Signup and view all the answers

    What non-stimulant enhances precordial function to improve mental focus?

    <p>Clonidine</p> Signup and view all the answers

    Bupropion (Wellbutrin) is considered?

    <p>DA-NE reuptake inhibitor</p> Signup and view all the answers

    What non-stimulant is best for patients with concurrent depression and tobacco abuse?

    <p>Bupropion (Wellbutrin)</p> Signup and view all the answers

    Which medication is a first-line agent for treating Restless Leg Syndrome (RLS)?

    <p>Ropinirole (Requip)</p> Signup and view all the answers

    What is the location of the 'on switch' in the brain?

    <p>Tuberomammillary nucleus (TMN)</p> Signup and view all the answers

    What is the function of Guanfacine?

    <p>Alpha 2 agonist NE inhibitor (non-stimulant)</p> Signup and view all the answers

    What is the effect of Methylphenidate on neurotransmitters?

    <p>Blocks DAT and NET</p> Signup and view all the answers

    What is the main difference between ADHD symptoms in children and adults?

    <p>Children present with hyperactivity, while adults report internal restlessness &amp; difficulty sitting still</p> Signup and view all the answers

    What is the function of Melatonin and melatonin receptor agonists?

    <p>They are effective hypnotics for sleep onset</p> Signup and view all the answers

    Which brain region is responsible for modulating impulsivity?

    <p>Orbitofrontal cortex and dorsal anterior cingulate cortex</p> Signup and view all the answers

    What part of the brain is associated with hyperactivity in ADHD?

    <p>Prefrontal cortex</p> Signup and view all the answers

    What is a characteristic of non-stimulant medications?

    <p>They are effective for the long-term treatment of comorbid anxiety, depression, or substance abuse because it has no potential for abuse or diversion</p> Signup and view all the answers

    All of the following are reasons why non-stimulant medications be used?

    <p>When clients response to stimulants alone</p> Signup and view all the answers

    What should be monitored when taking non-stimulant drugs?

    <p>All of the above</p> Signup and view all the answers

    What is a contraindication for concurrent use of non-stimulants?

    <p>All of the above</p> Signup and view all the answers

    What may non-stimulant medications exacerbate in clients with a history of the disorder?

    <p>Depression</p> Signup and view all the answers

    What is a characteristic of non-stimulant medications in terms of effectiveness?

    <p>They take longer to achieve desired effects than stimulants</p> Signup and view all the answers

    Why is withdrawal from non-stimulant medications tapered?

    <p>To prevent rebound hypertension and neurological side effects</p> Signup and view all the answers

    What is a significant cause of societal morbidity, lost productivity, and reduced quality of life?

    <p>Disruption of healthy sleep</p> Signup and view all the answers

    What is the recommended approach when using z-drugs?

    <p>Use them for the shortest duration possible</p> Signup and view all the answers

    This part of the brain contains the "off" switch

    <p>Ventrolateral preoptic nucleus</p> Signup and view all the answers

    All of the following are sedating antidepressants EXCEPT?

    <p>Trazadone</p> Signup and view all the answers

    Z-drugs are considered what schedule controlled substance?

    <p>IV</p> Signup and view all the answers

    Restless Leg Syndrome (RLS) is idiopathic and associated with which of the following conditions

    <p>All of the above</p> Signup and view all the answers

    Why should z-drugs be avoided in clients with dementia?

    <p>Because they can cause falls &amp; cognitive impairment</p> Signup and view all the answers

    What is considered a psychiatric 'vital sign'?

    <p>Sleep</p> Signup and view all the answers

    All of the following are BZOs EXCEPT?

    <p>Clonidine</p> Signup and view all the answers

    What is the function of dual orexin receptor antagonists (DORA)?

    <p>Regulating arousal, wakefulness, and appetite</p> Signup and view all the answers

    What is the effect of Valarian root on other sleep medications?

    <p>It increases the effects of other sleep medications (e.g, alcohol, BZOs, &amp; narcotics)</p> Signup and view all the answers

    What is the function of Ramelteon?

    <p>Prescription melatonin receptor 1 &amp; 2 agonist, produced by the pineal gland in response to darkness to help regulate sleep-wake cycle</p> Signup and view all the answers

    Daytime NTMs include all of the following EXCEPT?

    <p>GABA &amp; Melatonin</p> Signup and view all the answers

    Why should Suvorexant be decreased when combined with CYP 450 inhibitors such as diltiazem, erythromycin, & ketoconazole?

    <p>Because it can lead to increased sedation and next-day drowsiness</p> Signup and view all the answers

    What is the mechanism of action of Z drugs?

    <p>Producing a calming effect by binding to GABA receptors</p> Signup and view all the answers

    When prescribing non-stimulants it is important to pay special attention to what parts of the clients history?

    <p>All of the above</p> Signup and view all the answers

    Beers criteria includes all of the following

    <p>Avoid prescribing medication at night to prevent falls</p> Signup and view all the answers

    alking excessively, blurting out answers in class, & not waiting thier turn are all examples of which ADHD symptoms?

    <p>Impulsivity</p> Signup and view all the answers

    What medication is recommended to control irritability and help with sleep if taken at bedtime?

    <p>Guanfacine</p> Signup and view all the answers

    Not listening & making careless mistakes is an example of what ADHD symptoms?

    <p>Selective attention</p> Signup and view all the answers

    Inability to find the motivation to complete his homework or pay attention in class is an example of what ADHD symptoms?

    <p>sustained attention</p> Signup and view all the answers

    What is the recommended 1st step to increasing the dose of methylphenidate from 5 mg q day?

    <p>Consider a second dose after lunch if appetite is affected</p> Signup and view all the answers

    running & climbing on the chairs & desks, trouble playing quietly, & refusing to stay in seat are examples of what ADHD symptoms?

    <p>Hyperactivity</p> Signup and view all the answers

    Inhibiting NE NTM in the PFC increases what?

    <p>Both</p> Signup and view all the answers

    Benadryl can cause anticholinergic effects due to the _________ ________.

    <p>muscarinic antagonism</p> Signup and view all the answers

    What is the primary reason for treating alcohol abuse before treating ADHD and anxiety disorders?

    <p>To address the highest degree of impairment</p> Signup and view all the answers

    What is the effect of pulsed stimulation on dopamine and norepinephrine firing?

    <p>Pulsatile stimulation amplifies undesirable phasic DA &amp; NE firing, which can lead to euphoria and abuse</p> Signup and view all the answers

    All of the following medications are good alternatives for sleep in pt.s with insomnia EXCEPT?

    <p>Exercise for 30 min before sleep</p> Signup and view all the answers

    Which brain region is involved in the reward center of the brain?

    <p>Nucleus accumbens</p> Signup and view all the answers

    Amitriptyline is an acceptable sleep medication not typically used first line due to risk for falls. It is classified as?

    <p>Tricyclic antidepressant</p> Signup and view all the answers

    All of the following should be monitored when RLS is suspected EXCEPT?

    <p>CBC</p> Signup and view all the answers

    Which medication is a DA-NR reuptake inhibitor?

    <p>Amphetamine</p> Signup and view all the answers

    Wellbutrin is a _______________?

    <p>DA reuptake inhibitor</p> Signup and view all the answers

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