Term
what are the 3 symptoms that at least 1 is needed for insomnia |
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Definition
difficulty initating sleep difficulty maintaing sleep early morning wake and cant return to sleep |
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Term
for insomnia sleep disturbances occur _ nights per week |
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Definition
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for insomnia, sleep problems had to be apparent for how mnay months |
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Definition
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Term
T/F- insomnia is where you have sleep problems when don't have adequate oppourtiny for sleep? |
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Definition
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Term
can you have insomnia if it occurs during another sleep disorder? |
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Definition
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Term
when is insomnia episodic |
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Definition
symptoms last 1 month but less than 3 |
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Term
when is insomnia persistent? |
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Definition
last longer than 3 months |
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Term
when is insomnia recurrent |
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Definition
two or more episodes wihtin 1 yr |
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Term
look at slide 4 for medicla causes of sleep distrubance |
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Definition
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Term
what are the psychiatric causes of sleep distrubrance-4 |
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Definition
anxiety depression bipolar alholol/substances |
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Term
what are some drugs that cause sleep disturbance? (look on pg 5 to see the rest) -4 |
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Definition
alcohol diuretics theophylline thyroid hormones |
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Term
for diagnosis of insomnia pt shoudl keep a? what other things are done?-2 |
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Definition
sleep log PE, psychiatric eval |
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Term
look on slide 5 for non pharm methods for insomnia- what are 4? |
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Definition
dont force sleep try to avoid naps exercise avoid lrg amnt of liuquids at bedtime |
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Term
majority of time use long/short term treatment for insomnia |
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Definition
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Term
the bad thing about many insomnia drugs is- |
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Definition
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Term
what are the 3 antidepressants for insomnia |
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Definition
trazadone, mirtzapine, TCAs |
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Term
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Definition
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Term
what is reccomendation for taking doxepin why? |
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Definition
dont take within 3 hrs of meal bc will delay and increase daytime sedation |
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Term
which antidepressant should be used in elderly? why? |
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Definition
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Term
whihc med is often used for antidepressant induced insomnia? |
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Definition
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Term
which class of meds is only used for episodic insomnia? |
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Definition
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Term
melatonin is useful for -2 |
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Definition
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Term
when is melatonin reccomended for insomnia? |
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Definition
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Term
which med as ER formulation can be used to help disct BDZ therapy |
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Definition
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Term
whihc med isnt approved by FDA? why? |
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Definition
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Term
whihc med class is only approved for short term use for insomnia? |
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Definition
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Term
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Definition
# of awakenings latency for sleep onset |
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Term
what are the most important things about BDZs-2 |
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Definition
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Term
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Definition
cns depression, tolerance, amnesia |
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Term
what 2 meds can cause complex sleep bhaviors-def? examples-3 |
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Definition
BZD, non BZD hypnotics dirivng, sex, eating |
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Term
meds that act on CYP _ cna affect BDZs |
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Definition
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Term
when on BDZ counsel pt to avoid- |
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Definition
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Term
for BDZs what do you do for elderly |
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Definition
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Term
contrainidcations for BDZs-4 |
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Definition
hepatic impair, sleep apnea, substance abus, preggo |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
what is the short acting BZD |
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Definition
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Term
what are the intermediate BZDs-2 |
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Definition
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Term
what are the long lasting BZDs |
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Definition
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Term
which non BZD hypnotic are approved just for short term use |
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Definition
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Term
which non BDZ hypnotic is approves for long and short term |
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Definition
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Term
tolerance and withdrawal for non BDZ hypnotics? |
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Definition
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Term
non BZDs are substrates of what CYP? |
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Definition
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Term
what do you avoid while on non BZD hypnotics |
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Definition
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Term
counsel pt when taking non BZD hyponitc- |
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Definition
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Term
how does ADEs and changing sleep structure compare for non BZDs |
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Definition
better ADEs, doesnt change structure |
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Term
what are contrainidcaitons for non BZD hypnotics-2 |
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Definition
hepatic impair, sleep apnea |
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Term
can you use non BZDs with preggos? |
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Definition
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Term
what is the only non BZD that just decreases latency and doesnt also increase sleep time? |
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Definition
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Term
on avg- are non BZDs quikc/long acting and how long is duration |
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Definition
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Term
non BZD hypnotics are what type of controlled substances- |
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Definition
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Term
ramelteon takes how long to see effects |
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Definition
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Term
what is the melatonin agonist? |
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Definition
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Term
ramelteon is metab by what? |
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Definition
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Term
counsel pt when taking ramelteon-2 |
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Definition
dont take with high fatty meal take 30 min before bedtime |
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Term
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Definition
daytime sedation, headache, increased prolactin |
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Term
can you use ramelteon for preggo? |
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Definition
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Term
with insomnia- what are the first 2 things to try |
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Definition
treat underlying porblem try non pharmacological |
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Term
what are the first line agents for insomnia?-2 |
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Definition
BZDs and non BZD hypnitcs |
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Term
what is 2nd line therapy for insomnia? |
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Definition
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Term
what is 3rd line therapy fr insomnia? |
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Definition
sedating antidepressants- can use earlier if pt has depression too |
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Term
what combination therapies are available?-2 when are they used? |
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Definition
BZd/non BZD + sedating antidepressant ramelteon + sedating antidepressant last |
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