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What neurotransmitters control sleep? How?
- Serotonin and Norepinephrine
- Keep parts of the brain active while we are asleep
- Adenosine
- Builds up while we are awake and causes drowsiness, broken down while we are asleep
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How many sleep stages exist?
5 (1-4 and REM)
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50% of our sleep is spent in what stage?
Stage 2
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20% of our sleep is spent in what stage?
REM
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What stage: light sleep, awaken easily, eye movement slows?
Stage 1
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In what stage does eye movement stop and the brain waves are slower?
Stage 2
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In what stage is there no eye movement and brain waves continue to slower?
Stage 3
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What stage is considered "deep" sleep?
Stage 4
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Describe the REM stage.
- Breathing rapid/shallow
- Eyes jerk
- Limbs paralyzed
- HR/BP increased
- Male erections
- Dreams
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What are some things that affect sleep?
- Caffeine
- Antidepressants
- Smoking
- Alcohol
- Too hot/cold
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When do women need more sleep?
In the first trimester of pregnancy.
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How many hours of sleep does an average person get?
7-8 hours
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What are some symptoms of too little sleep?
- Hand/eye coordination impairment
- Hallucinations
- Lack of concentration
- Unable to function
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What are 4 types of sleep disorders?
- Insomnia
- Obstructive Sleep Apnea (OSA)
- Restless Legs Syndrome
- Narcolepsy
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What percentage of women have insomnia? Men?
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What is a factor that increases the chances of insomnia?
Increase in age
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What are symptoms of insomnia disorders?
- Difficulty falling asleep
- Waking during sleep
- Early-morning awakenings
- Produces impairment in next-day activities
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What are some tips for a goodnight sleep?
Set a night-time schedule, avoid naps, exercise during the day, relax before bed, sleep until sunlight, don't lie in bed awake, control room temp
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What are 3 Nonbenzodiazepine GABAergic Sedatives?
- Ambien (CR)
- Lunesta
- Sonata (Zaleplon)
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What are example classes of sleep medications?
- Nonbenzodiazepine GABAergic sedatives
- Benzodiazepines (reduce stages 3 and 4)
- Antihistamines
- Antidepressants: tricyclic antidepressants, Mirtazapine, Trazodone)
- Melatonin: Rozerem (Ramelteon)
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What class is Zolpidem?
Non-benzodiazepine hypnotic
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Is Zolpidem absorbed rapidly or slowly from the GI tract? What is the onset of action?When should it be taken?
- Rapid absorption and a short elimination half-life
- Onset of action = 30 minutes
- Take immediately before bedtime.
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What are the effects of benzodiazepines?
Affect GABA--> induces sleep
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What antihistamines are commonly used for a sleep aid? What is a side effect?
- Diphenhydramine, Doxylamine
- Next day drowsiness
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What is sleep apnea?
A serious sleep disorder in which breathing repeatedly stops and starts
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What are some symptoms of sleep apnea?
Excessive daytime sleepiness, loud snoring, observed episodes of breathing cessation during sleep, abrupt awakenings accompanied by SOB, waken with a dry mouth or sore throat, morning headache, difficulty staying asleep, uncontrollable hypertension
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What are risk factors for sleep apnea?
- Overweight
- Size of neck circumference
- Hypertension
- Narrow airway
- Male
- > 65 years of age
- Using alcohol or smoking
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What is a polysomnogram?
Sleep study for sleep apnea that records brain and body activity during sleep to help diagnose and treat sleep disorders
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What are treatment options for OSA?
- Positional therapy
- Weight loss
- Avoid alcohol
- Surgery
- CPAP
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What is conjunctivitis?
Redness or irritation of the membranes on the inner part of the eyelids and the membranes covering the whites of the eye.
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What are causes of pink eye?
- bacteria
- viruses
- allergy-provoking agents
- irritants
- toxic agents
- underlying diseases
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What are common symptoms of pink eye?
- watery eyes and discharge
- irritation
- usually starts with one eye and then spreads
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What treatment options are available for bacterial pink eye?
- Vigamox (Moxifloxacin)
- Zymar (Gatifloxacin)
- TobraDex (Tobramycin with Dexamethasone)
- Ciloxan (Ciprofloxacin)
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What treatment option is available for allergic pink eye?
Patanol (olopatadine)
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What are the two types of glaucoma?
- Open angle
- Closed angle (emergency)
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What causes glaucoma?
Damage to the optic nerve causes an increase in intraocular pressure which results in vision loss
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Are there always symptoms present for glaucoma?
No
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What type of ophthalmic drops are used in treating glaucoma?
- Beta-blockers
- Adrenergics
- Cholinergics
- Alpha Agonists
- Prostaglandin Analogs
- Cholinesterase Inhibitors
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Can eyedrops for glaucoma be used with contacts?
No--must be removed for 15 minutes
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List some of the autoimmune disorders.
- Addison's disease
- Type 1 diabetes
- Lupus
- MS
- Grave's disease
- Celiac disease
- Pernicious anemia
- Rheumatoid arthritis
- Chrohn's disease
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How do we treat autoimmune diseases?
- Decrease symptoms and control the process
- Reduce the immune response
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What are some common immunosuppressant medications?
- Azathioprine
- Cyclophosphamide
- Cylcosporine
- Methotrexate
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What are the strongest drugs available to reduce inflammation and decrease the body's ability to fight infection?
Corticosteroids
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How are corticosteroids often seen?
- Creams and ointments
- Asthma medications
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What are counseling points for corticosteroids?
- Tapered Dose
- Do not discontinue abruptly
- Take with food
- Many side effects
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Vigamox
- Moxifloxacin
- Conjunctivitis
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Zymar
- Gatifloxacin
- Conjunctivitis
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Medrol
- Methylprednisolone
- Autoimmune disorders
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Sterapred/Deltasone
- Prednisone
- Autoimmune disorders
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Decadron
- Dexamethasone
- Autoimmune disorders
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