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Why do we need sleep?
- Necessary for survival
- Allow body to repair itself
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How is sleep controlled?
Sleep is controlled via neurotransmitters:
Serotonin and Norepinephrine: keep parts of the brain active while we are asleep
Adenosine: builds up while awake and then is broken down while we are asleep; causes drowsiness
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What are the 5 stages of the sleep cycle?
- Stage 1
- Stage 2
- Stage 3
- Stage 4
- Rapid Eye Movement (REM)
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How do sleep cycles work?
- Go through an entire cycle (stage 1 through REM), and then repeat.
- 50% of sleep in stage 2
- 20% of sleep in REM
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What happens in stage 1 of the sleep cycle?
- light sleep
- awake easily
- eye movement slows
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What happens in stage 2 of the sleep cycle?
- eye movement stops
- slower brain waves
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What happens in stage 3 of the sleep cycle?
- no eye movement
- slower brain waves
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What happens in stage 4 of the sleep cycle?
DEEP sleep
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What happens in REM of the sleep cycle?
- breathing is rapid and shallow
- eyes jerk
- limbs paralyzed
- HR/BP increased
- lose ability to regulate temperature
- male erections
- dreams
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What affects sleep?
Recall that neurotransmitters regulate sleep. Therefore, the following can mess with neurotransmitters, and therefore sleep:
- caffeine
- antidepressants
- smoking (nicotine withdrawal)
- alcohol
- temperature (being too hot or too cold)
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In what stage of sleep do you lose the ability to regulate temperature?
REM stage of sleep
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How much sleep does the average person need?
7 to 8 hours
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For women, in what circumstance might they need more sleep?
Pregnancy: in the first trimester
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What are some consequences of getting too little sleep?
- can accumulate sleep-debt (overdrawn)
- impaired hand-eye coordination
- hallucinations
- lack of concentration
- inability to function
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What are some common sleep disorders?
- insomnia
- obstructive sleep apnea (OSA)
- restless leg syndrome
- narcolepsy
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What is Obstructive Sleep Apnea (OSA)?
A potentially serious sleep disorder in which breathing repeatedly stops and starts.
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What are symptoms of Obstructive Sleep Apnea (OSA)?
- excessive daytime sleepiness
- loud snoring
- observed episodes of breathing cessation during sleep
- abrupt awakenings accompanied by shortness of breath
- awakening with a dry mouth or sore throat
- morning headache
- difficulty staying asleep
- uncontrollable hypertension
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What are some Obstructive Sleep Apnea (OSA) risk factors?
- overweight
- size of neck circumference
- hypertension
- malenarrow airway
- > 65 years of age
- using alcohol or smoking
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What are treatment options for Obstructive Sleep Apnea (OSA)?
- positional therapy
- weight loss
- avoid alcohol
- surgery
- continuous positive airway pressure (CPAP)
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What is CPAP?
CPAP = Continuous Positive Airway Pressure
CPAP gently blows pressurized room air through the patient's airway at a high enough pressure to keep the throat open
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How are sleep disorders diagnosed?
Sleep orders can be diagnosed through a sleep study machine, or a polysomnogram, which records brain waves and body activity during sleep so that sleep disorders can be diagnosed and treated.
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What is the prevalence of insomnia by numbers? by gender?
- ~ 60 million Americans a year have insomnia frequently or for extended periods of time
- insomnia increases with age
- ~40% of women
- ~30% of men
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What are the symptoms of insomnia?
- difficulty falling asleep
- waking during sleep
- early-morning awakenings
- produces impairment in next day's activities
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What are "sleep hygeine" tips, or in other words, tips for a good night's sleep?
- set a night-time schedule
- avoid day time naps
- exercise during the day
- avoid caffeine, nicotine and alcohol
- relax before bed
- sleep until sunlight
- do not lie in bed awake
- control your room temperature
- see a doctor if your sleeping problem continues
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What are the drug classes used to treat sleep disorders?
- GABAergic sedatives (non-benzodiazepines)Zolpidem (CR) (Ambien) (CR)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Benzodiazepines
Lorazepam (Ativan)Clonazepam (Klonopin)Alprazolam (Xanax)Diazepam (Valium)Chlordiazepoxide (Librium)Temazepam (Restoril)AntihistaminesDiphenhydramine (Benadryl)Doxylamine (Unisom)- Antidepressants
Tricyclic antidepressants (amitriptyline, doxepin)- Mirtazapine
- Trazadone
- Melatonin
- Melatonin OTC
- Rozerem = Ramelteon
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What is a disadvantage of using antihistamines as sleep aids?
They may cause next day drowsiness.
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Which neurotransmitter do the benzodiazepines affect?
GABA
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Zolpidem (Ambien)
- Non-benzodiazepine hypnotic
- rapid absorption from the GI tract
- short elimination half life
- onset of action = 30 minutes
- take immediately before bedtime
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What is pink eye (conjunctivitis)?
redness or irritation of the membranes on the inner part of the eyelids and the membranes (conjunctiva) covering the whites of the eyes
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In whom does pink eye most often occur?
common in children, but can occur at any age
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What are the causes of pink eye?
- bacteria
- viruses
- allergy-provoking agents
- irritants
- toxic agents
- underlying diseases
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What are the symptoms of pink eye?
- watery eyes
- discharge
- irritation
- usually starts with one eye and can spread
- infectious and contagious
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What are pharmacologic treatment options for pink eye?
- Bacterial
- ciprofloxacin (Ciloxan)
- moxifloxacin (Vigamox)
- gatifloxacin (Zymar)
- tobramycin with dexamethasone (TobraDex)
- Allergy
- olopatadine (Patanol)
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What is glaucoma?
increased intraocular pressure
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What are the symptoms of glaucoma?
- there may be no symptoms (half of the people affected by glaucoma don't know they have it)
- damage loss may occur due to damage to the optic nerve (may steal sight without warning)
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What are the two types of glaucoma?
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Which type of glaucoma is an emergency?
closed angle glaucoma is an emergency
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Patient Perspective of Glaucoma
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What are the ophthalmic drop drug classes used to treat glaucoma?
- Beta-Blockers
- Adrenergics
- Cholinergics
- Alpha Agonists
- Prostaglandin Analogs
- Cholinesterase Inhibitors
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How do you counsel a patient on self-administering eye drops?
- wash hands
- do not touch tip of applicator to eye
- pull down lower lid to form a pocket
- tilt head back
- insert drops into one eye, waiting one minute between drops
- close eye
- press finger against inside corner of eye next to nose
- wait 10-15 minutes between types of eye drops
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What is the purpose of the immune system in the body?
- Immune system protects from:
- cancers
- foreign blood or tissue
- toxins
- differentiates body from "self" vs. "non-self"
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What destroys what in the immune system?
Antibodies destroy antigens in the immune system.
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What is an autoimmune disorder?
When the body mistakenly attacks itself via the immune system.
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What are some autoimmune disorders?
- Addison's disease
- Type 1 diabetes
- Lupus
- Multiple Sclerosis (MS)
- Grave's disease
- Celiac disease
- Pernicious anemia
- Rheumatoid arthritis
- Crohn's disease
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What are the goals of treatment in autoimmune disorders?
- decrease symptoms
- control the process
- reduce the immune response
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What are the pharmacologic treatment options for autoimmune disorders?
- Corticosteroids
- Prednisone
- Dexamethasone
- Triamcinolone
- Methylprednisolone
- Betamethasone
- Beclomethasone
- Flunisolide
- Fluticasone
- Hydrocortisone
- Immunosuppressant medications
- Azathioprine
- Cyclophosphamide
- Cyclosporine
- Methotrexate
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What are the strongest drugs available to decrease inflammation?
corticosteroids: they decrease the body's ability to fight infection
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What are the sub-types of corticosteroids?
- glucocorticoids
- mineralcorticoids
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Which corticosteroids are common in creams and ointments?
- triamcinolone
- hydrocortisone
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Which corticosteroid is long acting?
dexamethasone
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Where other disease state are corticosteroids used for besides autoimmune disorders?
asthma
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Which corticosteroids have tapered doses?
- prednisone: Sterapred Packs
- methylprednisolone: Medrol DosePak
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What are patient counseling points for corticosteroids?
- do not discontinue abruptly
- take with food
- many side effects
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Methotrexate
- immunosuppressant
- used as chemotherapy
- sometimes paired with leucovorin
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Drug List: Brand-Generic
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Latanoprost (Xalatan)
- Travoprost (Travatan)
- Brimonidine Tartrate (Alphagan P)
- Moxifloxacin HCl (Vigamox)
- Gatifloxacin (Zymar)
- Olopatadine (Patanol, Pataday)
- Methylprednisolone (Medrol)
- Sterapred/Deltasone (Prednisone)
- Dexamethasone (Decadron)
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