Top 200: Sleep/Ocular/Autoimmune
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Why do we need sleep?
- Necessary for survival
- Allow body to repair itself
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
What are the 5 stages of the sleep cycle?
- Stage 1
- Stage 2
- Stage 3
- Stage 4
- Rapid Eye Movement (REM)
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
What happens in stage 1 of the sleep cycle?
- light sleep
- awake easily
- eye movement slows
What happens in stage 2 of the sleep cycle?
- eye movement stops
- slower brain waves
What happens in stage 3 of the sleep cycle?
- no eye movement
- slower brain waves
What happens in stage 4 of the sleep cycle?
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
What affects sleep?
Recall that neurotransmitters regulate sleep. Therefore, the following can mess with neurotransmitters, and therefore sleep:
- smoking (nicotine withdrawal)
- temperature (being too hot or too cold)
In what stage of sleep do you lose the ability to regulate temperature?
REM stage of sleep
How much sleep does the average person need?
7 to 8 hours
For women, in what circumstance might they need more sleep?
Pregnancy: in the first trimester
What are some consequences of getting too little sleep?
- can accumulate sleep-debt (overdrawn)
- impaired hand-eye coordination
- lack of concentration
- inability to function
What are some common sleep disorders?
- obstructive sleep apnea (OSA)
- restless leg syndrome
What is Obstructive Sleep Apnea (OSA)?
A potentially serious sleep disorder in which breathing repeatedly stops and starts
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
What are some Obstructive Sleep Apnea (OSA) risk factors?
- size of neck circumference
- malenarrow airway
- > 65 years of age
- using alcohol or smoking
What are treatment options for Obstructive Sleep Apnea (OSA)?
- positional therapy
- weight loss
- avoid alcohol
- continuous positive airway pressure (CPAP)
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
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
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
What are the symptoms of insomnia?
- difficulty falling asleep
- waking during sleep
- early-morning awakenings
- produces impairment in next day's activities
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
What are the drug classes used to treat sleep disorders?
- GABAergic sedatives (non-benzodiazepines)Zolpidem (CR) (Ambien) (CR)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- BenzodiazepinesLorazepam (Ativan)Clonazepam (Klonopin)Alprazolam (Xanax)Diazepam (Valium)Chlordiazepoxide (Librium)Temazepam (Restoril)AntihistaminesDiphenhydramine (Benadryl)Doxylamine (Unisom)
- AntidepressantsTricyclic antidepressants (amitriptyline, doxepin)
- Melatonin OTC
- Rozerem = Ramelteon
What is a disadvantage of using antihistamines as sleep aids?
They may cause next day drowsiness.
Which neurotransmitter do the benzodiazepines affect?
- Non-benzodiazepine hypnotic
- rapid absorption from the GI tract
- short elimination half life
- onset of action = 30 minutes
- take immediately before bedtime
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
In whom does pink eye most often occur?
common in children, but can occur at any age
What are the causes of pink eye?
- allergy-provoking agents
- toxic agents
- underlying diseases
What are the symptoms of pink eye?
- watery eyes
- usually starts with one eye and can spread
- infectious and contagious
What are pharmacologic treatment options for pink eye?
- ciprofloxacin (Ciloxan)
- moxifloxacin (Vigamox)
- gatifloxacin (Zymar)
- tobramycin with dexamethasone (TobraDex)
- olopatadine (Patanol)
What is glaucoma?
increased intraocular pressure
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)
What are the two types of glaucoma?
Which type of glaucoma is an emergency?
closed angle glaucoma is an emergency
Patient Perspective of Glaucoma
What are the ophthalmic drop drug classes used to treat glaucoma?
- Alpha Agonists
- Prostaglandin Analogs
- Cholinesterase Inhibitors
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
What is the purpose of the immune system in the body?
- Immune system protects from:
- foreign blood or tissue
- differentiates body from "self" vs. "non-self"
What destroys what in the immune system?
Antibodies destroy antigens in the immune system.
What is an autoimmune disorder?
When the body mistakenly attacks itself via the immune system.
What are some autoimmune disorders?
- Addison's disease
- Type 1 diabetes
- Multiple Sclerosis (MS)
- Grave's disease
- Celiac disease
- Pernicious anemia
- Rheumatoid arthritis
- Crohn's disease
What are the goals of treatment in autoimmune disorders?
- decrease symptoms
- control the process
- reduce the immune response
What are the pharmacologic treatment options for autoimmune disorders?
- Immunosuppressant medications
What are the strongest drugs available to decrease inflammation?
corticosteroids: they decrease the body's ability to fight infection
What are the sub-types of corticosteroids?
Which corticosteroids are common in creams and ointments?
Which corticosteroid is long acting?
Where other disease state are corticosteroids used for besides autoimmune disorders?
Which corticosteroids have tapered doses?
- prednisone: Sterapred Packs
- methylprednisolone: Medrol DosePak
What are patient counseling points for corticosteroids?
- do not discontinue abruptly
- take with food
- many side effects
- used as chemotherapy
- sometimes paired with leucovorin
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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