2 Written Questions

1. avoid alcohol, caffeine, and nocotine especially at or near bedtime, daytime napping, exercising late in the day, and the use of an alarm clock in the bedroom
   
   Maintain a regular sleep wake cycle, implementing an exerrcise routine, creating a comfortable sleep env, creating a relaxing routine before bedtime, and using the bedroom only for sleep.
2. Histamine antagonist
   OTC
   Antidepressants
   TCA (amitriptyline and doxepine), mirtazapine, and trazodone
   
   Melatonin receptor agonist
   Rozerem (ramelton) RX only
   
   Melatonin
   
   Nature supplement (not FDA regulated)
   used for insomnia, jet-lag, tinnitus
   Appears to re-set the body to the environmental clock and allows patients to normalize physiologic and behavioral sleep patterns

2 Multiple Choice Questions

1. affects about 50% of US pop at some point during lifetime
   
   3 components of DX
   difficultiy initiating or maintaining sleep and/or experiencing nonrestorative sleep
   associated distress or impairment in areas of life functioning
   
   having an adequate opportunity to obtain sleep
   1. Insomnia
   2. Pharmacologic Treatment
   3. Types of Insomnia
   4. Nonpharmacologic TX
2. Primary:
   sleep distrubance that occurs in the abscnce of a medical or psychiatric condition, a drug or sustance or poor sleep hygiene
   
   Secondary:
   result of an emotional, neurologic or other medical disorder or condition
   restless leg syndrome
   heart failure
   depression
   anxiety
   BPH
   PSE, methylphenidate, BB's (propranolol, metoprololo) Prednisone
   1. Nonpharmacologic TX
   2. Types of Insomnia
   3. Pharmacologic TX cont.
   4. Insomnia

1 True/False Question

1. Pharmacologic TX cont. → GABA agonist
   Bind to GABA receptor complex sites, leading to enhancement of GABA activity in the CNS
   
   Benzodiazepines
   dalmane (flurazepam) Restoril (temazepam), Halcion (Triazoloam)
   
   Long acting vs. short acting
   Long acting-PB, flurazepam
   Short acting-chloral hydrate, zolpidem, zaleplon
   no alcohol while on CNS drugs
   Take on an as needed basis
   
   Nonbenzodiazepines
   "Z" drugs
   Ambien (Zolidem), Lunesta (Eszopiclone), Sonata (Zaleplon)

   True        False