Please see attachment for instructions. 

Unit 8 Medications for Sleep Disorders —2 Peer Response 600w. due 10-25-23

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

• Compare and contrast your initial posting with those of your peers.

• How are they similar or how are they different?

• What information can you add that would help support the responses of your peers?

• Ask your peers a question for clarification about their post.

• What most interests you about their responses?

Please be sure to validate your opinions and ideas with citations and references in APA format.

Ingrid A.

· There are multiple sleep disorders such as insomnia, sleep apnea, restless leg syndrome, hypersomnia, circadian rhythm disorders, and parasomnia which I think is “sleepwalking” or at least very similar to sleepwalking (Sleep Disorders, 2020).

Screening tools to diagnose sleep disorders can be just as gathering information from the patient, like history and physical. There are other screening tools such as actigraphy which is something like a watch the patient must wear and this tracks the movements the patient makes when sleeping and being awake (How is actigraphy used to evaluate sleep?, 2022)

Adding more we also have polysomnography also known as the “sleep study”, and this particular test records brain waves, oxygen level as well as heart rate (Polysomnography (Sleep Study) 2023). Epic (electronic health record) has something called the stop-bang questionnaire and it basically asks questions about snoring, blood pressure, and the size of the neck. There is also something called the Athens Insomnia Scale and Epworth Sleepiness Scale (Sleep disorders: Clinical tools, 2023).

Z-drugs such as zolpidem, zopiclone, and zaleplon are innovative hypnotics that aid with sleep, reduce sleep latency, and improve quality. These drugs are prescription dispensed only and they work by slowing the activity in the brain (Commissioner, 2023).

Benzodiazepines are medications such as lorazepam, diazepam, temazepam, alprazolam, and clonazepam among others that can have potential side effects such as respiratory depression, drowsiness, impaired judgment, nausea and vomiting, confusion, addiction, and even respiratory distress (Brandt & Leong, 2017).

References:

Brandt, J., & Leong, C. (2017). Benzodiazepines – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470159/

Commissioner, O. of the. (2023). Taking z-drugs for insomnia? know the risks. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks

How is actigraphy used to evaluate sleep?. Sleep Foundation. (2022, May 10). https://www.sleepfoundation.org/sleep-studies/actigraphy

Mayo Foundation for Medical Education and Research. (2023, February 17). Polysomnography (Sleep Study). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877#:~:text=Polysomnography%2C%20known%20as%20a%20sleep,measures%20eye%20and%20leg%20movements.

Sleep disorders: Clinical tools. CAMH. (2023). https://www.camh.ca/en/professionals/treating-conditions-and-disorders/sleep-disorders/sleep-disorders—clinical-tools

U.S. National Library of Medicine. (2020, January 3). Sleep disorders. MedlinePlus. https://medlineplus.gov/sleepdisorders.html

Mojgan A

Week 8, Medications for Sleep Disorders

What screening tools can be used to affirm your initial diagnosis that a patient may meet the diagnostic criteria for a sleep disorder?

        There are different tools for assessing sleep disorders. Among various rating scales, the Pittsburgh Sleep Quality Index (PSQI) was specifically designed to evaluate overall sleep quality and is among the recommended questionnaires for examining global sleep patterns and symptoms related to insomnia (Zitser et al., 2022). It is a self-report questioner and will assess the sleep quality over one month. Another useful scale is the Epworth Sleepiness Scale (ESS), which is a questionnaire designed to assess daytime sleepiness. A higher score on the ESS suggests the need for further evaluation for possible sleep disorders (Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale, 2023).

        According to the literature, the gold standard for monitoring sleep and breathing is polysomnography (PSG). PSG observes various physiological factors during sleep, including brain activity, eye movement, heart rate, and muscle activity. It involves the use of special bands around the chest and abdomen, as well as sensors for temperature and airflow in the nose. PSG also utilizes a device to measure airflow and sensors for air pressure in the airway. However, it's important to note that these methods can be invasive and time-consuming to set up and understand (Naik et al., 2023). Home sleep apnea testing (HSAT) is a simplified version of PSG that can be conducted at home and offers several potential benefits compared to traditional PSG, such as increased accessibility, quicker treatment initiation, and cost savings (Johns et al., 2022).

Describe the pharmacological actions of non-z sleep medications?

       Non-benzodiazepine (non-Z) sleep medications, such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), function by enhancing the activity of the neurotransmitter known as gamma-aminobutyric acid (GABA) in the central nervous system. GABA is an inhibitory neurotransmitter that promotes relaxation and facilitates sleep. One key distinction between benzodiazepine medications and non-Z medications is their selectivity in targeting GABA receptors (Stahl, 2021).

       Benzodiazepines act on various GABA receptor subunits (including alpha 1, alpha 2, alpha 3 and alpha 5 receptors) nonselectively. Benzodiazepines acting on alpha2 and alpha3 receptor subtypes have effects that reduce anxiety, promote muscle relaxation, and enhance the effects of alcohol. On the other hand, the alpha5 subtype, found in the hippocampus, may be implicated in cognitive processes. As a result, benzodiazepines are employed for the treatment of sleep disorders, seizure disorders, and anxiety disorders due to their broader spectrum of activity (Stahl, 2021).

        In contrast, non-Z medications selectively target alpha 1 receptors, which are primarily associated with the sleep process. Therefore, non-Z medications are specifically designed to induce and improve sleep without affecting the full spectrum of GABA receptors. Another distinction to note is that benzodiazepines typically have longer half-lives, which means they remain in the body for a more extended period compared to non-Z medications. This difference in half-life can have implications for factors such as prolong sedation and potential for dependence or withdrawal when using these medications. Non- Z medications are usually used for short amount of time and do not cause dependence or withdrawal symptoms (Stahl, 2021).

What problems can occur when benzodiazepines are used to help with sleep?

        Benzodiazepines are potent medications known for their effectiveness, but they come with a range of significant concerns and potential problems. They have sedative properties, leading to drowsiness and increased sleepiness in patients. Additionally, benzodiazepines exhibit a prolonged half-life, resulting in an extended duration of action within the body, which can impact a patient's overall quality of life. These medications have been associated with several adverse effects (Stahl, 2021).

        Benzodiazepines can impair cognitive function, memory, and coordination, potentially leading to accidents and reduced overall performance. A major concern with benzodiazepines is the development of tolerance. Over time, patients may require higher doses to achieve the same therapeutic effect. This can lead to physical and psychological dependence, as patients become addicted to the sedative properties of the medication (Stahl, 2021).

        Abruptly discontinuing benzodiazepines can result in unpleasant withdrawal symptoms, which can be challenging for patients. One study by Ritvo et al. (2023) revealed that over 40% of the respondents reported experiencing 17 or more symptoms persisting for at least one year after discontinuing their use of benzodiazepines. Common side effects associated with benzodiazepines include dizziness, drowsiness, and coordination problems, which can be especially problematic for individuals who need to remain alert and functional. It's essential to be mindful of potential drug interactions, as benzodiazepines can interact with other medications, potentially affecting their effectiveness or causing unexpected side effects (Stahl, 2021)

        Given these concerns, it is advisable to use benzodiazepines cautiously and only for short durations. When discontinuing their use, a slow tapering approach is often recommended to minimize the risk of withdrawal symptoms. This ensures that the benefits of these medications are balanced against the potential risks and adverse effects they may cause.

References

Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale (ESS) for sleep apnea headache. (2023). 
Sleep Science and Practice, 7, 1-9. 
https://doi.org/10.1186/s41606-023-00084-2Links to an external site.

Johns, J. D., Armin, M., Alexandra, W., Jeffrey, K. H., Mikula, S. K., & Hoa, M. (2022). Reliability of home sleep apnea testing for diagnosing obstructive sleep apnea in patients with spontaneous cerebrospinal fluid leaks. 
Cureus, 14(10)

https://doi.org/10.7759/cureus.29854

Naik, G. R., Breen, P. P., Jayarathna, T., Tong, B. K., Eckert, D. J., & Gargiulo, G. D. (2023). Morphic sensors for respiratory parameters estimation: Validation against overnight polysomnography.
 Biosensors, 13(7), 703. 
https://doi.org/10.3390/bios13070703Links to an external site.

Ritvo, A. D., Foster, D. E., Huff, C., Reid Finlayson, ,A.J., Silvernail, B., & Martin, P. R. (2023). Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey.
 PLoS One, 18(6) https://doi.org/10.1371/journal.pone.0285584

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

Zitser, J., Allen, I. E., Falgàs, N., Le, M. M., Neylan, T. C., Kramer, J. H., & Walsh, C. M. (2022). Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults.
 PLoS one, 17 (6) https://doi.org/10.1371/journal.pone.0270095

 Reply

Step 1: Reflect on your personal views related to nurses’ being appointed to boards, organizations or other policy forming entities.

Step 2: Post a response to the discussion board by addressing the following questions:

1. Why would a nurse want to seek an appointed position in government?
2. How would you prepare for consideration to an appointed position?
3. Use research and give examples of how nurses in various appointed positions  can affect public policy .

Cite any sources in 7th ed. APA format.

Select Reply to join the discussion.  See rubric for grading details. You can find this by clicking the three dots to the top right of this thread.

Response Posts: In your responses to your classmates, contribute to the discussion with your own original opinions about why a nurse would seek an appointed position in government and offer other examples of how nurses can affect public policy.

Week 3 ion channel —3 Peer Response 800w. due9-20-23

Instructions:

Please read and respond to the two peers' initial postings for week 2 below. Consider the following questions in your responses.

Compare and contrast your initial posting with those of your peers.  

1. How are they similar or how are they different?

2. What information can you add that would help support the responses of your peers?

3. Ask your peers a question for clarification about their post.

4. What most interests you about their responses? 

5. Summaries at least 1 evidence based article that supports there point.

Please be sure to validate your opinions and ideas with citations and references in APA format.

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Response 1 400 words

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Week 3 Discussion: Ion Channels

Compare and contrast the two different major classes of ion channels.

The two different major classes of ion channels are ligand-gated ion channels and voltage-gated ion channels, both of which are membrane proteins that play a vital role in regulating cell membrane potential and neuron communication (Stahl, 2021). Ligand-gated ion channels are also referred to as ionotropic receptors, this is because LGIC is both a receptor and channel and thus serves a dual function (Stahl, 2021). LGIC are made of amino acids and contain multiple binding sites to bind ligands such as neurotransmitters, ions, and drugs, allowing ions to either bind to a receptor or travel through the channel (Stahl, 2021). Voltage-gated ion channels are channels that mediate nerve conduction, action potential, and neurotransmitter release (Stahl, 2021). These channels are controlled by the change in ionic charge or voltage across the cell membrane (Stahl, 2021). Voltage-gated ion channels tend to be more selective, allowing the influx of only one ion at a time, whereas ligand-gated channels are less selective in nature and allow different types of ions to pass through the channel (Alberts, 2002).

Explain the difference between full agonists, partial agonists, antagonists, and inverse agonists.

An agonist is a ligand that binds to a receptor changing its state to result in a response (Stahl, 2021). The difference between full agonist, partial agonist, antagonist, and inverse agonist is that a full agonist leads to maximum signal transduction, whereas a partial agonist does not reach maximum signal transduction even with full receptor occupancy and can act as an antagonist in the presence of a full agonist (Stahl, 2021). Antagonists, on the other hand, is a ligand that binds to a receptor inhibiting its agonist-stimulated response (Stahl, 2021). Inverse agonists are ligands that when binding to a receptor cause a decrease in signal transduction, thus, their effect is the opposite of an agonist (Stahl, 2021).

References

Alberts, B. (2002). Ion channels and the electrical properties of membranes. Molecular Biology of the Cell – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK26910/

Stahl, S. M. (2021). Stahl’s Essential Psychopharmacology. https://doi.org/10.1017/9781108975292

Response 2. 400 words

1.
Compare and contrast the two different major classes of ion channels.

To start this discussion board I would like to define what are ion channels. Ion channels are membrane proteins, which play a major role in regulating cellular excitability. There are 3 major ion channels but for this homework assignment, I will compare and contrast voltage-gated ion channels and Ligand-Gated Ion Channels (LGIC).

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Ligand-gated ion channels open when a chemical ligand such as a neurotransmitter binds to the protein (Libretexts, 2023).

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Voltage channels open and close in response to changes in membrane potential (Libretexts, 2023). Ion channels can be classified by how they respond to the environment.

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Ligand-gated ion channel’s permeability is greatly increased when some type of chemical ligand binds to the protein structure (Libretexts, 2023)

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Voltage-gated channels respond to disturbances in cell membrane potential and are highly selective for specific ions such as sodium, potassium, calcium, and chloride (Ratan, 2018).

1.
Explain the difference between full agonists, partial agonists, antagonists, and inverse agonists.

Full agonists	Partial agonist	Antagonist	Inverse agonists
A molecule or chemical compound that can bind to a receptor and activate the receptor therefore causing a biological response (Agonist, partial agonist, antagonist, inverse agonist, 2019)	A molecule or chemical compound that can bind to a receptor and “weakly activate the receptor below maximum response (Agonist, partial agonist, antagonist, inverse agonist, 2019)	A molecule or chemical compound that binds to the receptor but does not cause any activation in the receptor, therefore not causing any biological response (Agonist, partial agonist, antagonist, inverse agonist, 2019)	Molecule of chemical compound that can bind to a receptor leading to deactivation, and decreasing the baseline activity of the receptor (Agonist, partial agonist, antagonist, inverse agonist, 2019)

References:

Agonist, partial agonist, antagonist, inverse agonist. PharmaEducation. (2023, August 11). https://pharmaeducation.net/agonist-partial-agonist-antagonist-inverse-agonist/

Libretexts. (2023, January 17). 10.5b: Ion Channels. Medicine LibreTexts. https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/10%3A_Overview_of_the_Nervous_System/10.5%3A_Neurophysiology/10.5B%3A_Ion_Channels

Ratan , N. (2018, October 26). Types of ion channels in the body. News. https://www.news-medical.net/health/Types-of-Ion-Channels-