The January meeting was held at Scampi’s restaurant in Johnson City, TN. The meeting was sponsored by Tonya with Cephalon pharmaceuticals.  Dr. Gratli, a psychiatrist from Johnson City spoke on “Excessive Sleepiness/Hypersomnolence.”

PRESENTATION HIGHLIGHTS

Excessive Daytime Somnolence  

• PREVALENCE AND CAUSES:   ·       
  • One out of every 20 adults experience Excessive Daytime Somnolence ·       
  • Disrupted/fragmented sleep ·       
  • Circadian misalignment with sleep/wake schedule ·       
  • CNS related sleep/wake dysregulation  
• DEFINITION:
  • Sleepiness is normal state of decreased ability to maintain wakefulness and requires no medical treatment
  • Excessive sleepiness is an abnormal symptom of difficulty in maintaining wakefulness with propensity to fall asleep at inappropriate time/settings.  It is also called hypersomnolence.  This is related to decreased cortical activity and can be managed medically.
  • Patients with hypersomnolence present with tiredness, fatigue, lapses of attention, lack of energy, low motivation, and difficulty concentrating
•   CONSEQUENCES OF EXCESSIVE SLEEPINESS:
  • Decreased concentration
  • Increased accidents
  • Undesired sleep episodes/fatigue/loss of energy and motivation
  • Decreased productivity and errors at work and home
  • Irritability/mood shifts
  • Negative effects on family and social life
•     TREATMENT:
  • Screen for and treat sleep apnea
  • Provigil
•   MEDICAL TREATMENT WITH PROVIGIL:
  • Promotes wakefulness without generalized CNS stimulation
  • Approved for narcolepsy, obstructive sleep apnea/hypopnea, and shift work sleep disorder
  • Schedule IV
  • Results occur within 2 weeks
  • $200 a month
  • Can use as a pulse dose if patient does shift work
  • If tolerance develops, stop for 2-3 days and restart
  • Recommended dose is 200 mg in the am. Start at 100 mg and taper up every few days
  • Recommended dose in elderly and with hepatic impairment is maximum of 100 mg a day
  • Most common side effects include Headache, Nausea, Nervousness, Rhinitis and GI symptoms
•   IMPORTANT TREATMENT CONSIDERATIONS:
  • Advise patients that their level of wakefulness may not return to normal
  • Frequently reassess degree of sleepiness
  • Prescribers should be aware that patients may not acknowledge sleepiness or drowsiness until directly questioned about specific activities (i.e. falling asleep when sitting or driving; not feeling rested with awakening, etc.
•   CONCLUSIONS:
  • Excessive sleepiness is a primary complaint in patients with narcolepsy, obstructive sleep apnea and shift work sleep disorders
  • Hypersomnolence is a prominent and disabling symptom
  • It is important to assess and treat obstructive sleep apnea
  • Provigil can improve wakefulness when used appropriately for sleep disorders.

Business Meeting

• President Kathy Sharp opened the meeting by thanking our Cephalon representative and Dr. Gratli  
• Secretary’s Report:
  • The minutes were approved by unanimous vote. 
  • Tracy Luther reminded everyone to carefully check the sign in sheet for appropriate addresses, phone numbers and especially email addresses. If your email address is correct and you are not receiving the notices, check to make sure that it isn’t being sent to your junk senders file or being counted as SPAM.
• Treasurer’s Report:
  • Current balance $11,618.67. 
  • Paula Countiss reminded everyone that all membership dues are up in January.  It is $35.00 for the year for APN’s and $15.00 a year for APN students.  Checks can be mailed to Paula Countiss at 720 Park St., Bristol, VA 24201  

Old Business:

• Pfizer has placed Tennessee into the non-restrictive delegation of authority category for samples of Lyrica.  As of January 8, 2007, restrictions have been removed and APN’s are now eligible to receive samples.

New Business:

• The TNA listserve has hosted several questions of late about a mass mailing from the state of TN regarding registration for dispensing of controlled substances.  This has caused a lot of confusion. The clear answer is:  the NP does not have to register with the state unless he or she is actually dispensing a controlled substance like narcotics, anxiolytics, hypnotics, etc from their office.  This only applies to controlled substances that you purchase and dispense from your office. It does not apply to samples or prescriptions you write. ·       
• The Center for Nursing Advocacy:  This group is a non-profit organization devoted to helping nurses improve public understanding of their work and work with obtaining resources for clinical nursing practice, research and education.  Please go to www.nursingadvocacy.org to sign up for their news alerts and emails. They can also use financial support and accept donations.     
• Published letters in regards to Wendy Vogel’s response in her interview with Medscape about the DNP are now available for viewing online at www.medscape.com  

Job Opportunities:

• Cardiovascular Associates, P.C. in Bristol has openings for 2 Nurse Practitioners
• Mountain Empire Neurology is looking for a Nurse Practitioner to do hospital consults.  If interested contact Jessica Gode at (423) 764-0987

Next Meeting:   February 15th at 6:30 pm at Skoby’s in Kingsport-speaker to be announced at a later date. Please plan to attend!!    

Submitted by Tracy Luther, Secretary