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Flashcards in 4 - Sleep Aids / Stimulants Deck (33)
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1

NoDoz (Caffeine)

Indication / Dose

Alerness Aid

Aid in Staying Awake & Restoring Mental Alertness

200mg Caffeine

200mg q3-4 hours

as needed, not for children

Max 600 mg/day

2

Unisom

( Diphenhydramine / doxylamine )

Dose / indication

Sleeping Aid

Doxylamine = Tabs ONLY

DPH = 50mg Caps / Melt / Liquid

25mg at bedtime

15 min prior to retiring

3

Insomnia Classifications

Transient (<1wk)

Short-Term (1-3wk)

Chronic (>3wks)

From Medical / psychological problem / substance abuse

 

4

S/S of Insomnia

Difficulty in Falling asleep / Staying asleep

Too early final awakening

Poor Quality of Sleep

w/ unusual or troublesome dreams

5

Stress & Anxiety

Insomnia Etiology

DNT OTC if psychiatric or chronic

Most common in young people

Can bue due to acute life stress

travel / illness / exam / anticipation

6

Psychiatric Disorders

​Insomnia Etiology

DNU OTC see MD if appear to be depressed

 

Chronic insomnia maybe a s/s of depression

esp w/ decrease in energy/weight loss/gain / anxiety

 

most commonly complain of early morning awakenings

7

Drugs that cause/exacerbate insomnia

Nicotine / Alcohol

Amphetamines / PSE / Methylphenidate

Corticosteroids / Caffeine

tea / chocolate / mountain DEW / COKE

8

Questions to ask

for INSOMNIA

How long have you had trouble sleeping

Unusual stress?

What medications?

Caffine intake / what times

Alcohol intake

Any current methods / attempts to fix?

9

EX-ST

Insomnia

Chronic Insomnia > 4weeks

 

Sleep disturbance SECONDARY to Psychiatric / medical disorder

depression

 

Try Non-Drug Measures FIRST

10

Diphenhydramine

for Insomnia

Dose / Indication

Only FDA CAT 1 sleep aid, for short-term use along w/ good sleep hygeine

12+ older for Insomnia

25-50mg hs

30 min before bedtime, <14 consec nights

intermittent use for 3 days w/ "OFF" night

help reduce tolerance to hypnotic effect

11

Diphenhydramine

Side Effects

AC Effects

Dizziness / Blurred Vision / Dry mouth /

Constipation / Urinary retention

"hangover" effects = residual sedation

 

DNU w/ older men w/ prostatic hyperplasia / urinary difficulty

DNU w/ glaucoma / dementia pts

BEERS LIST <65 yrs old

12

Doxylamine (Unisom tabs)

Advantages

FDA CAT 3

1st gen ATC Antihistamine also on BEERS list

NOT AS SEDATING AS DPH

same side effects as DPH

secondary to DPH still

13

Alcohol on Sleep

Sedating in the early part of night

but disrupts sleep in later part of night (once alcohol decreases)

Decrease REM sleep

vivid dreams / nightmares

exacerbate sleep apnea

can lead to chronic insomnia

14

Analgesics for Sleep

Function to relieve pain which may hinder sleep

Combined w/ Antihistamine in sleep aid products:

Unisom Pain

Tylenol PM

Percogesic

Excedrin PM

15

Patient Counseling for Antihistamine

Sleep aids

Drowsiness / Next-Day sedation

Avoid Alcohol & other products w/ DPH

Paradoxical Excitation

<14 days (short term use only)

SEE MD if w/ weight loss/gain + anxiety / energy loss

MAINTAIN HEALTHY SLEEP HABITS

16

Melatonin

Hormone produced by pineal gland

Regulates Sleep / Circadian Rhythms

release is Induced by Darkness

supressed by light, esp blue light from phones

Studied for:

Jet lag / shift work

Depression / cancer / immune booster / contraceptive

17

Melatonin for Jetlag

 Dose 

 2-5mg

the evening of arrival day

at bedtime for the next 2-5 days

 

no good dosing studies available

avoid in pregnancy / children

MAO-I / SSRI / Corticosteroids

18

Melatonin Facts

Sold as a Nutritional Supplement

not regulated by FDA (no assurance of purity/efficacy/safety)

Synthetic Products Preferred

(less risk from contamination)

 

Nocturnal melatonin levels decrease w/ age

19

Melatonin

AE's

Morning Hangover

Headache

Depression

Tachycardia

Irritability

N/V

20

Melatonin Counseling

Avoid in Preganancy / Nursing / CHILDREN

MAO-I / Seratogenic Drugs / Corticosteroids

Paxil / Prozac / Zoloft

 lowered prod. of estrogen / testosterone / thyroid

Immune system diseases : RA / rhinitis / Asthma / Cancer

21

Non-Pharma Treatment

Regular Sleep Cycle

Exercise EARLY / Relax at bedtime

leave bed if you can't sleep

avoid napping / electonic devices @ bedtime

avoid caffeine / nicotine / alcohol 4-6 hrs before bed

avoid heavy meals / heavy drinking in evening

22

Caffeine Dose

 

Only FDA approved agent

both a DRUG & Food Additive

100-200mg 

to induce wakefulness / CNS stimulation in adults

NOT A SUB FOR SLEEP

23

Caffine PK's

Rapidly Absorbed

Peaks in about 30-75 min

elimination half life = 3-6 hours

100-200mg q34hrs

max 600mg/day

relieve a sense of boredom & fatigue

24

Tolerance

of caffeine

Dependence / effects occur w/ little as

100mg/day

best to have intermittent use

 

25

Withdrawal of Caffeine

May occur after abrupt cessation of 500-600mg/day

Symptoms: rebound vasodilation

fatigue / headache / muscle tension / anxity

/ nausea / stuffy nose / irritability

Onset is 12-24 hours after last ingestions

can last for 1-5 days

26

Caffeinism

Excessive intake associated =

 >250mg ONCE

More common in occational users / elderly

Overdose @ doses >1000mg

Lethal dose 5-10g or >1750mg/kg

Symptoms: nervousness / insomnia / diuresis

flushing / GI upset / HR increase / Rambling thought

27

Caffeine Side Effects

Mild Diuretic -> Hasten Dehydration / Electrolyte Imbalances

issue if taken before physical exertion

Adverse effects shown at low doses of 250-300mg

Nervousness / Tremors / Restlessness / Insomnia

GI irritation / BP elevation / Tachycardia / Palpitation

 

28

Caffeine & Pregnancy

<200mg/day 

preferred

ACOG recs

29

Caffeine Counciling

DOES NOT INDUCE SOBRIETY

beware of energy drinks w/ alcohol

H/O anxiety / CV / HTN / GERD/PUD + Other stimulant meds

determine regular caffeine intake / other caffeine products

educate on short term only

if driving -> frequent stops / fresh air

 

30

Energy Drinks

Characterized as a Nutritional Supplement

no limit on caffeine vs SODA from FDA <71mg/12oz

Caffeine content does not have to be listed on label

Guarana = 4x caffeine vs coffee beans