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

NoDoz (Caffeine)

Indication / Dose

A

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
Q

Unisom

( Diphenhydramine / doxylamine )

Dose / indication

A

Sleeping Aid

Doxylamine = Tabs ONLY

DPH = 50mg Caps / Melt / Liquid

25mg at bedtime

15 min prior to retiring

3
Q

Insomnia Classifications

A

Transient (<1wk)

Short-Term (1-3wk)

Chronic (>3wks)

From Medical / psychological problem / substance abuse

4
Q

S/S of Insomnia

A

Difficulty in Falling asleep / Staying asleep

Too early final awakening

Poor Quality of Sleep

w/ unusual or troublesome dreams

5
Q

Stress & Anxiety

Insomnia Etiology

A

DNT OTC if psychiatric or chronic

Most common in young people

Can bue due to acute life stress

travel / illness / exam / anticipation

6
Q

Psychiatric Disorders

​Insomnia Etiology

A

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
Q

Drugs that cause/exacerbate insomnia

A

Nicotine / Alcohol

Amphetamines / PSE / Methylphenidate

Corticosteroids / Caffeine

tea / chocolate / mountain DEW / COKE

8
Q

Questions to ask

for INSOMNIA

A

How long have you had trouble sleeping

Unusual stress?

What medications?

Caffine intake / what times

Alcohol intake

Any current methods / attempts to fix?

9
Q

EX-ST

Insomnia

A

Chronic Insomnia > 4weeks

Sleep disturbance SECONDARY to Psychiatric / medical disorder

depression

Try Non-Drug Measures FIRST

10
Q

Diphenhydramine

for Insomnia

Dose / Indication

A

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
Q

Diphenhydramine

Side Effects

A

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
Q

Doxylamine (Unisom tabs)

Advantages

A

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
Q

Alcohol on Sleep

A

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
Q

Analgesics for Sleep

A

Function to relieve pain which may hinder sleep

Combined w/ Antihistamine in sleep aid products:

Unisom Pain

Tylenol PM

Percogesic

Excedrin PM

15
Q

Patient Counseling for Antihistamine

Sleep aids

A

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
Q

Melatonin

A

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
Q

Melatonin for Jetlag

Dose

A

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
Q

Melatonin Facts

A

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
Q

Melatonin

AE’s

A

Morning Hangover

Headache

Depression

Tachycardia

Irritability

N/V

20
Q

Melatonin Counseling

A

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
Q

Non-Pharma Treatment

A

Regular Sleep Cycle

Exercise EARLY / Relax at bedtime

leave bed if you can’t sleep

  • avoid nappin*g / electonic devices @ bedtime
  • avoid caffeine / nicotine / alcohol 4-6 hrs before bed*
  • avoid heavy meals / heavy drinking in evening*
22
Q

Caffeine Dose

A

Only FDA approved agent

both a DRUG & Food Additive

100-200mg

to induce wakefulness / CNS stimulation in adults

NOT A SUB FOR SLEEP

23
Q

Caffine PK’s

A

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
Q

Tolerance

of caffeine

A

Dependence / effects occur w/ little as

100mg/day

best to have intermittent use

25
Q

Withdrawal of Caffeine

A

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
Q

Caffeinism

A

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
Q

Caffeine Side Effects

A

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
Q

Caffeine & Pregnancy

A

<200mg/day

preferred

ACOG recs

29
Q

Caffeine Counciling

A

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
Q

Energy Drinks

A

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

31
Q

Energy Drink Counseling

for NON-ATHLETE

A

<500ml or 1 can / day

depends on other caffeine consumption

DO NOT MIX WITH ALCOHOL

  • avoid if you are being treated for HTN*
  • avoid if CAD / CHF / Arrhythmia*
32
Q

Energy Drink Counseling

for ATHLETE / Exercise participant

A

DO NOT USE ENERGY DRINKS

Possibility of DEHYDRATION

elvation of BP

  • lack of benefits vs water / sport drinks*
  • need electrolytes / carbs*
33
Q

Melatonin for Insomnia

A

0.3 - 5mg

30-60min before bedtime

avoid in Pregnancy / Children

MAO inhibitors / SSRI** / **Corticosteroids