insomnia/drowsiness/fatigue

Question 1

stage 1 of sleep

Answer 1

transitional, occurs as one falls asleep

Question 2

stage 2 of sleep

Answer 2

light sleep, about 50% of sleep time

Question 3

stage 3 and 4 of sleep

Answer 3

deep sleep

Question 4

REM

Answer 4

not light or deep, characterized by eyes move rapidly from side to side

Question 5

cycle of sleep repeats every

Answer 5

70-120 minutes

Question 6

transient insomnia

Answer 6

lasts < 1 week; self-limiting

Question 7

short term insomnia

Answer 7

1-3 weeks (can progress to long term)

Question 8

chronic/long term insomnia

Answer 8

lasts > 3 weeks, often result of medical problem, psychiatric disorder or substance abuse

Question 9

primary insomnia definition

Answer 9

sleep difficulty lasting at least one month, but is not cause by another sleep disorder, medical condition, psychiatric condition, or medication

Question 10

exclusions for self treatment of insomnia

Answer 10

1. < 12 years of age
2. > or equal to 65
3. pregnancy
4. frequent nocturnal awakenings or early morning awakenings
5. chronic insomnia
6. sleep disturbances secondary to psychiatric or general medical disorder

Question 11

non pharm treatment of insomnia

Answer 11

1. bed for sleeping
2. regular sleep pattern
3. avoid electronic devices
4. exercise regularly
5. avoid large meals two hours before bed
6. avoid daytime napping
7. avoid caffeine, alcohol, nicotine within 4-6 hours of bed
8. do not watch clock
9. relaxing activity

Question 12

non prescription options

Answer 12

antihistamines and ethanol

Question 13

antihistamine usage in insomnia

Answer 13

indicated for transient and short term use, poor for long term bc tolerance develops

Question 14

dosing of antihistamines

Answer 14

typically 50 mg, can be 25 mg

Question 15

duration of antihistamines

Answer 15

use no more than 7-10 consecutive nights

Question 16

adverse effects of antihistamines

Answer 16

additive sedation if used in combo with other medication that has other anticholinergic effects, dry mouth, constipation, blurry vision

Question 17

do not use antihistamines in patients with these conditions

Answer 17

BPH, arrhythmias, or dementia

Question 18

cessation of ethanol

Answer 18

can cause rebound insomnia

Question 19

complementary therapies for insomnia

Answer 19

melatonin and valerian

Question 20

melatonin regulates

Answer 20

sleep and circadian rhythm

Question 21

melatonin improves

Answer 21

attempts at sleeping, but doesn’t cause drowsiness

Question 22

dosing of melatonin

Answer 22

0.3-0.5 mg 30-60 min before bed time

Question 23

dosing of melatonin for jetlag

Answer 23

2-5 mg in the evening of arrival day at destination and at bedtime for 2-5 days

Question 24

pregnancy considerations

Answer 24

doxylamine approved in combo with pyridoxine for NV but not insomnia

Question 25

children considerations

Answer 25

encourage nonpharm measures first, antihistamines are not indicated in less than 12 years

Question 26

fatigue caused by

Answer 26

insufficient duration of poor quality of sleep

can be impacted by CNS depressants or chronic conditions

Question 27

exclusions for fatigue

Answer 27

1. less than 12
2. pregnancy
3. breastfeeding
4. heart disease
5. anxiety disorders
6. medication-induced drowsiness
7. chronic fatigue

Question 28

pharm therapy for fatigue

Answer 28

caffeine

Question 29

moa of caffeine

Answer 29

nonselective adenosine antagonist at A1 and A2A receptors; adenosine acts centrally to promote sleep; secondary effect on dopamine and acetylcholine may increase alertness also

Question 30

low-moderate doses of caffeine can

Answer 30

increase arousal, fatigue, and elevate mood

Question 31

higher doses of caffeine can cause

Answer 31

anxiety, nausea, nervousness, increased BP/HR

Question 32

dose of caffeine

Answer 32

100-200 mg every 3-4 hours prn

Question 33

smoking increases clearance of caffeine by

Answer 33

about 56%

Question 34

DDI with caffeine

Answer 34

MAOIs, CHA, uncontrolled HTN, or arrhythmias

Question 35

complementary therapy for fatigue

Answer 35

ginseng is used to boost physical and mental energy and enhance sense of wellbeing

Question 36

pregnancy and caffeine

Answer 36

limit intake to < 200 mg/day

Question 37

nursing mothers and caffeine

Answer 37

only small-moderate amounts per day immediately after breastfeeding

Question 38

children and caffeine

Answer 38

not indicated in less than 12

Question 39

elderly and caffeine

Answer 39

elimination is prolonged in elderly, thus have more interference with sleep