4 - Sleep Aids / Stimulants Flashcards by Karlo Sison

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

How well did you know this?

Not at all

Perfectly

Unisom

( Diphenhydramine / doxylamine )

Dose / indication

Sleeping Aid

Doxylamine = Tabs ONLY

DPH = 50mg Caps / Melt / Liquid

25mg at bedtime

15 min prior to retiring

How well did you know this?

Not at all

Perfectly

Insomnia Classifications

Transient (<1wk)

Short-Term (1-3wk)

Chronic (>3wks)

From Medical / psychological problem / substance abuse

How well did you know this?

Not at all

Perfectly

S/S of Insomnia

Difficulty in Falling asleep / Staying asleep

Too early final awakening

Poor Quality of Sleep

w/ unusual or troublesome dreams

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Drugs that cause/exacerbate insomnia

Nicotine / Alcohol

Amphetamines / PSE / Methylphenidate

Corticosteroids / Caffeine

tea / chocolate / mountain DEW / COKE

How well did you know this?

Not at all

Perfectly

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?

How well did you know this?

Not at all

Perfectly

EX-ST

Insomnia

Chronic Insomnia > 4weeks

Sleep disturbance SECONDARY to Psychiatric / medical disorder

depression

Try Non-Drug Measures FIRST

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

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

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

Melatonin

AE’s

Morning Hangover

Headache

Depression

Tachycardia

Irritability

N/V

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

Non-Pharma Treatment

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*

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

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

Tolerance

of caffeine

Dependence / effects occur w/ little as

100mg/day

best to have intermittent use

**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**

**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

**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

**Caffeine & Pregnancy**

***\<200mg/day*** preferred ACOG recs

**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**

**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

**Energy Drink Counseling** **for *NON-ATHLETE***

**\<500ml or 1 can / day** ## Footnote _depends on other caffeine consumption_ ***DO NOT MIX WITH ALCOHOL*** * avoid if you are being treated for **HTN*** * avoid if **CAD / CHF / Arrhythmia***

**Energy Drink Counseling** for **ATHLETE / Exercise participant**

***DO NOT USE ENERGY DRINKS*** Possibility of **_DEHYDRATION_** elvation of **BP** * lack of benefits vs **water / sport drinks*** * need electrolytes / carbs*

**Melatonin for Insomnia**

**_0.3 - 5mg_** ## Footnote **30-60min before bedtime** *avoid in Pregnancy / Children* ***MAO inhibitors / SSRI** / **Corticosteroids***