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Pharmacy Practice 720 Year 1 Term 1 > Insomnia, Drowsiness and Fatigue > Flashcards

Insomnia, Drowsiness and Fatigue Flashcards

1
Q

What is insomnia?

3

A
  • Perception of difficulty with Falling asleep, staying asleep, or non-restorative sleep
  • Despite adequate opportunity and circumstances
  • Associated with daytime impairment or distress
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2
Q

How many adults have symptoms of Insomnia

A

33-50%

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3
Q

What are risk factors for Insomnia

5

A
  • Age
  • Female
  • Comorbidities (Other diseases)
  • Shift work
  • Others
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4
Q

What are the two types of sleep disorders?

A
  • Short term

- Long term

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5
Q

Long term

A

3x a week for longer than 3 month

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6
Q

How many adults have symptoms of Insomnia

A

33-50%

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7
Q

What are the two types of sleep disorders?

A
  • Short term

- Long term

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8
Q

Short Term sleep disorder

A

Less than 3 weeks

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9
Q

Long term

A

3x a week for longer than 3 month

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10
Q

What are diseases that can cause Insomnia?

A 
Pulmonary disease
Heart failure
Pain conditions
Neurologic diseases
Urologic
Endocrine
Dermatologic
GERD or Gastroesophageal Reflux Disease
Psychiatric
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11
Q

What are some medications that can cause Insomnia

A 
Stimulants
Antidepressants
Beta blockers
Corticosteroids 
Alcohol
Caffeine
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12
Q

What are some drugs that their withdrawl can cause insomnia?

A 
Alcohol
Amphetamines
Antihistamines
Barbituates
Benzodiazepines
MAO inhibitors
Opiates
Tricyclics
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13
Q

Sleep latency. What is it?

What can cause?

A

How long does it take to fall asleep

Stress, anxiety, hospital ?

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14
Q

Early awakening

What can cause?

A
  • Depression, anxiety (Chronic Insomnia, or Depression)

- Obstructive Sleep Apnea, Circadian Rythym

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15
Q

What is restless leg syndrome?

A

periodic limb movement disorder, nocturnal leg cramps

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16
Q

Circadian rhythm sleep-wake disorders

A

Jet lag, shift work, delayed or advanced sleep phase

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17
Q

Parasomnias

A

category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep.

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18
Q

What are the two OTC approved sleep aids?

A

-Diphenhydramine
-Doxylamine
(Older Histamines)

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19
Q

Diphenhydramine is under what class?

  • Dose
  • Mechanism
  • When to take
  • Half-life?
A

Older H1 Antihistamine (Anticholinergic)
25-50 mg (

  • Works on the H1 Histamine Receptor, crosses the blood brain barrier
  • 30-60 minutes before bedtime
  • Half life = 6-13
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20
Q

Early awakening

What can cause?

A
  • Depression, anxiety (Chronic Insomnia, or Depression)

- Obstructive Sleep Apnea, Circadian Rythym

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21
Q

What are some other important things with Diphenhydramine ?

A
  • Take 3 days and One day off to asses sleep quality without medication
  • Do not take more than 7-10 consecutive nights, it may be concealing other problems
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22
Q

What are some tools anyone can use to assess sleep?

5

A 
(Epworth Sleepiness Scale
Pittsburgh Sleep Quality Index
Insomnia Severity Index
Comprehensive Sleep History
Sleep Diary
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23
Q

What are some other tools a professional may need to use? 3

A 
Polysomnography
-Overnight sleep study
Multiple Sleep Latency Test:
 -Series of monitored naps
-Measure tendency to fall asleep
Sleep Actigraphy
-Wrist device that detects motion
24
Q

What are the two OTC approved sleep aids?

A
  • Diphenhydramine

- Doxylamine

25
Q

Diphenhydramine

  • Dose
  • Mechanism
  • Adverse effects
  • Interactions
A

25-50 mg

  • 30-60 minutes before bedtime
  • Half life = 6-13
26
Q

Diphenhydramine

  • Adverse effects
  • Interactions
A 
Adverse Effects (anticholinergic effects)
-urinary retention  
-blurred vision 
-dry mouth 
-constipation
-drowsiness
Interactions
-certain CYP metabolized drugs
-Alcohol
27
Q

What are some other important things with Diphenhydramine ?

A
  • Take 3 days and One day off to asses sleep quality without medication
  • Do not take more than 7-10 consecutive nights, it may be concealing other problems
28
Q

What are some CAM therapies used for sleep aid?

A
  • Alcohol (not really advised)
  • Melatonin (Effective for jet lag)
  • Valerian
29
Q

What are ways to practice good sleep hygiene?

8

A

Routine bedtime and wake time
Allow 7-9 hours for sleep
If not falling asleep, get up and do something relaxing
Quiet, dark, bedroom. Remove distractors.
Avoid caffeine, nicotine, alcohol before bedtime
Regular exercise
Avoid daytime naps

30
Q

Hypnotic

A

induces sleep

31
Q

What is GABA

A

Inhibitory neurotransmitter

GABA(A) receptor controls sleep

32
Q

What does a Melatonin do?

A

Secreted by pineal gland
MT1 and MT2 receptors
Regulate neuronal activity and circadian rhythms

33
Q

What do Histamines do?

A
  • H1, H2, H3 receptors in brain

- Many functions, including arousal, wakefulness

34
Q

What do Orexins do?

A

Excitatory neurotransmitters

Wakefulness and feeding

35
Q

What are some anti-depressants that can be used?

A

doxepin, trazodone, mirtazepine, amitriptyline

36
Q

Hypnotic

A

induces sleep

37
Q

What are prescriptions used for sleep aid?

A

GABA agonists
Melatonin agonist
Orexin receptor antagonist
Sedating low dose antidepressants

38
Q

Examples of GABA Agonist?

2

A

Benzodiazepines (nonspecific)

Nonbenzodiazepine (selective for GABA subtypes)

39
Q

Example Melatonin Agonist?

A

Ramelteon

40
Q

example of an Orexin receptor Antagonist

A

suvorexant (Belsomra)

41
Q

Ramelteon
Drug Class
Onset
Duration

A

Melatonin agonist
15-30 min (Rapid)
1-5 hours (short)
Helps fall asleep

42
Q

Temazepam
Drug Class
Onset
Duration

A

Benzodiazepine
30-60 minutes (slow)
5-12 hours (Intermediate)
Helps Stay Asleep

43
Q

Zolpidem IR
Drug Class
Onset
Duration

A

Nonbenzodiazepine
15-30 minute (rapid)
1-5 hours (short)
Helps fall asleep

44
Q

Eszopiclone
Drug Class
Onset
Duration

A

Nonbenzodiazepine
15-30 minute (rapid)
5-12 hours (intermediate)
Help fall asleep

45
Q

Zaleplon
Drug Class
Onset
Duration

A

Nonbenzodiazepine
15-30 minute (rapid)
1-5 hours (short
Help fall asleep

46
Q

Suvorexant
Drug Class
Onset
Duration

A

Orexin receptor antagonist
30-60 min (slow)
12
Help stay asleep

47
Q

Ramelteon
Drug Class
Onset
Duration

A

Melatonin agonist
15-30 min (Rapid)
1-5 hours (short)
Help fall asleep

48
Q

Doxepin
Drug Class
Onset
Duration

A

Histamine Blocker
15-30 min (Rapid)
5-12 hour (Intermediate)
Help fall asleep

49
Q

What are some Adverse Effects of Caffeine?

4

A

Transient Increase in HR and BP
Increase in Stomach HCl, and pepsin
Withdrawal symptoms
CYP1A2

50
Q

What is Fatigue?

How does each sex report fatigue?

A

lack of energy, mental exhaustion
May report feeling tired (men)
depressed/anxious (women)

51
Q

What is Drowsines/ Sleepiness?

A

feeling a need to sleep, or tendency to fall asleep

52
Q

What are some underlying reasons for Fatigue?

A 
Obstructive Sleep Apnea Syndrome
Insomnia
Medications 
Anemia
Psychological: Depression
Cardiovascular : Heart Failure
Neurological: Stroke
Endocrine
53
Q

Stimulant for Fatigue?

A

Caffeine

54
Q

What happens when you take Caffeine?

5

A 
What does an adenosine antagonist do?
Increase arousal, Decrease fatigue
Anxiety, nausea
Rapidly absorbed
3-6 hr half-life
55
Q

What are some Adverse Effects of Caffeine?

4

A

Transient Increase in HR and BP
Increase in Stomach HCl, and pepsin
Withdrawal symptoms
CYP1A2

56
Q

What are examples of Rx stimulants?

4

A

Modafinil
Methylphenidate
Dextroamphetamine
Atomoxetine

57
Q

What are some ways to address sleep nonpharmalogically

A

adequate sleep and sleep hygiene
regular exercise

30 minutes of moderate activity most days of the week

Pharmacy Practice 720 Year 1 Term 1 (11 decks)

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