Insomnia + Hair Loss Jeopardy

What type of hair loss can be treated by self-care w/ an FDA approved option and what would it look like?

androgenetic alopecia is the ONLY type

• in men: starts w/ receding hairline and circular area on top back of head

• in women: along the midline of the head

Which type of hair loss could be amenable to protein or vitamin/mineral supplementation after it is properly diagnosed by a primary care or specialist clinician?

telogen effluvium

What is the MOA of minoxidil for hair growth in androgenetic alopecia?

minoxidil = alpha-1 adrenoreceptor blocker → dilates blood vessels going to hair follicles → speeds up hair growth in shorted anagen phase → hair is more likely to protrude out of scalp before it reaches later phases

What is the cause of the shortened anagen phase in androgenetic alopecia and what prescription therapy can be used once prescribed by a clinician?

DHT; shrinks anagen phase and 5-alpha reductase inhibitors (i.e. finasteride) are options

Minoxidil 2% is reserved for what specific patient type w/ androgenetic alopecia while the 5% products are available for which broader group?

women can use 2% solution 2x daily or 5% foam 1x daily while men should use 5% solution/foam 2x daily

How long should people using minoxidil products wait before rinsing hair, swimming, using hair gel/mousse, hairspray, or hair powder?

solution takes 4 hrs, foam takes 30 mins

Why should patients run cold water over their hands and then dry them immediately before using the foam?

cold and dry hands will keep the foam from melting and being absorbed into their bloodstream unnecessarily

Which form is more likely to irritate the scalp?

solution bc it has propylene glycol in it

Why can’t you use 3x the dose daily?

too much absorption of drug into the bloodstream → can cause dizziness or fainting

What are the three exclusions for self care for androgenetic alopecia w/ topical minoxidil?

• <18 yrs of age

• pregnant or breastfeeding

• scalded/sunburned/damaged scalp

Which of the following is NOT a sedating antihistamine and which is FDA approved to use as a sleep aid?

loratadine is NOT sedating; diphenhydramine is approved to use as sleep aid

When should sedating antihistamines be taken before bedtime and which type of insomnia can it help?

at least 30 mins before bed, helps w/ falling asleep but not nighttime awakenings

Why should sedating antihistamines only be used for 3 days at a time?

• building tolerance

• chronic insomnia = medical referral

• anticholinergic adverse effects possible

What anticholinergic adverse effects can people experience while taking antihistamines?

• dry mouth

• constipation

• urinary retention

• blurred vision

Diphenhydramine is a CYP2D inhibitor and has interactions w/ which common drug classes?

• any other CNS stimulants (antidepressants, antipsychotics)

• analgesics

• beta-blockers/antiarrhythmics

Which dietary supplement could be used in shift workers and people traveling across the globe?

melatonin

Name three components of sleep hygiene that can help people fall asleep and get better rest:

• no blue light before bed

• keeping same sleep schedule

• no eating before bed

List the exclusions to self care for insomnia:

• <12 yrs or >65 yrs

• pregnant or breastfeeding

• sleep apnea

• insomnia >3 months

What is the only FDA approved treatment to enhance alertness during the day?

caffeine

Why should you not exceed 400 mg of caffeine in one day?

doses >400mg can cause jitteriness, hand tremor, lack of concentration, and cardiac arrhythmias

• The higher the dose, the greater the risk

Caffeine has what important drug interactions?

• smoking: reduces effects of caffeine

• enhances the effects of other stimulants

• blocks effects of adenosine

What are the exclusions for self-care for drowsiness/fatigue?

• <12 yrs

• Pregnancy or breastfeeding

• Heart disease

• Chronic fatigue >6 mo (assure no sleep apnea, hypothyroidism,
  depression)

• Drug induced issue

Is whole lead kratom an effective and safe energizing natural product?

kratom enhances energy like caffeine but has worse withdrawals and a higher risk of addition

Which of the following natural products is unlikely to promote sleep?

St. John’s Wort

What is the least safe product to fend off fatigue during the day?

energy drinks

A patient is describing their history of present illness and past medical history, and you are listening for exclusions for self-care of insomnia. Which of the following would exclude a patient from receiving self-care w/ an OTC product?

obstructive sleep apnea