Pharmacotherapy - Drowsiness and Fatigue

Vocabulary flashcards covering evaluation factors for fatigue, nonpharmacologic strategies, caffeine pharmacology and interactions, and treatment planning from the video notes.

Fatigue evaluation

Assessment of drowsiness/fatigue determinants by reviewing age, medical conditions, medications, and lifestyle to identify causes.

Age exclusion (<12 years)

Patients under 12 are excluded from fatigue evaluation in this protocol.

Anemia

A condition with reduced red blood cell mass or hemoglobin that can contribute to fatigue.

Cancer

Malignancy that can cause fatigue through illness burden or treatment effects.

Chronic pain

Persistent pain that can lead to fatigue due to ongoing physical strain and sleep disruption.

Depression

Mood disorder associated with fatigue, low energy, and decreased motivation.

Eating disorder

Disordered eating patterns that may contribute to fatigue via malnutrition or metabolic stress.

Hypothyroidism

Underactive thyroid causing slowed metabolism and fatigue.

Overexertion

Excessive physical activity leading to fatigue.

Medications contributing to fatigue

Various medications (e.g., alcohol, antibiotics, anticonvulsants, antidepressants, antihistamines, antihypertensives, barbiturates, benzodiazepines, dopamine agonists, opiates, TCAs) that can cause drowsiness or fatigue.

Nonpharmacologic lifestyle modifications

Lifestyle changes (e.g., regular exercise) to help fatigue without prescription medications.

Sleep hygiene

Practices for better sleep: regular sleep pattern, relaxing pre-sleep routine, avoid alcohol/caffeine/naps/large meals before bed, a comfortable bedroom, and using the bed for sleep.

Caffeine (pharmacology)

Over-the-counter stimulant that blocks adenosine receptors, increasing alertness and reducing fatigue.

Caffeine MOA

Non-selective adenosine receptor antagonism at A1 and A2A; increases intracellular cAMP; weak GABA receptor antagonism; improves psychomotor performance.

Caffeine dosing

Typical dosing is 100–200 mg every 3–4 hours as needed (PRN).

Common caffeine adverse effects

Arousal, elevated mood, decreased motor coordination, headache, dizziness, nervousness.

High-dose caffeine adverse effects

Anxiety, bronchodilation, tachycardia, tremor, elevated blood pressure, headache, nausea.

Caffeine withdrawal

Symptoms such as decreased concentration, headache, fatigue, and irritability after abrupt cessation.

Tobacco interaction with caffeine

Tobacco smoking increases caffeine clearance, reducing caffeine levels.

Ciprofloxacin/Norfloxacin interaction

These antibiotics decrease caffeine clearance, increasing caffeine effects.

Atomoxetine/cannabinoids/linezolid/MAO inhibitors interaction

These agents can increase caffeine’s adverse effects when used with caffeine.

Lithium interaction with caffeine

Lithium may decrease caffeine effects.

Theophylline/tizanidine interaction with caffeine

These agents can increase caffeine effects.

MAO inhibitors with caffeine (blood pressure)

MAO inhibitors can elevate caffeine-related blood pressure or hypertensive effects.

Caffeine contraindications/cautions

Hypersensitivity to caffeine; anxiety; cardiovascular, GI, hepatic, or renal impairment; seizure disorder.

Sleep hygiene counseling points

Sleep hygiene is essential; caffeine cannot compensate for insufficient sleep and withdrawal is possible with regular use.

Ginseng

Herbal supplement mentioned in treating fatigue; consult relevant lecture for details.

Treatment plan for fatigue without prescription meds

Identify and remove underlying cause, alleviate symptoms, and restore patient’s functioning to optimal level.