Upload
dara
View
114
Download
1
Tags:
Embed Size (px)
DESCRIPTION
Caffeine-related disorders. All answers are from DSM-IV-TR and First and Tasman [pages 440-464] unless otherwise indicated. This edition was done on 1Sep08. Action of caffeine. Q. What is the cellular site of action of caffeine?. Action of caffeine. - PowerPoint PPT Presentation
Citation preview
Caffeine-related disorders
All answers are from DSM-IV-TR and First and Tasman [pages 440-464] unless otherwise indicated. This edition was done on 1Sep08.
Action of caffeine
Q. What is the cellular site of action of caffeine?
Action of caffeine
Ans. Adenosine receptor antagonist. By antagonizing adenosine, caffeine increases dopamine activity.
Role of adenosine
Q. What physiological effects does adenosine produce?
Role of adenosine
Ans.In general, adenosine is a suppressant of
brain activity. Also an antidiuretic, inhibits rennin release, inhibits gastric secretion, and inhibits lipolysis.
[If asked and don’t remember, remember that it is the opposite of what a cup of coffee does, so can guess some of the answer.]
Caffeine in coffee
Q. How much caffeine in a six oz of coffee?
Caffeine in coffee
Ans. About 100 mg. Remembering this will get you in the ballpark of how much in other drinks.
Other sources of caffeine
Q. What other drinks or foods have caffeine?
Other sources of caffeine
Ans. Soft drinksTea Chocolate[also, might say that some analgesics
contain caffeine]
Average intake
• Q. In the US, what is the average caffeine intake per day?
Average intake
Ans. 200 mg/d
Drink caffeine
Q. What percentage of Americans drink caffeine drinks?
Caffeine drinks
Ans. About 85%.
> 500 mg/d
What percentage of US people consume more than > 500 mg/d?
> 500 mg/d
Ans. 30%
Caffeine half-life
Q. What is the half-life of caffeine?
Caffeine half-life
Ans. 3 – 6 hours.
Caffeine-related disorders
Q. What are the DSM-IV caffeine-related disorders?
Caffeine-related disorders
Ans.Caffeine intoxicationCaffeine-related anxiety disorderCaffeine-related sleep disorderCaffeine disorder, NOS[Note, no “abuse” or “dependence” because DSM
authors thought that evidence for such was insufficient, but if you think the evidence is overwhelming in a pt, can use NOS.]
Caffeine intoxication
Q. DSM-IV lists 12 signs and expects at least 5 for the dx of caffeine intoxication. See how many of the 12 you can name? [There is a lot of overlap among the 12, so don’t expect to get all.]
Caffeine intoxication -1
Ans.1. Restlessness2. Nervousness3. Excitement4. Insomnia5. Flushed face6. Diuresis[see next screen]
Caffeine intoxication - 2
7. GI complaints8. Muscle twitching9. Rambling speech10. Tachycardia or arrhythmia11. Periods of inexhaustibility12. Agitation
Differential dx
Q. Differential dx of caffeine intoxication?
Differential dxAns. -- other substance-induced stimulant intoxications-- other substance-induced sedative withdrawal-- mania-- panic disorder-- generalized anxiety disorder-- sleep disorder-- medication side effect, especially those that
have akathisia
Tolerance
Q. Do people develop tolerance to caffeine?
Tolerance
Ans. Yes, very much so, even though DSM-IV doesn’t recognize dependence.
Treatment of caffeine intoxication
Q. What is the treatment of caffeine intoxication?
Treatment of caffeine intoxication
Ans. Supportive. First and Tasman focus on educating the pt about the dangers of caffeine – i.e., prevention, not focus on the episode itself.
Caffeine withdrawal
Q. Signs of caffeine withdrawal are what?
Caffeine withdrawal
Ans. Headache,SluggishnessDrowsinessDysphoriaIrritabilityNauseaMuscle soreness or stiffness
Caffeine withdrawal course
Q. What is the typical course of caffeine withdrawal
Caffeine withdrawal course
Ans. Onset between 12 and 24 hours of last
ingestion of caffeine, signs get worse for the next day or two, and last 2 to 7 days.
Treatment of caffeine withdrawal
Q. What is the treatment of caffeine withdrawal?
Caffeine withdrawal treatment
Ans. Give caffeine and taper.
Caffeine-induced anxiety disorder
Q. How does caffeine-induced anxiety disorder differ from caffeine intoxication or withdrawal?
Caffeine-induced anxiety disorder
Ans. The signs of anxiety are more severe than those seen in intoxication or in withdrawal
Caffeine-induced sleep disorder, definition
Q. Definition of caffeine-induced sleep disorder?
Caffeine-induced sleep disorder, definition
Ans. Insomnia, hypersomnia [rare], or parasomnia [rare].