Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult

  

Pt 31 yrs old male with worsening insomnia following the death of his fiance. Patient has difficulty sleeping, and problem staying asleep during the night. Patient has difficulty performing his job due to this insomnia.

Record indicates that patient has history of opiate abuse following a skiing accident due to prescribed pain medication Hydrocodone/ acetaminophen for acute pain.Patient has not taken any pain medication in 4 yrs, but has been consuming 4 bottles of beer nightly instead.

 

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Running Head: INSOMNIA DECISION TREE 1

INSOMNIA DECISION TREE 6

Insomnia Decision Tree

Student name

Institution Affiliation

Introduction

The case that I will focus on in this paper is about a 31 years male that is suffering from insomnia. This got worse when he lost his fiancée 6 months ago. Nowadays the case is just worse because he falls asleep even as he is undertaking his job. There is a history of opiate abuse which has been evidenced since it was recorded that he got involved in an accident for the past 4 years he said that he has never taken any sleeping oils or any pain relieving medicine. However, the addiction that the man has is that he has to take at least 4 bottles of beer on daily basis.

He states that this will help him to do away with hard time that he is facing currently. After some of the relatives saw his condition getting worse each and every day that’s when they decided to take him to a medical center so that his condition can be assessed and at the same time so that he can be given any assistance that will help him to overcome all the challenges that he has. From the assessment the patient had all the symptoms of a person suffering from insomnia. The patient had two problem for instance states that he was not in a position to find sleep especially in the time that he was wishing to sleep. The other problem was not staying asleep even though after struggle he will get some sleep.

The purpose of the assignment was to examine a case study of a man who had insomnia. I will also discuss the three decisions about the medications which the patient can be prescribed. (Physician Desk Reference, 2018).

Decision 1

. It was necessary that the patient was supposed to be treated as early as possible because the anger the patient was staying without getting treated the higher the chances that he was towards getting heart diseases, accid3nts, depressions, memory loss and many other. This can be attributed by the fact that they will not be in a position to fall asleep for a very long time. The first attempt to treat this insomnia from the patient was using of Trazodone 50-100mg daily at bedtime Gives him prolong erection for 15 minutes when awake. However this was the side effect that it really needed to be addressed based on the fact that the girlfriend had died 6 months ago and therefore giving the patient of such drug would be doing him some more harm and this would make home to think more of his girlfriend. Therefore a remedy or any other drug which could be more environmental friendly for him at that moment would be the most appropriate. This drug as well made him not to be in a position to have a coffee especially in the morning with his daughter because of the side effects that the drug was subjecting him to. Based on all the many side effects that this drug would have on the patient it was necessary that those who were attending to him not to settle on it. This is because the goal that the medicine was supposed to achieve will not have achieved. Therefore however this in some of the people treats insomnia in most of the cases it was not appropriate for this 31 male young adult and therefore it was important that the doctors should make another decision two to make sure that they are solving this problem. When treating the patient the side effects should not be more than the positive impacts that it is going to cause to the patient, (Centers for Disease Control and Prevention 2018)

Decision 2

After assessing the side effects that the patient had from the previous decision, the health care personnel wished to put the patient under Decrfease trazodone to 25mg. However, the patient was supposed to be going to the clinic after every two weeks so that he can be assessed on the progress that he was making. This was because he was not supposed to stop the medicine even though he was feeling like as if he was getting better but he was to continue taking the medicine and that is the reason as to why it was important that he was supposed to continue being monitored. Because if he was to stop taking medicine without the doctors knowledge the disease would relapse and therefore the drug could not be effective. Withdrawing from taking the medicine without the doctor’s prescription would lead to some withdrawal symptoms which can include have anxiety, being agitated and the problem of either staying or difficulty in having a sleep would be evidenced in such a patient It is important that the doctor would continue monitoring the patient when he returns in the clinic so that in case there was some improvement the dose would be decreased gradually. However after some assessment was carried out when he was going for his checkups, it was seen that Priapism was not being enough and there was diminishing of 35mg and therefore it was not effective enough to carry him throughout the night. But the best thing was that there was no auditory hallucination, and after seeing this as medical practitioner expert there was some signs that the future for the patient was bright and there was some improvement but he had not reached that level where you would say that he is alright and free from the disease. It is ethical to give him a remedy that will be in a position to ensure that he is free from any ailment, (Gaxiloa-Aguilar & Gullotta, 2018).

Decision 3

The patient in this juncture it was important that because the condition is decreasing he was supposed to continue being assisted in terms of advices so that he can know what he was supposed to do to make sure that the condition did not deteriorate but it will continue increasing. What practitioners came with after those two weeks of getting assessment he was encouraged that he was supposed to continue taking his medicine so that the disease will not relapse and basing on the fact that he was improving meant that the medicine was getting along with his body very well. Another advice that he was given was the tips on how to have a healthy sleep through having sleeping hygiene. These hygiene routines included having a clear and regular sleeping routine, he was to avoid taking naps especially during the day. He was to avoid staying in the bed after 5 to 10 minutes of waking up. He was a s well not supposed to use either a TV, phone or any other thing that could have caused distractions while he was in the bed. The bedroom was always supposed to be having clean and fresh air as well as having quiet and comfortable bedroom. The patient was supposed to go for follow ups after 4 weeks so that the progress will be assessed. This is because trazodone is therapeutic Will not introduce hydroxyzine because of its negative side effects, Benadryl will not be recommended as well has negative effects on patient. It is important that before the patient is given any medication it is important that all the negative impacts should be asses to make sure that the condition of the patient is improving, (Guzman, 2018)

Conclusion

Insomnia in most cases it is a problem that is caused and it has caused many people to suffer and there are many causes that makes a person to suffer from the disease. It is important that the medical practitioners should be keen when making the three decisions to make sure that the best decision that they are making on the patient is having more advantages than disadvantages. There are specific treatments which are addressing particular medical disorders. There are some general the trauptic approaches which can be used in the treatment of the disorder and they include pharmacologic and behavioral strategies. This is because the two strategies have got impacts in regard to applicability to those patients who are having insomnia. There are different advantages and disadvantages of dome medications which can be used to treat insomnia. There are as well some substances that can help the individual to be in a position to improve the sleep in case he is lacking enough sleep. There are some special emphasis which are given to those who use some new generations’ such as benzodiazepine receptor which is a treatment against hypnotics. The medication which is given to the individual is supposed to be after assessing all the possible outcomes of the medicine so that the ultimate goal which is of treatment is achieved. There are some medicine which reacts differently according to the person and therefore a medicine that worked so well for a person with insomnia does not necessarily mean that it will work so well on this other new patient. This is the reason as to why a decision tree is very important in making sure that in all the three different decision categories everything has been assessed and making sure that the drug which one will settle on it will be the best and for the best interest of the patient, (Fava, et al, 2016).

References

Centers for Disease Control and Prevention (2018). Prevalence of depression among adults aged 20 and over: United States, 2013-2016. Retrieved from

https://www.cdc.gov/nchs/products/databriefs/db303.htm

Fava, M., Rush, J., Thase, M., Clayton, A., Stahl, S., & Pradko, J. (2016). 15 Years of Clinical Experience with Bupropion HCL: From Bupropion to Bupropion SR to Bupropion XL. Primary Care Companion Journal of Psychiatry 7(3), 106-113. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1163271/

Gaxiloa-Aguilar, S. & Gullotta, T. (2018). Depression in Latinos. Retrieved from https://books.google.com/books?id=8SuoKfG3TBEC&pg=PA218&dq=hispanics+and+depression+views&hl=en&sa=X&ved=0ahUKEwja0cSNscDdAhXi6YMKHRl7CwgQ6AEIJzAA#v=onepage&q=hispanics%20and%20depression%20views&f=false

Guzman, F. (2018). Sertraline Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing. Retrieved from

https://psychopharmacologyinstitute.com/antidepressants/ssris/sertraline-essentials-mechanism-action-indications-pharmacokinetics-dosing/#Pharmacokinetics

Physician Desk Reference (2018). Phenelzine sulfate drug summary. Retrieved from http://www.pdr.net/drug-summary/Nardil-phenelzine-sulfate-462