NURS 6630 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders,100% CORRECT

NURS 6630 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology This study source was downloaded by from CourseH on :26:30 GMT -06:00 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders Sleep disorders are prevalent mental health disorders affecting 50 to 70 million adults in the united states (American Sleep Association, 2021). Insomnia is the most commonly reported sleep disorder. Insomnia results from various causes, including sleep disorders and psychiatric disorders (Levenson et al., 2015). Insomnia refers to persistent chronic dissatisfaction with sleep quality or quantity that is related to difficulty with initiating sleep, frequent night-time awakenings and difficulty returning to sleep after awakening (Levenson et al., 2015). The purpose of this paper is to make three pharmacologic decisions for the treatment of a patient presenting with a sleep disorder. Introduction The case presents a 31-year-old male who presents with complaints of insomnia. The patient reports that his insomnia has worsened over the past six months. Even though the patient states that he has had sleeping problems in the past, he states that his current situation is worse, particularly due to problems falling asleep and maintaining sleep at night. As reported by the patient, his situation has worsened, and this has prompted him to seek medical care. He also adds that his symptoms of insomnia have significantly affected his capacity to perform his job as a forklift operator. Patient-specific factors are important when assessing and treating the patient to ensure proper and informed decision-making concerning the patient's treatment. One of the significant factors is his medication history. Essentially, the patient reports that he previously used diphenhydramine to manage his symptoms of insomnia, but he does not like the way the drug makes him feel in the morning. Additionally, the patient has a history of opiate abuse, which began after breaking his ankle, and was prescribed hydrocodone (acetaminophen) for acute pain management. Another factor is that the patient has been using alcohol to help him sleep, and he takes around four bottles of beer before sleeping. This study source was downloaded by from CourseH on :26:30 GMT -06:00 Decision #1 Start trazodone 50–100 mg daily at bedtime. The first decision would be to start 50-100 mg daily of Trazodone at bedtime. Trazodone is a selective serotonin reuptake inhibitor (Stahl., 2013). As a sedating antidepressant, the medication is used off-label as a hypnotic for the treatment of insomnia related to depression. As such, the medication is the most appropriate for this patient given that he attributes his insomnia symptoms to his fiancé's death, thus illustrating depression as the possible cause of his insomnia. Besides, compared to nonbenzodiazepine receptor agonists, sedating antidepressants have fewer adverse effects. The drug works by blocking serotonin 2A receptors potently (Stahl., 2013). The drug has a half-life of about 6-8 hours, and it is a highly effective hypnotic when administered at lower doses than that used as an antidepressant (Stahl., 2013). Lower doses of trazodone (25 mg-100mg) administered at bedtime have been shown to induce and maintain sleep devoid of causing daytime sedating effects (Sateia et al., 2017) I choose not to select the alternative choice of starting zolpidem 10 mg orally at bedtime. Essentially, this is because of the associated side effects of the drug, which is a nonbenzodiazepine hypnotic (Riemann et al., 2017). These side effects include dizziness, nightmares, nausea, anterograde amnesia, and agitation. Stahl. (2013) states that in some patients, the use of a 10 mg dose increases the risk of next-day impairment in driving and other activities that require alertness. Additionally, the medication can lead to visual and auditory hallucinations when used with alcohol. Riemann et al. (2017) state that if co- administered with alcohol, this increases the risk of CNS depression. I also choose not to select 25-100 mg of hydroxyzine due to its strong sedative properties similar to diphenhydramine. This makes the drug dangerous given that the patient is a forklift operator (Riemann et al., 2017). This study source was downloaded by from CourseH on :26:30 GMT -06:00 Following the administration of trazodone 50mg daily at bedtime, it was expected that the patient would report a reduction in his sleeplessness in addition to an improvement in his depression. It was also expected that the patient would tolerate the current dose of the medication well with no side effects. After two weeks, the patient returned to the clinic for follow up where he reported that the medication was working well but it gives him unpleasant side effects of priapism and difficulty getting to work. Decision #2 Decrease trazodone to 25 mg daily at bedtime At this point, the most appropriate decision would be to reduce the dosage of trazodone to 25 mg daily administered at bedtime. This is based on the fact that the patient reported improvements in his condition with 50 mg including improved sleep. However, the patient reports side effects of priapism and difficulty getting up. Sateia et al. (2017) state that progressively tapering off trazodone effectively reduces side effects and adverse effects. I choose not to select the decision of explaining to the patient that priapism is a side effect of the medication and that it will diminish over time since this would not be the best decision at this end. Continuing with the same dose would lead to further side effects, including daytime drowsiness, which can put the patient at the risk of injury when working. I also choose not to select the second option of discontinuing trazodone and initiating suvorexant 10 mg daily at bedtime because discontinuing the drug abruptly can lead to withdrawal symptoms, including agitation, anxiety, and difficulty staying or falling asleep (Riemann et al., 2017). After lowering the dosage of trazodone to 25 mg daily at bedtime, it was expected that the patient would report a sustained improvement in his insomnia and depression symptoms. Additionally, it was expected that lowering the dosage would effectively manage the occurrence of side effects, including priapism and difficulty getting up. It was also expected This study source was downloaded by from CourseH on :26:30 GMT -06:00 that the patient would experience a normal life function. After two weeks, the patient reported that trazodone 25 mg was very effective for sleep but stated that at times, 25 mg is not adequate in helping him sleep through the night. The patient did not report the occurrence of side effects including priapism and difficulty getting up. Decision # 3 Continue dose. Encourage sleep hygiene and follow up after four weeks. The most appropriate decision at this point would be to continue the current dose of trazodone and encouraging the patient to practice proper sleep hygiene. The patient reports that the current dose is not sufficient in keeping him asleep, and this prompted the third decision. Sleep hygiene refers to behavioral and environmental interventions that promote consistent and uninterrupted sleep. Stahl (2013) states that all patients with chronic insomnia should be educated on sleep hygiene rules as adjunctive therapy. Discontinuing trazodone and initiating ramelteon 8mg at bedtime would not be the most appropriate since it does not suffice in the current situation. This is because the drug, which is a Melatonergic hypnotic, is associated with severe side effects including daytime drowsiness, irritability, and lethargy (Riemann et al., 2017). Discontinuing trazodone and initiating hydroxyzine 50 mg would not be the most appropriate decision given that it is associated with similar side effects as those of diphenhydramine, including strong sedative properties (Riemann et al., 2017). The drug has a long half-life of 20 hours, and this can result in daytime sedation after night-time dosing (Stahl, 2013). This makes the drug dangerous given that the patient is a forklift operator. Besides, the patient is already showing partial treatment response with the current dose of trazodone, and as such, it may not be prudent to switch therapy. After continuing the dose and encouraging sleep hygiene, it would be expected that the patient’s sleep hygiene would improve the patient’s sleep as well as help him maintain a This study source was downloaded by from CourseH on :26:30 GMT -06:00 regular sleep/wake cycle that enables functionality during the day. It is also expected that the patient would continue tolerating the current dose of trazodone well without any side effects. Ethical Considerations When making the three decisions about the treatment of the patient presented in the case study, various ethical considerations were made as they could affect the treatment plan along with communication with the patient. First, it was ensured that the selected interventions adhered to the ethical principles of beneficence and nonmaleficence. (Barber, 2017). The principle of beneficence requires providers to act in the best interests of the patient, while the principle of nonmaleficence requires providers to do no harm (Barber, 2017). For instance, when making all the decisions, the potential effectiveness and side effects of the medication options were compared to ensure maximum benefit to the patient and to avoid harm. When making the first decision, Trazodone was selected over zolpidem or hydroxyzine due to the potential side effects of these drugs and the potential efficacy of trazodone in alleviating symptoms associated with insomnia and depression. Conclusion Insomnia is a prevalent sleep disorder that is characterized by persistent difficulty with initiating sleep, duration, consolidation, or quality. The patient presented in the case study presents with insomnia as a result of depression and stress from the death of his fiancé. The goal of treatment was to reduce the patient's insomnia and depression symptoms. The initial decision involved prescribing trazodone given that evidence shows that it would be more appropriate for the treatment of patients with insomnia and depression and is more tolerable than the other two options of starting zolpidem or hydroxyzine. The second decision entailed decreasing the dosage of trazodone to 25 mg to reduce the occurrence of side effects of trazodone including priapism and difficulty getting up. The last decision involved continuing the current dose of trazodone and encouraging the patient to practice good sleep This study source was downloaded by from CourseH on :26:30 GMT -06:00 hygiene. At this point, the patient was already showing response to the drug, and as such, switching therapy was not an option. When making the three decisions, various ethical considerations related to beneficence and nonmaleficence were put into account as they could affect the treatment plan of the patient. This study source was downloaded by from CourseH on :26:30 GMT -06:00 References American Sleep Association. (2021). Sleep Statistics - Data About Sleep and Sleep Disorders. Retrieved 25 April 2021, from statistics/ Barber, L. K. (2017). Ethical considerations for sleep intervention in organizational psychology research. Stress and Health, 33(5), 691-698. Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., ... & Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of sleep research, 26(6), 675-700. Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307-349. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. This study source was downloaded by from CourseH on :26:30 GMT -06:00