ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

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Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

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

 

 

Sample Solution

Decision 1: Which medication to prescribe?

The patient in the case study is a 25-year-old woman who is experiencing insomnia. She has been having difficulty falling asleep for the past few months, and she is now averaging only 5-6 hours of sleep per night. She has tried over-the-counter sleep aids, but they have not been effective.

There are a number of different medications that can be used to treat insomnia. Some of the most commonly prescribed medications include:

  • Benzodiazepines: Benzodiazepines are a class of drugs that work by binding to GABA receptors in the brain. GABA is a neurotransmitter that helps to promote relaxation and sleep. Benzodiazepines are effective in treating insomnia, but they can also be addictive.
  • Z-drugs: Z-drugs are a newer class of drugs that work similarly to benzodiazepines. They are also effective in treating insomnia, but they are less likely to be addictive.
  • Melatonin: Melatonin is a hormone that is produced by the pineal gland in the brain. It helps to regulate the sleep-wake cycle. Melatonin supplements can be helpful in treating insomnia, especially in people who have delayed sleep phase syndrome.

In the case of the patient in the case study, I would consider the following factors when making a decision about which medication to prescribe:

  • The patient’s age: The patient is 25 years old, which is relatively young. This means that she is less likely to have developed any underlying medical conditions that could interact with the medication.
  • The patient’s history of substance abuse: The patient does not have a history of substance abuse. This means that she is less likely to become addicted to the medication.
  • The patient’s preferences: The patient would prefer to take a medication that is not addictive. This means that I would avoid prescribing a benzodiazepine.

Based on these factors, I would prescribe melatonin to the patient. Melatonin is a safe and effective medication that is not addictive. It is also a good choice for the patient because she is young and does not have any underlying medical conditions.

Decision 2: What dosage to prescribe?

The recommended dosage of melatonin for insomnia is 0.5-5 milligrams. The dosage can be adjusted depending on the individual’s response.

In the case of the patient in the case study, I would start her on a dosage of 0.5 milligrams. I would then monitor her response and adjust the dosage as needed.

Decision 3: How long to continue the medication?

Melatonin is generally a safe medication to take for short-term use. However, it is not recommended to take it for more than 4 weeks at a time.

In the case of the patient in the case study, I would recommend that she take melatonin for 2-4 weeks. I would then reassess her condition and decide whether to continue the medication or try another treatment option.

I would also recommend that the patient make lifestyle changes to improve her sleep quality. These changes include:

  • Establishing a regular sleep schedule: The patient should go to bed and wake up at the same time each day, even on weekends.
  • Creating a relaxing bedtime routine: The patient should avoid caffeine and alcohol before bed, and she should engage in relaxing activities before bed, such as reading or taking a warm bath.
  • Making sure the bedroom is dark, quiet, and cool: The bedroom should be a dark, quiet, and cool environment that is conducive to sleep.

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