Treating Insomnia In Young Adults Assignment Paper

Treating Insomnia In Young Adults Assignment Paper

To prepare for this Assignment:
Review this weekâ€™s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.
The Assignment: 5 pages
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 patientâ€™s pharmacokinetic and pharmacodynamic processes Treating Insomnia In Young Adults Assignment Paper.

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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. Treating Insomnia In Young Adults Assignment Paper
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) Treating Insomnia In Young Adults Assignment Paper

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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.

Case scenario
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html Treating Insomnia In Young Adults Assignment Paper

Introduction

Insomnia is a condition associated with difficulty falling or staying asleep, which causes substantial impairment in daytime functionality. Insomnia is a common disorder with a prevalence rate of approximately 10% of the general population (Krystal et al., 2019). Insomnia symptoms are common across all age groups, with the persistence slightly high among women and the elderly. Insomnia has been identified as a significant risk factor for anxiety, hypertension, major depressive disorder, substance use disorder, and hypertension. In many cases, it is believed that insomnia is comorbid with psychiatric or physical conditions. The implications of the illness are detrimental, including impaired functionality, accidents, impaired quality of life, and psychiatric morbidity. Therefore, an early diagnosis must be made to identify and implement a treatment plan.

The diagnostic criteria for insomnia are based on a chief complaint of trouble falling or staying asleep, affecting daytime functioning for at least three days per week for at least three months (Krystal et al., 2019). Sleep disruptions must occur despite having an appropriate environment and adequate opportunity for sleep. The DSM-V categorizes insomnia into subtypes: psychophysiological insomnia, insomnia due to substance, mental disorder insomnia, paradoxical insomnia, behavioral insomnia, and idiopathic insomnia (Krystal et al., 2019). Assessment of insomnia may take different forms, with the chief complaint being difficulty in staying and initiating sleep. Others include current sleep history, bedtime routines, daytime dysfunction, nocturnal behavior, and past medical history. Patients who meet insomnia diagnostic criteria must be treated promptly. Various pharmacological and pharmacotherapy approaches have been identified in treating insomnia. Pharmacological options include antidepressants, anticonvulsants, melatonin receptor agonists, and non-selective histamines (Sateia et al., 2017)Treating Insomnia In Young Adults Assignment Paper. Pharmacotherapy options include cognitive behavioral therapy.

Summary of the Case and Patient Factor Considerations that may Affect Medication Prescription

The case given for this assignment involves a 31-year-old male who visits the clinic with a chief complaint of insomnia. The patient reports that he previously had difficulties falling and staying asleep at night, but his condition has worsened over the past six months and affects his work. He notes that he has used diphenhydramine to manage the disease but does not like how he feels the following morning. He also states the insomnia issue has escalated after the demise of his fiancé, who passed on six months ago. He highlights that the condition is affecting his work, where he works as a forklift operator in a local chemical company, as he falls asleep at work because of a lack of sleep from the previous night. In a medical report, his last physician states the patient has a history of opiate abuse, which began after he was prescribed hydrocodone for acute pain management from a skilling accident that broke his ankle. The patient reports he has not taken opiate analgesic in four years and currently takes approximately four beers before bedtime to help him fall asleep. Mental status examination shows an oriented and alert patient aware of his surroundings. He has dressed appropriately and maintains eye contact throughout. The patient denies hallucinations, insights, and suicidal thoughts Treating Insomnia In Young Adults Assignment Paper.

Determining the most appropriate treatment medication for the patients will involve consideration of various patient factors to ensure improved health outcomes. It is important to consider psychological factors when recommending a drug. This will help establish if the cause of insomnia is the recent bereavement of his fiancé or other psychiatric conditions which consequently affect the drug (Krystal et al., 2019). Another factor to consider is substance use, as the patient reports he takes beer to help with his sleep. This aspect is essential as it helps determine how the factors might affect drug metabolism (Krystal et al., 2019). It is also necessary to consider the current/past prescribed medications because of drug interactions and contraindications. Other factors to consider might include patient preference, cost, and potential adverse side effects.

Decision Point One

The first decision was to administer trazodone 50mg PO at bedtime with a follow-up after two weeks. I chose the medication because trazodone is an antidepressant recommended for insomnia because of its sedative effect, which is brought through the antagonism of the HT-2A receptor, H1 receptor, and alpha-1-adrenergic receptors (Lie et al., 2015). Additionally, the drug’s unique property of simultaneously inhibiting the SERT, 5-HT2A, and 5-HT2C receptors make it effective as it has no side effects such as sexual dysfunction and anxiety-like other medication such as dopamine. In patients with acute to chronic insomnia, the recommended starting dose is 25 to 50 mg at bedtime. Depending on its effectiveness, the dose can be titrated up to 100mg daily. The drug is effective as the patient’s symptoms show chronic insomnia lately due to the psychological factor of recent bereavement Treating Insomnia In Young Adults Assignment Paper.

I did not select to administer zolpidem 10mg daily at bedtime because the lower dosage might not have been effective in enhancing the patient’s sleeping. According to (Sateia et al., 2017), the effectiveness of zolpidem, when administered in low quantity, is weak in improving sleep onset, maintenance, and quality. Additionally, zolpidem has been associated with adverse side effects, including nausea, dizziness, nightmare, and agitation. I also did not choose to administer hydroxyzine since it has a relatively long half-life of 20 hours which can cause daytime sedation after nighttime dosing.

The ethical consideration of informed consent might impact the treatment plan and communication with the patient. It is essential to communicate and discuss with the patient the appropriate treatment for them to also decide on the recommended treatment. This might involve communicating the efficacy and side effects associated with the recommended treatment.

Decision Point Two

The second decision was to reduce the trazodone dosage from 50 to 25 mg daily at bedtime. This option was geared towards improving the patient after two weeks; the patient reports the medication is effective and works well. However, he notes that it gives him an unpleasant side effect of an erection lasting up to 15 minutes. According to (Shin & Saadabad, 2022)Treating Insomnia In Young Adults Assignment Paper, trazodone significantly increases total nocturnal erectile activity, especially when taken in high amounts. Trazodone significantly impairs the corpeal smooth muscle contractions brought about by adrenergic nerve stimulation. Therefore, by reducing the dosage, the main goal is to reduce the side effect of prolonged erection while improving the patient’s sleep habits.

I did not choose to administer zolpidem or hydroxyzine because, after the second visit, the patient reported that the medication was working well with only the unpleasant side effect of an erection that affected his work. A follow-up after medication prescription is vital to establish its effectiveness in reducing the symptoms. Discontinuation of certain medications is recommended if there is no improvement of patient symptoms or if the side effects are adverse. In this case, the patient reports the medicine is working well and has reduced insomnia. Additionally, the resulting side effect is manageable with reduced trazodone dosage.

The ethical consideration will involve providing the patient with detailed information and the basis of the treatment option. Additionally, it is essential to communicate other treatment options from which the patient can make an informed decision about the approach they prefer. In this case, it is necessary to share that reducing the dosage might help with the erection and become less effective in reducing the symptoms. With such information, patients can adhere to medication and monitor the side effects.

Decision Point Three

The third decision involves continuing the dose and encouraging sleep hygiene and follow-up. This decision is based on the fact that the patient is already showing substantial response to the trazodone 25mg daily at bedtime. From the previous visit, he reports the medication is very effective for sleep, but sometimes the dosage is not enough to help with sleep. Therefore, it is crucial to assess the patient sleep hygiene to determine if to discontinue a dose. Since the amount is helping with sleep, encouraging proper sleeping hygiene will aid sleep throughout the night( Ellis & Allen, 2019)Treating Insomnia In Young Adults Assignment Paper. The main aim of selecting the decision is for the patient would continue showing signs of symptom improvement and complete symptom remission. The other two options were not chosen because the current dose works effectively with no reported severe side effects. The ethical consideration is respect for person and autonomy, where an individual can make a personal decision regarding treatments and participation in their health.

In conclusion, insomnia is a sleeping disorder that makes falling and staying asleep difficult. The condition is associated with other comorbid psychiatric illnesses, such as anxiety and major depression. Therefore, when establishing a treatment plan, it is vital to have adequate information on patient history to determine the most effective treatment. In treating insomnia, antidepressants in precisie trazodone are recommended. The medication has no reported side effects and is taken at the proper dosage. Thus, for the scenario, trazodone was chosen as the most appropriate medication to help with insomnia.

References

Ellis, J. G., & Allen, S. F. (2019). Sleep hygiene and the prevention of chronic insomnia. Sleep and Health, 137–145. https://doi.org/10.1016/b978-0-12-815373-4.00011-3

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: An update. World Psychiatry, 18(3), 337–352. https://doi.org/10.1002/wps.20674

Lie JD, Tu KN, Shen DD, Wong BM. Pharmacological Treatment of Insomnia. P T. 2015 Nov;40(11):759-71. PMID: 26609210; PMCID: PMC4634348.

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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(02), 307–349. https://doi.org/10.5664/jcsm.6470

Shin JJ, Saadabadi A. Trazodone. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470560/ Treating Insomnia In Young Adults Assignment Paper