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. Consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes
Assessing and Treating Patients with Sleep/Wake Disorders
The case presented is of a 31-year-old male presenting with insomnia. His insomnia began six months ago after he lost his fiancee. The patient’s insomnia has been progressively worsening over the past six months. In addition, he reports that he has had a history of sleeping problems and often had difficulties maintaining sleep. Currently, he is having difficulties in both maintaining and falling asleep.
The patient reports that he has been using diphenhydramine to help with his sleep but does not like the morning-after feeling. He also says that he has recently been using alcohol to induce sleep. The patient’s social history reveals he works as a folk lift operator at a local chemical company. He notes that his insomnia affects his operability as he sometimes falls asleep on the job. His past medical history reveals opiate abuse. This began after breaking his ankle during a skiing accident and being prescribed a hydrocodone and acetaminophen combination to manage his pain.
The mental status exam revealed that he is alert and oriented to person, event, time, and place. The patient has dressed appropriately for the time of the year. The patient also makes good eye contact. The patient denies having auditory or visual hallucinations. His judgment, contact with reality, and insight are also still intact. He also denies having any suicidal ideation or tendencies. The patient is also orientated to the future.
The case study describes a patient who has a positive diagnosis of insomnia. Insomnia is a sleep disorder characterized by difficulties inducing and maintaining sleep. Individuals with this disorder often experience multiple night awakenings and fail to achieve restorative sleep (Kaur et al., 2022). Functional deficits are usually apparent in this disorder and are attributable to fatigue, irritability, and lack of concentration that accompanies the disorder.
Decision Point 1
The initial intervention for the patient is to administer trazodone 50mg every 24 hours at bedtime. Trazodone is a serotonin antagonist and reuptake inhibitor. This medication is used in the off-label management of insomnia and other sleep disorders. Research findings reveal that trazodone effectively improves sleep duration and sleep latency and promotes daytime wakefulness (Wang et al., 2020). The patient in the case may benefit from this medication.
The other two options provided are equally effective in the management of insomnia. Their use is, however, limited by their intolerable toxicity profile. Zolpidem has been associated with headaches, dizziness, and nasal stuffiness that may affect the patient’s operability during the day (Xiang et al., 2021). Hydroxyzine also causes headaches, dizziness, and xerostomia, which may also affect the patient’s functionality during work. Trazodone maintains higher efficacy in managing insomnia and has tolerable side effects. Additionally, the desired outcome of maintaining wakefulness during work hours is only effectively and optimally achieved with trazodone.
The choice of trazodone aims to enhance the patient’s sleep quality and optimize daytime operability. Trazodone maintains superiority in managing insomnia as it improves sleep latency and duration and promotes daytime wakefulness. These features are the most desired in the patient as he works as a machine operator and requires maximum alertness when executing his duties. When administering this medication, the patient should be educated on the anticipated side effects of the drug. He should also be advised to report these side effects. Before initiating therapy, informed consent should be obtained from the patient. Confidentiality between the patient and his caregiver is also important.
Decision Point 2
The decision is to decrease the dose of trazodone to 25mg daily at bedtime. The patient’s report on return to the clinic confirmed the effectiveness of trazodone in managing insomnia. The patient stated that the medication worked well except for the side effects. Trazodone maintains effectiveness in managing insomnia but may elicit unwanted effects when used at conventional doses in depression. These side effects include headaches, prolonged erections, and dizziness. A dose reduction from 50mg to 25 mg is necessitated in this patient because of complaints of prolonged erection reported by the patient. Trazodone dose reduction lessens its side effects while maintaining its effectiveness in managing insomnia. In the patient case presented, halving the dose may eliminate the side effects encountered with the initial dose.
Discontinuing trazodone is not warranted in this case. This is because the patient has started responding to the medications. The benefits of continuing with this reg