Posted: September 6th, 2023

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia

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.
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

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This case study involves a 25-year-old male patient who has been experiencing insomnia for the past six months. He has no significant medical history, but he reports a high level of stress and anxiety due to work-related issues. The patient’s primary care physician has recommended pharmacologic interventions to help manage his insomnia. The patient has no known allergies and is not currently taking any medications or supplements. Patient factors that may impact decision-making include age, weight, gender, and other medications the patient may be taking.

Decision #1:

I would recommend the patient start with a non-benzodiazepine hypnotic medication such as zolpidem (Ambien) 5mg at bedtime. This decision is based on the patient’s age and lack of medical history, which make him a good candidate for a shorter-acting, non-benzodiazepine medication. Zolpidem has been shown to be effective in treating insomnia in younger adults, and it has a relatively short half-life, reducing the risk of morning grogginess or residual sedation. Additionally, the recommended dose of zolpidem for men is 5mg, which is lower than the 10mg dose recommended for women, and should reduce the risk of side effects.

I did not select the other two options provided in the exercise because trazodone is known to have a high incidence of adverse effects, including sedation, dizziness, and orthostatic hypotension, and can lead to next-day hangover effects. Additionally, the patient has no history of depression or anxiety, which are the primary indications for trazodone. The use of melatonin as a standalone therapy is not recommended for chronic insomnia as its efficacy is limited, and in some cases, it can exacerbate symptoms.

The goal of this decision is to help the patient achieve better sleep quality and duration without causing adverse effects or creating a dependency on medication. Non-benzodiazepine hypnotics such as zolpidem have been shown to improve sleep quality and increase total sleep time in younger adults, leading to improved mood and daytime functioning.

Ethical considerations are important when prescribing medications to patients, especially those with potential for abuse or dependence. It is essential to inform the patient of the risks and benefits of pharmacologic interventions and to monitor for any adverse effects. Patients should also be educated on the importance of following dosing instructions and not exceeding recommended dosages.

Decision #2:

If the patient continues to experience insomnia after 1-2 weeks of using zolpidem, I would recommend switching to a longer-acting non-benzodiazepine medication such as eszopiclone (Lunesta) 2mg at bedtime. This decision is based on the fact that the patient may develop tolerance to zolpidem over time, and a longer-acting medication may be needed to maintain sleep throughout the night. Eszopiclone has been shown to be effective in treating insomnia in younger adults and has a longer half-life than zolpidem, reducing the risk of early morning sedation.

I did not select the other two options provided in the exercise because increasing the dose of zolpidem beyond 5mg is not recommended due to the increased risk of adverse effects, including dizziness, confusion, and memory impairment. Additionally, adding melatonin to the patient’s regimen would not be effective as a standalone therapy for chronic insomnia.

The goal of this decision is to improve the patient’s sleep quality and duration and reduce the risk of developing a tolerance to medication. Eszopiclone has been shown to improve sleep quality and increase total sleep time in younger adults, leading to improved mood and daytime functioning.

Ethical considerations when switching medications include informing the patient of the potential for