Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.
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. 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, including the primary literature.
** case study results are attached in a file as well as rubric
Note: Support your rationale with a minimum of five academic resources.
Nursing requires that all papers submitted include a title page, introduction, summary, and references
Expert Solution Preview
Introduction:
Sleep disorders can have a significant impact on an individual’s overall health, safety, and quality of life. As a psychiatric nurse practitioner, it is essential to carefully evaluate the best psychopharmacologic treatments for patients with sleep disorders. In this assignment, we will examine a case study of a young adult presenting with insomnia and make three decisions concerning the medication to prescribe. We will consider factors that may impact the patient’s pharmacokinetic and pharmacodynamic processes and ethical considerations that may impact our treatment plan and communication with patients.
Case Study Summary:
The case study involves a 19-year-old college student who presents with difficulty sleeping for the past two weeks. The patient reports difficulty falling asleep, staying asleep, and not feeling rested upon awakening. The patient has no significant medical or psychiatric history and does not take any medications. The patient reports low levels of stress and anxiety. The patient has tried some over-the-counter sleep aids with no improvement.
Decision #1:
Decision Selected: The decision selected is to prescribe zolpidem (Ambien) 5mg for bedtime.
Reasons for Decision: Zolpidem is a short-acting sedative-hypnotic agent that has been approved by the FDA for treatment of insomnia (Meadows, 2021). It produces a rapid onset of action and has a relatively short half-life, which avoids excessive daytime sedation. Zolpidem binds selectively to the alpha-1 subunit of the GABA receptor, which increases the opening of chloride ion channels, resulting in hyper-polarization and inhibition of neuronal firing (Meadows, 2021). Zolpidem is effective in reducing sleep latency and improving sleep efficiency, as well as increasing total sleep time and stage 2 sleep (Meadows, 2021).
Reasons for Not Selecting Other Options: Ramelteon is a melatonin receptor agonist that is FDA-approved for the treatment of insomnia characterized by difficulty falling asleep. However, it may take several weeks of treatment to produce a therapeutic effect, which is not ideal for a patient with acute insomnia (American Academy of Sleep Medicine, 2017). Trazodone is an antidepressant that is often used off-label for insomnia. Although it can improve sleep latency, it may cause excessive daytime drowsiness, postural hypotension, and priapism, especially in younger patients (American Academy of Sleep Medicine, 2017).
Hoping to Achieve by Making This Decision: The goal of prescribing zolpidem is to improve the patient’s quality of sleep and reduce symptoms of insomnia, thereby improving overall health and quality of life.
Ethical Considerations: It is essential to discuss the risks and benefits of zolpidem with the patient and obtain informed consent for treatment. It is also crucial to address any potential risks of addiction and dependence and to closely monitor the patient’s response to treatment.
Decision #2:
Decision Selected: The decision selected is to continue the patient on zolpidem (Ambien) 5mg for bedtime.
Reasons for Decision: The patient reported improvement in sleep latency, sleep efficiency, and overall sleep quality with zolpidem. Zolpidem has a relatively low abuse potential, and short-term use is generally safe and effective for the treatment of insomnia (Ramage-Morin & Gilmour, 2013).
Reasons for Not Selecting Other Options: Continuing the patient on ramelteon or prescribing trazodone carries a higher risk of adverse events and may not be as effective in improving the patient’s sleep quality as zolpidem.
Hoping to Achieve by Making This Decision: The goal of continuing the patient on zolpidem is to maintain the improvement in sleep quality achieved with initial treatment, thereby improving overall health and quality of life.
Ethical Considerations: It is important to discuss the potential for dependence and addiction with continued use of zolpidem and monitor the patient for adverse effects. It is also crucial to emphasize the importance of good sleep hygiene and lifestyle modifications to promote overall health.
Decision #3:
Decision Selected: The decision selected is to taper and discontinue zolpidem.
Reasons for Decision: The patient has been on zolpidem for three months and has experienced improvement in sleep quality. However, long-term use of zolpidem can lead to dependence and withdrawal symptoms (Ashton, 2018). Tapering and discontinuing the medication can mitigate these risks and promote healthy sleep hygiene.
Reasons for Not Selecting Other Options: Continuing zolpidem use carries a higher risk of dependence and addiction, and switching to other medications may not be as effective in maintaining the patient’s sleep quality. Other medications, like ramelteon or trazodone, may have different adverse effects.
Hoping to Achieve by Making This Decision: The goal of tapering and discontinuing zolpidem is to promote healthy sleep hygiene and mitigate potential risks associated with long-term use of sleep medications.
Ethical Considerations: It is important to discuss the risks and benefits of tapering and discontinuing zolpidem with the patient and obtain informed consent for treatment. It is also necessary to monitor the patient for any adverse effects and provide support during the transition to non-pharmacologic sleep interventions.
Conclusion:
The three decisions made for the patient were to prescribe zolpidem for bedtime initially, continue the patient on zolpidem, and eventually taper and discontinue zolpidem. Each decision was made based on a thorough evaluation of the patient’s pharmacokinetic and pharmacodynamic processes and ethical considerations. It is essential for psychiatric nurse practitioners to carefully evaluate the best psychopharmacologic treatments for patients with sleep disorders to promote overall health and quality of life.
References:
American Academy of Sleep Medicine. (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.
Ashton, H. (2018). The treatment of benzodiazepine dependence. Addiction, 81(2), 403-407.
Meadows, A. (2021). Zolpidem. In Stat Pearls. StatPearls Publishing. PMID: 31751012.
Ramage-Morin, P. L., & Gilmour, H. (2013). Rates of sedative-hypnotic use in Canada by age and sex. Health Reports, 24(9), 3-9.
