Go to this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html
Follow these steps:
Decision Point One- Click \”Trazodone 50mg\”
Decision Point Two- Click \”Explain than an erection lasting 15 min…\”
Decision Point Three- Click \”Continue dose. Explain to patient he may…\”
Assignment Paper-
The Assignment: 5 pages
Examine Case Study: 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.
-Page 1: Introduction
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.
– Page 2: Decision #1
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.
-Page 3: Decision #2
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.
-Page 4: Decision #3
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.
-Page 5: Conclusion
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.
Treating Patients with Sleep/Wake Disorders
Name
Institution
Date
Treating Patients with Sleep/Wake Disorders
Introduction
The patient case study presented is about a 31-year-old male patient who comes to the clinic with the chief complaint of insomnia. The patient claims that he has experienced the problem for the past 6 months after the death of his fiancé. The problem has affected his way of life and work. He falls asleep during the day affecting his productivity since he works as a forklift operator. More so, he has been taking four beers every night to help him fall asleep. His medical records indicate that he has a history of opiate abuse, which he began after getting into a skiing accident where he was prescribed acetaminophen for pain management. It is also vital to note that for the past four years, the patient has not had a prescription for an opiate analgesic.
The patient’s mental status exam indicates that he is oriented to time, place and event. He has dressed appropriately for the occasion and weather. He denies hallucinations or even suicidal ideations. He makes eye contact throughout the session. Nursing professional standards require that the nurses promote a patient’s well-being by causing minimal or no harm. Based on the patient’s history of opiate abuse, the clinician should design a plan aimed at preventing further dependency and abuse of drugs. Another factor that should be looked into is the side effects of the drug. The patient’s previous experience with diphenhydramine was not favorable and posed risk due to his nature of work. Diphenhydramine is an antihistamine with anticholinergic effects such as sedation (Randall & Hawkins, 2018).
Decision 1- Administer Trazodone 50 mg daily at Bedtime
The first decision is to administer Trazodone 50 mg daily at bedtime. According to Wang et al. (2020), Trazadone is an antidepressant, which is prescribed off-label to manage insomnia using a dosage of between 25 mg to 100 mg. A starting dosage of 50 mg would be effective in improving the patient’s sleeping patterns as well as regulating his mood.
The other two drugs indicated as choices for decision one were Zolpidem 10 mg daily at bedtime and Hydroxyzine 50 mg daily at bedtime. Zolpidem is a drug in the class of imidazopyridine. The drug is used to treat insomnia and is a sedative-hypnotic. Sedative hypnotics are associated with a high risk of self-injury to patients due to dependence and behavioral changes. The mediation would therefore not be suitable for the patient due to its side effects and the nature of his work as a forklift operator. The second medication, hydroxyzine is an antihistamine in the same class as the previous medicine, diphenhydramine which the patient had not liked the side effects. The drug could not have been a better choice due to its less tolerable properties.
Therefore, the choice of Trazodone as a first-line treatment for insomnia would have not only improved his sleep patterns but also his mood. It is vital to acknowledge that the insomnia symptoms began immediately after the death of his fiancé; hence, it could be assumed that it is depression-related insomnia. Trazodone manages both insomnia and depressive symptoms.
Ethical considerations are of great significance when choosing a pharmacological agent to manage a patient’s symptoms. Decision 1 was based on non-maleficence which requires that a healthcare practitioner not do any harm to a patient. A comparison of the three medications shows that Trazodone has the most effective therapeutic effects and is better tolerated as compared to the other two.
Decision 2- Continuation of the Current Dose of Trazodone at 50 mg Daily at Bedtime
After two weeks of being on Trazadone 50 mg daily at bedtime, the patient returns to the clinic. He claims that the medication has improved his sleeping patterns however has an unpleasant side effect of giving him an erection that lasts 15 minutes after waking up. The patient claims that the long-lasting erection makes it difficult for him to get ready for work or even go downstairs to have coffee with his girlfriend and daughter. The patient however denies any hallucinations and has a future orientation.
The decision was selected as a continuation of the current dose. The clinician explained to the patient that the erection lasting fifteen minutes is considered priapism and will therefore diminish over time. During the visit, the patient notes that Trazodone at 50 mg daily at bedtime has been effective but sometimes he wakes up the following day with drowsiness. At this stage, it would not be advisable to change the medication based on the reported effectiveness and tolerance of the patient.
The other two options of stopping the administration of Trazodone 50 mg and initiating a new therapy of Suvorexant or lowering the Trazadone therapy to 25 mg were not chosen because they could not provide the patient with optimal therapeutic effects. Suvorexant is in a class of medications known as orexin receptor antagonists. The medication is used to manage insomnia by helping the patients sleep longer. However, the medication has been associated with a high risk of abuse. Based on the patient’s history of opiate abuse, the medication would not be recommended. More so, the medication has been evidenced to impair mental and physical capabilities among patients (Kuriyama & Tabata, 2017). It would hence affect his work as a forklift operator. Reducing the dosage to 25 mg daily at bedtime would not be enough to make the patient sleep through the night.
The ethical consideration addressed in this decision point is patient autonomy. The clinician puts into consideration the patient’s views about the medication that he has been put on. For example, the patient notes that the medication has been causing an erection lasting 15 minutes as well as drowsiness. The clinician however using his medical knowledge assures the patient that the side effects will go away after some time.
Decision 3- Continue Trazodone at 25 mg Daily at Bedtime
After two weeks, the patient returns to the clinic. He confirms that the priapism has diminished over time. He claims that Trazodone 50 mg dose is effective but usually makes him wake up the next day with drowsiness. The patient denies visual/audio hallucinations and is future-oriented.
The decision that was reached at this point was to continue the Trazodone dose. The patient was however explained that he may split the 50 mg tablet into two. The decreased dose is expected to minimize the level of drowsiness in the patient. A lower dosage of Trazodone as a maintenance dose is effective in maintaining positive sleep patterns while at the same time having more tolerable side effects (Wang et al., 2020). Since the patient has been presenting with somnolence, there was a need to reduce the dose by 50 percent and reassess the patient’s reactions after four weeks.
The other three options were not viable for the patient’s case. Sonata is a sedative-hypnotic. The drug is a non-benzodiazepine hypnotic and is from the pyrazolopyrimidine class. The drug has the risk of complex sleep behaviors. Hence, it would not be suitable for the patient based on his nature of work as it exposes him to the risk of injuring himself and others. Sonata (Zaleplon) has adverse side effects such as memory loss, dizziness, hallucinations, gastrointestinal upset, and disinhibition (Matheson & Hainer, 2017). The other option that would not be feasible for the patient’s case is hydroxyzine. Hydroxyzine is an antihistamine, which has strong sedative properties. Patients prescribed the medication usually complain of anticholinergic side effects such as Xerophthalmia and Xerostomia.
Ethical considerations that would need to be put into place, in this case, would regard patient safety concerning the medications’ adverse effects. The principle of beneficence states that the physician must act for the benefit of the patient by preventing harm and removing conditions that are likely to cause harm (Varkey, 2021). The choice to lower the dosage rather than introduce a new drug shows the commitment to preventing harm.
Conclusion
Based on the patient case study, the best decision reached was for the patient to be administered Trazodone at a starting dose of 50 mg and a maintenance dose of 25 mg. The change in the drug dosage was attributed to the experienced side effects that affected the patient’s functioning and quality of life. As compared to the other medication choices, Trazodone was the best drug based on its profile and more tolerable side effects. The lower dosage of Trazodone would be effective in managing the patient’s sleep patterns while at the same time having minimal side effects that would ensure his work as a forklift operator was not affected.
References
Kuriyama, A., & Tabata, H. (2017). Suvorexant for the treatment of primary insomnia: a systematic review and meta-analysis. Sleep Medicine Reviews, 35, 1-7. https://doi.org/10.1016/j.smrv.2016.09.004.
Matheson, E., & Hainer, B. L. (2017). Insomnia: Pharmacologic Therapy. American family physician, 96(1), 29-35.
Randall, K. L., & Hawkins, C. A. (2018). Antihistamines and allergy. Australian prescriber, 41(2), 41–45. https://doi.org/10.18773/austprescr.2018.013
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119
Wang, J., Liu, S., Zhao, C., Han, H., Chen, X., Tao, J., & Lu, Z. (2020). Effects of Trazodone on Sleep Quality and Cognitive Function in Arteriosclerotic Cerebral Small Vessel Disease Comorbid With Chronic Insomnia. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00620