Applied Sciences Assignment 1 and 2

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Assignment #1

As you complete this assignment, please keep in mind that you are to concisely answer the following questions within the stated guidelines. Your answers should be short, to the point, and address only what the question is asking. Be sure to include references to the Resources for this week.

· In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of depressive symptoms?

· List 4 predictors of late onset generalized anxiety disorder.

· List 4 potential neurobiology causes of psychotic major depression.

· An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

· List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

Here are some resources to use for this assignment:

· Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

· Chapter 10, "Disorders of Sleep and Wakefulness and Their Treatment: Neurotransmitter Networks for Histamine and Orexin" (pp. 401-448)

· American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

· Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health.

Current Psychiatry ReportsLinks to an external site. , 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8

· Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. ChestLinks to an external site. , 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

· Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEPLinks to an external site. , 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

· Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP Links to an external site. , 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

· 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 MedicineLinks to an external site. , 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

· Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of MedicineLinks to an external site. , 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740

Assignment # 2

five-page paper on the case entitled Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.

I ntroduction to the case (1 page)

· You must briefly summarize the case in your own words.

· You must also highlight the specific patient factors that will impact your decision making when prescribing medication for this patient. To clearly identify patient-specific factors, please begin your sentence with, “The patient-specific factors I will consider as I make my decisions are…” Beginning your sentence with this phrase will help me recognize it and will ensure that you get credit for it. You will not get credit for simply mentioning patient-specific factors within your case summary; they must be clearly identified and revisited.

· Please note that background information on the diagnosis, diagnostic criteria, diagnostic testing, or epidemiology is NOT required. It is assumed that you know this; therefore, you should devote yourself to summarizing the case and highlighting specific patient factors that will impact your decisions rather than discussing the aforementioned items. After all, you only have one page (or less) to cover the required information.

· Be aware that the writing template and grading rubric require your introduction to end with ONE sentence that is your thesis statement. See the writing template for format and the grading rubric for details on how you are graded on this statement.

Body of your document

· The body of your document should contain three sections that are labeled as follows: decision point 1, decision point 2, and decision point 3. Each section should be one page and address the topics below. In your writing, you should be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.

Decision Point 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. *In order to receive full credit here, your ethical considerations must be clearly identified as such. You can identify them in one of two ways: (1) You can identify them within each "decision" section. For example, “My ethical considerations are….” (2) Or you can identify them separately in a new section labeled “Ethical Considerations.” This new section should be inserted after the section entitled Decision Point 3 and before the Conclusion section. Either one of these options is acceptable.

Decision Point 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.

· 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. *See Decision #1 for more information.

Decision Point 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.

· 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. *See Decision #1 for more information.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. As stated in the writing template, “The conclusion section should recap the major points of your paper. Do not introduce new information in this paragraph.”

CASE STUDY (Insomnia) 31 Year old male:

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient's medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtime

Trazodone 50 mg po at bedtime (CORRECT CHOICE)

Hydroxyzine: 50 mg daily at bedtime

Results from the decision made;

RESULTS OF DECISION POINT ONE

· Patient returns to clinic in 2 weeks

· Patient states medication works well but gives him an unpleasant side effect of an erection lasting approximately 15 minutes after waking

· Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning

· Patient denies auditory/visual hallucinations and is future oriented

· Decision Point Two

· Select what you should do next:

· Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with current dose (CORRECT CHOICE)

· Discontinue trazodone. Initiate therapy with suvorexant 10 mg daily at bedtime

· Decrease trazodone to 25 mg daily at bedtime

RESULTS OF DECISION POINT TWO

· Patient returns to clinic in 2 weeks

· Patient states priapism has diminished over time

· Patient denies auditory/visual hallucinations and is future oriented

· Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness

· Patient denies auditory/visual hallucinations and is future oriented

· Decision Point Three

· Select what you should do next:

· Discontinue trazodone. Initiate therapy with sonata 10 mg nightly at bedtime. Follow up in 4 weeks

· Discontinue trazodone. Initiate therapy with hydroxyzine 50 mg at bedtime. Follow up in 4 weeks

· Continue dose. Explain to patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks (CORRECT CHOICE)

Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.

The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.

Applied Sciences Assignment 1 and 2

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