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NURS-6630C-8/NURS-6630N-8-Approaches to Treatment-QTR-Term-wks-1-thru-11-(03/01/2021-05/16/2021)-PT27•SafeAssign Drafts•Submitted on Sun, May 02, 2021, 1:34 PMView Originality Report - Old Design
Monica Castelao
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1Patients Requiring Sleep/Wake Therapy
Monica Castelao
Walden University
2April 26, 2021
3Patients With Sleep/Wake Disorders Introduction to the Case
4The current Psychopharmacologic case is of a patient aged 31-year-old male who comes to therapy stating that his insomnia has gotten progressively worse over the past six months.
According to the patient, he has never been a good sleeper, however, he is presently having problems sleeping and sustaining the sleeping condition throughout the night.
5The patient asserts that the problem began approximately six months ago after without knowing lost his fiancé.
6The 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.
7He states he has fallen asleep on the job due to a lack of sleep from the night before.
6The 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.
8The patient has not received a prescription for an opiate analgesic in four years.
9The patient states recently he has been using alcohol to help him fall asleep, approximately four beers before bed.
10The mental problem assessment of the patient indicates that he is alert and oriented to person, place, time, and event.
6He makes good eye contact and is dressed appropriately for the time of year. He denies auditory/visual hallucinations.
2Judgment, insight, and reality contact are all intact.
11The patient denies suicidal/homicidal ideation and is future-oriented.
In the current report, the patient’s treatment options are explained in detail considering the Psychopharmacologic rationale and decisions.
Decision #1:
Begin Trazodone:
650–100 mg Daily at Bedtime
The decision to administer Trazodone was informed by the results of many tests that were conducted on the patient.
It became apparent that the patient was suffering from depression or related mental problems.
Trazodone which is sold and manufactured under different brand names is one of the most effective antidepressant medications.
12It has and still is used to treat many depressive disorders, alcohol dependence, and anxiety in combination with other medications, and suicidal ideation (Fagiolini et al., 2012).
Based on the clinical explanation of the client, it is highly likely that he became depressed after the sudden death of the girlfriend or fiancé.
The decision to introduce him to Trazodone drugs was informed by its effectiveness in the past when working with people with depressive symptoms.
Although the drug has negative side effects such as headache, persistent erection, increased sexual urge, vomiting, dry mouth, and feeling faint, it is effective in managing depressive behaviors.
After beginning Trazodone medication on the patient, he returned to the clinic after two weeks stating that the medication is helping him suppress the symptoms but it makes him have a 15 minutes erection which in many instances hinders him to do what he expected to do with his family.
The patient feels that the erection that he experiences in the morning deter him to prepare for work or even have breakfast with the family.
Luckily, the patient does not have any symptoms of visual hallucinations or auditory hallucination and he remains future-oriented (Brogden et al., 2009).
Morning erection which is also known as priapism is one of the side effects of Trazodone and it is high at the onset of using the drug but its effects minimize as the patient continues to use the drug.
Based on the patient's assertions or claims or observations, Trazodone is working well for him.
Decision #2:
Continue Trazodone:
250 mg Daily at Bedtime
In the second decision, I considered the observations that the client had made and I decided that he continues with Trazodone:
250 mg Daily at Bedtime.
The decision was founded on the patient’s confession that the medication was working well for him.
From the patient's confession when he visited the clinic after two weeks, that many of the side effects had subsided (Stahl, 2009).
The patient is feeling relaxed and well enough to continue with his work despite the effects of the drug.
The patient attests to the fact that morning erections have gone and he is feeling good.
Interestingly, the patient does not report any symptoms of auditory or visual hallucinations and he maintains his future orientation.
The patient noted that the medication is effective and shows no side effects at a 50 mg dose, however, he feels that he in some days wake up with drowsiness symptoms.
The decision to continue the patient on the same medication and dosage was informed by the fact that many of the side effects of the medication were diminishing and the patient was feeling confident that the medication was working (Fagiolini et al., 2012).
At this point, I had to advise the patient that the morning erection was a side effect of Trazodone and it will go with time.
It is encouraging that the patient has realized that the priapism effects have subsided and is only feeling morning drowsiness.
Decision #3:
13Continue with Trazodone at 25 mg Daily at Bedtime
Based on the analysis of the patient, it is clear that the medication is doing wonders to him but the only problem or the side effect of the drug is drowsiness in the morning (Brogden et al., 2009).
In this way, the decision made in the third stage to continue with the medication but at a quarter dose (25 mg was informed by the need to stop morning drowsiness which is affecting the patient.
The side effects may have been caused by the high concentration of the medication which also has a low half-life of about seven hours.
To reduce the drowsiness experience in the patient, the dose has to be reduced further and it is because of this that the decision was made to continue with the drug but reduce the dosage further to only 25 mg at bedtime (Stahl, 2009).
Reducing the dosage will of course reduce the side effects that are associated with the medication and the patient will feel comfortable using the medication until the dose is finished.
Conclusion
Trazodone is one of the most selective serotonin reuptake inhibitors that has been used for a long time in the clinical setting because of its low side effect profile.
Although other medications could be used to treat the current patient, Trazodone is the most preferred one because of its little or low side effects.
A drug such as a sonata could have been prescribed in this case scenario but it will be found ineffective because of the many side effects that are associated with the drug.
The patient in the current case is presenting with the effects of somnolence, in this, it is only good that drugs that will not increase the situation be prescribed.
References
Brogden, R.
N., Heel, R.
C., Speight, T.
M., & Avery, G.
S.
(2009).
Trazodone:
a review of its pharmacological properties and therapeutic use in depression and anxiety.
Drugs, 21(6), 401-429.
14Fagiolini, A., Comandini, A., Dell’Osso, M.
C., & Kasper, S.
(2012).
14Rediscovering trazodone for the treatment of the major depressive disorder.
CNS drugs, 26(12), 1033-1049.
Stahl, S.
M.
(2009).
14Mechanism of action of trazodone: a multifunctional drug.
15CNS spectrums, 14(10), 536-546.
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