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POST # 2 MELISSA

The purpose of the following discussion post will discuss a course of questions related to the following neurological disorders: insomnia. For each diagnosis, review will take place of the pathophysiology, description of two drug categories used in the treatment of the disorder, and analysis of two specific pharmacological agents for each of the two categories. 1. Explanation of the pathophysiology of the diagnosis. 2. Description of the drug category (two per diagnosis): Overview of use/action. 3. Analysis of the specific agents (two per category, four total for each diagnosis): o Pharmacokinetics/pharmacotherapeutics, adverse drug reactions, interactions, monitoring, patient education Insomnia Insomnia is a disorder of sleep that is sometimes characterized within the symptoms of another disorder, and in other individuals the insomnia is a primary and chronic sleep disorder. Insomnia can lead to other health problems if not addressed in a thorough, patient-centered, and constructive manner to promote restful sleep in the patient (Maire et.al, 2020). Some individuals may experience difficulty in sleep onset, and others may have difficulty with sleep maintenance or continuation, which would look like someone having restless sleep, with many awakenings and difficulty falling back asleep once the sleep has been disturbed. Insomnia, even chronic, should not be treated as its own disorder and should be assessed in constellation with any other diagnoses or symptoms that patient has going on, such as anxiety, depression, psychotic disorder, chronic pain, chronic respiratory illness, chronic cardiac illness, as well as assessing if any of the medications that the patient currently takes could have sleep disturbance as an adverse effect (Woo & Robinson, 2020).  Two drug categories that are used in the treatment of insomnia are nonbenzodiazepine hypnotics and benzodiazepine hypnotics. Benzodiazepine hypnotics are those agents that have been approved by the FDA for insomnia and have a benzodiazepine base. Within the GABA molecule is what is referred to as a benzodiazepine receptor. Benzodiazepines increase action of GABA which decreases the effects, or symptoms, of excited neuron activity (Woo & Robinson, 2020). Benzos have a high risk of dependence and abuse and this should only be used for insomnia short term, for up to three weeks, to establish restful sleep and assist in sleep hygiene. They are not indicated in pregnancy, and withdrawal from benzos is similar to that of alcohol, another CNS depressant, and benzos should be slowly tapered for safe discontinuation. In the benzodiazepine hypnotics category, two specific pharmacologic agents used are Halcion and Restoril. Halcion is described as rapid onset and longer acting (Woo & Robinson, 2020, p249). Restoril is described as delayed-onset and intermediate acting (Woo & Robinson, 2020, p249). Non benzodiazepine hypnotics are also thought to act on GABA for decreased neuron excitation response. These agents should not be used in pregnancy and should be used in extreme caution in the elderly if at all. In the nonbenzodiazepine hypnotic category two agents prescribed are Ambien and Sonata. Both of these agents have a short half-life and should be taken immediately before bed. There is a dependence and abuse potential with both of these agents and abrupt cessation of therapy may induce withdrawal symptoms. There could also be acute behavior changes, sleep walking, sleep behaviors that appear like waking behaviors. These medications are meant for short term use, not more than 3 months. Sonata is not protein bound however ambien is 92% protein bound (Woo & Robinson, 2020, p250).   Extensive patient education should include taking the medication directly before sleep and achieving at least 6 hours of sleep. This is especially important to avoid any of the strange behavior change side effects possible with the nonbenzo hypnotics. Sleep hygiene should be extensively reviewed, and the patient should use a sleep journal and be given education materials on making the beahvior changes necessary, consistently, to promote and maintain restful sleep patterns. If sleep is not improved within 2-3 months, a referral should be made to a sleep specialist (Woo & Robinson, 2020). Additionally, cognitive behavioral therapy (CBT) is the first line treatment for insomnia and includes sleep hygiene promotion and education (Maire et.al, 2020).