coursework-banner

NURS 6630 treatment of Insomnia

NURS 6630 treatment of Insomnia

NURS 6630 treatment of Insomnia

Reason for Selection

For this particular case, trazodone is the drug for use in the management. From Randomized Clinical Trials on Trazodone use in the treatment of Insomnia, it was highly efficacious in maintaining sleep by reducing the number of awakenings during sleep, it remarkably improved the quality of sleep, and was well tolerated by a majority of patients in short-term treatment (Wichniak et al., 2021). In primary Insomnia, a combination of CBT and Trazodone was found to have the highest efficacy in reducing sleep latency. Trazodone has a half-life of 12 hours with a peak plasma concentration of four hours. When trazodone is taken 1-2 hours before bedtime, it can reduce sleep latency. Trazodone reduces the risk of relapse in alcohol-dependent patients. Hypnotics like Zolpidem reduce the quality and depth of sleep and has a higher risk of drug dependence. As a result, Zolpidem is not effective in the treatment of patients with poor quality sleep insomnia (Wichniak et al., 2021). Zolpidem is also associated with adverse effects such as anterograde amnesia and an increased risk of falls. Concerning Hydroxyzine, it is only indicated for the treatment of accidental insomnia (Krysta, 2020). It is also associated with marked sedation and increased morning drowsiness. The use of hydroxyzine in the management of insomnia is highly unpopular due to hyperacute tolerance and increased daytime somnolence (Albrecht et al., 2019).  There is no further literature that justifies its use.

Expectations

From the treatment with Trazodone, there is an expected reduction in sleep latency, increased duration of sleep, reduced number of awakenings during sleep, and a general increase in sleep quality. As the patient is currently dependent on alcohol for sleep, trazodone will work to reduce the relapse. There is also an expected clearing of the depressive symptoms that are set in.

Ethical Considerations

Ethical considerations of beneficence, justice, non-maleficence, and confidentiality go a long way in the management of the patient. These are achieved through explaining the illness to the patient. Psychosocial therapy like CBT requires the help of family members. Through this, the patient needs to understand there is a need for breach in confidentiality (Barber, 2017). Providing the patient with the best pharmacotherapy for the illness based on research and current studies. The need to employ a clinical innovation poses an ethical risk as these are auxiliary to the main course of treatment and have not been adequately researched though they possess an advantage such as sleep restriction therapy in insomnia. Proper communication between the caregiver and the patient provides an enabling environment for the treatment of both somatic and psychological disorders.

Decision 2

Explain to the patient that an erection lasting fifteen minutes is not considered priapism and should diminish over time and the patient to continue with the current dosage of Trazodone.

Reason for Selection

Priapism affects less than 1% of low-dose trazodone users (Shah et al., 2021). Priapism is a prolonged painful erection ideally lasting more than four hours. The 15-minute early morning erection does not qualify as priapism. It vital to watch out for these adverse effects among others to ensure early management. Suvorexant is rejected as it is associated with an increased number of awakenings and abnormal dreams. These greatly impair the quality and duration of sleep (Xue et al., 2022). The dual orexin receptor agonists have not been adequately compared to trazodone. Suvorexant has a higher efficacy in associated motor insomnia (Janto et al., 2018). Trazodone brought a huge improvement in the patient and there would not be any need to change the medication. Reducing the dosage of trazodone to 25mg at bedtime was rejected as the unpleasant side effect could not be attributed to trazodone. Moreover decreasing the dose just after a short course may lead to rebound insomnia (Jaffer et al., 2017). This makes this decision unsuitable.

Expectations

The expectations are that the prolonged erection will abate over time and the action of trazodone of reducing sleep latency and maintaining sleep will continue due to the low tolerance of the body to these effects. The patient should tolerate the drug with minimal side effects as only the low doses are used.

Ethical considerations

Constant continuous counseling on adherence is prime. Counseling the patient on the features of side effects such as priapism and hallucinations and the need for an immediate clinic visit when any of the adverse effects occur (Barber, 2017). Continue the perfect doctor-patient relationship to allow for ease of communication of the patient’s concerns

Decision 3

Continue dose. Explain to the patient that he may split the 50mg in half

Reason for selection

One of the main side effects of trazodone is morning drowsiness. This is due to its long half-life which is 12 hours. To reduce the symptoms, a reduction in the dosage is employed. The effective dose for insomnia ranges from 25mg to 200mg per day. A titration of the dosage to the lowest effective dose confers a reduction in the side effects (Jaffer et al., 2017). Monitoring and follow-up are important in appropriately managing any other side effects. Sonata is suitable for induction of sleep. It reduces sleep latency. It has a short half-life, and this leads to an increased number of awakenings in its use from randomized clinical trials. This makes it poor at the maintenance of sleep. The use of Hydroxyzine an H1 receptor antagonist is widely shunned due to its hyperacute tolerance and increased daytime somnolence. The use of hydroxyzine is likely to worsen morning drowsiness (Albrecht et al., 2019). Sedation is the main feature of this drug. Discontinuation of trazodone needs to be in a step-wise fashion, not abrupt.

This week, you will explore how medication adherence can impact a patient’s success with treatment. You will examine the epidemiology of adherence, the impact of non-adherence from a clinical and economic viewpoint, risk factors for non-adherence, assessing adherence, and integrating adherence into a treatment plan. You will also complete a self assessment to test your understanding of this module’s content.

Photo Credit: Getty Images

By Day 7

Complete the 20-question Quiz to gauge your understanding of this module’s content.

Submission Information

Submit Your Quiz by Day 7

To submit your Quiz:

Week 3 Quiz

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will begin to apply your assessment and therapy skills in treating patients for disorders with affective components.

Next Module

To go to the next module:

Module 2

Week 3: Concepts in Assessing Medication Adherence and Strategies to Mitigate Non-Adherence

Adherence to psychiatric treatments is a widespread clinical issue that has a negative impact on treatment response and remission rates. While empirically supported treatments for many psychiatric disorders are available, they are not universally effective. Patients frequently struggle to take prescribed psychotropic medications or attend recommended psychotherapy sessions, and as a result, may not achieve optimal results.

—Traeger, L., Brennan, M. M., & Herman, J. B. (2016, p. 20)

This week, you will explore how medication adherence can impact a patient’s success with treatment. You will examine the

epidemiology of adherence, the impact of non-adherence from a clinical and economic viewpoint, risk factors for non-adherence, assessing adherence, and integrating adherence into a treatment plan. You will also complete a Quiz to test your understanding of this module’s content.

Reference:
Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier. NURS 6630 treatment of Insomnia 

NURS 6630 Quiz Neurobiology and Medication Adherence Concepts

Learning Objective

Students will:

  • Identify concepts related to neuroanatomy, receptor theory, and medication adherence in psychopharmacology

Learning Resources

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 treatment of Insomnia

Required Readings (click to expand/reduce)

Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.

Fialko, L., Garety, P. A., Kuipers, E., Dunn, G., Bebbington, P. E., Fowler, D., & Freeman, D. (2008). A large-scale validation study of the medication adherence rating scale (MARS). Schizophrenia Research, 100(1–3), 53–59. https://doi.org/10.1016/j.schres.2007.10.029

LaMorte, W. W. (2019). The transtheoretical model (stages of change). Boston University School of Public Health. https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html

The transtheoretical model of health behavior change by Prochaska, J. O., & Velicer, W. F., in American Journal of Health Promotion, Vol. 12/ Issue 1.

Copyright 1997 by Sage Publications, Inc.Reprinted by permission of Sage Publications, Inc. via the Copyright Clearance Center.

Required Media (click to expand/reduce)

Centers for Disease Control and Prevention. (2017). Overcoming barriers to medication adherence for chronic diseases [Video]. https://www.cdc.gov/grand-rounds/pp/2017/20170221-medication-adherence.html

Quiz: Neurobiology and Medication Adherence Concepts

Photo Credit: Getty Images

By Day 7

Complete the 20-question Quiz to gauge your understanding of this module’s content.

Submission Information

Submit Your Quiz by Day 7

To submit your Quiz:

Week 3 Quiz

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will begin to apply your assessment and therapy skills in treating patients for disorders with affective components.

Next Module

To go to the next module:

Module 2

week 2 discussion
  1. Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

An agonist-to-antagonist spectrum of action of psycho pharmacologic agents, -is explained as when a chemical binds or connect to a receptor, the receptor activates, and a biological response is produced. When agonists activate receptors, like hormones, neurotransmitters, and other endogenous regulators that activate the receptors to which they bind (Golier, J. A., & Yehuda, R. (2018). Antagonists have no effects on the receptor function, but it can block effectiveness and prevent receptor activation by endogenous molecules and drugs(Golier, J. A., & Yehuda, R. (2018).The antagonist can be a drug with an affinity to bind to a receptor but does not have any intrinsic activity.  The process is considered an example of a full agonist (Golier, J. A., & Yehuda, R. (2018).  A partial agonist means that the molecules do not elicit a full response therefore does not obtain the maximum response from system even when they bind to the same number of receptors as an agonist (Golier, J. A., & Yehuda, R. (2018). When there is an agonist and a partial agonist working at the same time the partial agonist becomes an antagonist because they are both fighting for space on the same receptors (Frånberg, O et al).. An antagonist refers to molecules that block agonist mediated responses. Inverse agonists are molecules that want to attach to the same receptors as agonists, but they produce an opposite response than the agonist on the target cell (Golier, J. A., & Yehuda, R. (2018).

  1. Compare and contrast the actions of g couple proteins and ion gated channels.

G protein-coupled receptors (GPCRs) are a large family of cell surface receptors on the plasma membrane that transmit signals inside the cell through a type of protein called a G protein (Sunamita de Carvalho et al 2018).  G protein-coupled receptors serve many purposes in the body, and the disorder of GPCR signaling can cause disease. G proteins bind with nucleotide guanosinetriphosphate (GTP) (Sunamita de Carvalho et al 2018). G protein divides into two portions (one called the α subunit, the other consisting of the β and γ subunits), which are released from the GPCR (Sunamita de Carvalho et al 2018). The subunits can interact with other proteins, triggering other signaling pathways that lead to different responses.

When communication is allow to  occur from  one cell to  the next cell through a lipid membrane, charged molecules need assistance in the form of ion channels (Sunamita de Carvalho et al 2018). Ion channels control cellular excitability by using membrane-bound glycol proteins that contain pores filled with water (ion channels) which allows for the charged molecules to move from an extracellular to intracellular (Sunamita de Carvalho et al 2018). Charged molecules can go into the cell while allowing for uncharged molecules to move out of the cell in an organized, efficient manner. This movement of ions is important in the role of cell excitation, muscle contraction and intracellular signaling (Weir, 2020). G-protein-coupled receptors (GPCRs) are the largest category of receptors allowing for the bodies physiological function (Sunamita de Carvalho et al 2018). Most medications are made to target GPCRs due to their large distribution throughout the body. They are necessary membrane proteins used by cells to convert extracellular signals into intracellular responses by using hormones (Sunamita de Carvalho et al 2018).

  1. Explain how the role of epigenetics may contribute to pharmacologic action.

Epigenetics is when the expression of a gene can be controlled, promoting or repressing the expression of the gene without changing the code or genome’s sequence (Kumsta, R. 2019).Epigenetics is  gene function is changed by an adaptation in the code. The role of epigenetics may contribute to pharmacologic action by changing a DNA molecule, resulting in amended gene expression. When a DNA molecule is amended, then pharmacologic action is then modified. Gene articulation can be modified because of the variation of the DNA molecule chromatin. Long-term effects of cognition and behavior can be a result of the alteration of development brought on by abuse or mistreatment in childhood (Kumsta, R. 2019). Heritability is an effect of gene expression changes in the long-term

  1. Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

As a provider, when prescribing medication, it is necessary to treat each patient as individual patient with his or her own familiar history. The assessment should include genetic questing that will be use for the implementation of diagnosing implementation for treatment. Will also access for allergy since most antipsychotics’ medication are commonly cause allergy reaction. Closely monitor medications prescribed for the treatment of psychosis and behavioral and psychological symptoms of dementia in elderly patients for any adverse reaction (Kumsta, R. 2019)   Monitoring should always continue; it should not only be at the beginning of the therapy because patient can develop tolerance to medication and eventually medication or doses that use to work might not work. Doses should be monitor and adjusted appropriately.   Also, since aging can affect drug metabolism and clearance, additional pharmacokinetic and pharmacodynamic changes  require additional attention (Kumsta, R. 2019).

References:

Sunamita de Carvalho Lima, Lucas de Carvalho Porta, Álvaro da Costa Lima, Joana D’Arc Campeiro, Ywlliane Meurer, Nathália Bernardes Teixeira, Thiago Duarte, Eduardo Brandt Oliveira, Gisele Picolo, Rosely Oliveira Godinho, Regina Helena Silva, & Mirian Akemi Furuie Hayashi. (2018). Pharmacological characterization of crotamine effects on mice hind limb paralysis employing both ex vivo and in vivo assays: Insights into the involvement of voltage-gated ion channels in the crotamine action on skeletal muscles. PLoS Neglected Tropical Diseases12(8), e0006700. https://doi.org/10.1371/journal.pntd.0006700

Frånberg, O., Wiker, C., Marcus, M., Konradsson, Å., Jardemark, K., Schilström, B., Shahid, M., Wong, E., & Svensson, T. (2008). Asenapine, a novel psychopharmacologic agent: preclinical evidence for clinical effects in schizophrenia. Psychopharmacology196(3), 417–429. https://doi.org/10.1007/s00213-007-0973-y

Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. Psychology and Psychotherapy: Theory, Research and Practice92(2), 190–207. https://doi.org/10.1111/papt.12227

Golier, J. A., & Yehuda, R. (2018). Mifepristone as a Psychopharmacologic Agent: Consideration of Efficacy, Plasma Levels, and Mechanism of Action. Biological Psychiatry84(1), 5–