Question

S.H., age 47, reports difficulty falling asleep and staying asleep. These problems have been ongoing for many years, but she has never mentioned them to her health care provider. She has generally “lived with it” and self-treated the problem with OTC Tylenol PM. Currently, she is also experiencing perimenopausal symptoms of night sweats and mood swings. Current medical problems include hypertension controlled with medications. Past medical history includes childhood illnesses of measles, chickenpox, and mumps. Family history is positive for diabetes on the maternal side and hypertension on the paternal side. Her only medication is an angiotensin-converting enzyme inhibitor and diuretic combination for hypertension control. She generally does not like taking medication and does not take any other OTC products.

Diagnosis: Insomnia

Answer the following questions. Include two references, cited in APA style.

1-List specific goals of therapy for S.H.

2-What drug therapy would you prescribe? Why?

3-What are the parameters for monitoring the success of the therapy?

4-Discuss specific patient education based on the prescribed therapy.

5-List one or two adverse reactions for the selected agent that would cause you to change therapy.

6-What would be the choice for second-line therapy?

7-What OTC and/or alternative medicines might be appropriate for this patient?

8-What dietary and lifestyle changes might you recommend?

9-Describe one or two drug–drug or drug–food interactions for the selected agent.

Please answer all 9 quistion in details

Answer 1

1) Goals of therapy

• To achieve a good sleeping pattern for SH
• Health educate about the harmful effects of OTC medications
• Make her aware of perimenopausal symptoms and to manage it effectively.
• 2)Drug therapy

Antidepressants can be started , that can make her feel relaxed and induce sleeping

Anti-anxiety drugs can bring her tension down and comfort her

Mild Sedative like Ativan,Halcion,Restoril can make her sleep atleast for eight hours after popping the pull in bed time

3) Parameters for monitoring success of therapy

• Maintaining a sleep chart by patient
• Duration of sleep attained by patient
• Easy to fall asleep

4) Patient education

• Encourage to follow a specific time to sleep
• Encourage to go early to sleep
• Advice for a warm shower to induce sleep
• No strenuous exercise before sleeping
• No heavy meals and plenty of water at bed time

5)Adverse reaction

• Drug addiction if used for a longer time
• Lasix will trigger urination if taken at bedtime
• Gastrointestinal changes

6) Second line therapy

• Behavioral therapy and cognitive therapy can help her feel ease and encourage sleep with peace of mind

7) Alternative medicine

• Ramelteon is an OTC drug easily available in US
• Relaxation therapy
• Breathing exercises
• Yoga
• Psychotherapy

8) Dietary and life style change

• Light meal at bed time
• No excess liquid at bedtime
• Following a routine
• Regular follow up with physician

9) Usually antidepressants may lower the BP more when taken along with antihypertensive without proper dose adjustment.