Case Study: Pharmacologic Management of Insomnia in a Younger Adult

Case Study: Pharmacologic Management of Insomnia in a Younger Adult
Insomnia
31-Year-Old Male

Decision Point One:
Prescribed Trazodone 50 mg orally at bedtime.

Results of Decision Point One:

– Patient scheduled for a follow-up clinic appointment in 2 weeks.
– Patient reports that the medication is effective but causes an undesired side effect: an erection lasting approximately 15 minutes upon waking.
– Patient mentions that this side effect hinders his morning routine, making it challenging to prepare for work or have breakfast with his girlfriend and daughter.
– Patient denies experiencing auditory or visual hallucinations and appears to be future-oriented.

Decision Point Two:
Explained to the patient that an erection lasting 15 minutes is not classified as priapism and should diminish over time. Advised to continue with the current dosage.

NUR-514 Topic 2 Discussion Question 2

Results of Decision Point Two:

– Patient returns to the clinic for a follow-up in 2 weeks.
– Patient reports that the priapism has decreased over time.
– Patient denies auditory or visual hallucinations and remains future-oriented.
– Patient acknowledges that trazodone is effective at the 50 mg dose but sometimes results in next-day drowsiness.
– Patient denies auditory or visual hallucinations and is focused on the future.

Decision Point Three:
Recommended maintaining the current dose and suggested to the patient that he may split the 50 mg tablet in half to minimize next-day drowsiness. Scheduled a follow-up in 4 weeks.

Guidance to Student:
Trazodone, a selective serotonin reuptake inhibitor with a low side effect profile, was chosen as the initial treatment option. Sonata was not considered appropriate due to the risk of complex sleep-related behaviors associated with it. Hydroxyzine, while possessing strong sedative properties, often leads to adverse effects such as dry mouth (Xerostomia) and dry eyes (Xerophthalmia) in the morning, which many patients find bothersome.

Given the patient’s excessive somnolence, it is advisable to reduce the trazodone dose by 50% and reevaluate the patient’s condition in 4 weeks.

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