Insomnia
31-year-old Male

31-year-old Male

 

Decision Point One


Zolpidem: 10 mg daily at bedtime

RESULTS OF DECISION POINT ONE

Decision Point Two
Select what you should do next:


Decrease zolpidem to 5 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks.
  • Patient states his episodes of “nighttime activity” has greatly decreased.
  • His girlfriend told him that one time in the 2 weeks he got up and was getting ready to go for a drive.
  • Patient denies auditory/visual hallucinations and is future oriented.
  • Patient states that he likes the way the zolpidem helps him sleep and “is good with continuing to take it if most of the time I sleep through the night undisturbed.”
Decision Point Three
Select what you should do next:


Maintain dose. Patient to return in 4 weeks for follow up appointment
Guidance to Student

Zolpidem is a medication that has a host of negative side effects. It should not be the first choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider.

In this case, the patient is experiencing complex sleep behavior. It is prudent as the patient's healthcare provider to discontinue this medication and prescribe something different.

Trazodone is a selective serotonin reuptake inhibitor that is a much safer choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.


Discontinue zolpidem 5 mg tablets. Initiate therapy with Intermezzo 5 mg sublingual tablet nightly at bedtime, as needed. Follow up in 4 weeks
Guidance to Student

Zolpidem is a medication that has a host of negative side effects. It should not be the first choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider.

In this case, the patient is experiencing complex sleep behavior. It is prudent as the patient's healthcare provider to discontinue this medication and prescribe something different.

Trazodone is a selective serotonin reuptake inhibitor that is a much safer choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.


Discontinue zolpidem. Initiate therapy with trazodone 50 mg nightly at bedtime. Instruct patient he may take up to 100 mg if 50 mg is ineffective. Follow up in 4 weeks
Guidance to Student

Zolpidem is a medication that has a host of negative side effects. It should not be the first choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider.

In this case, the patient is experiencing complex sleep behavior. It is prudent as the patient's healthcare provider to discontinue this medication and prescribe something different.

Trazodone is a selective serotonin reuptake inhibitor that is a much safer choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.


Discontinue zolpidem. Initiate therapy with eszopiclone 1 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks
  • Patient states the eszopiclone really helps with sleep
  • Patient states he takes it approximately 2 hours prior to sleep, and it makes him feel good until the point he passes out
  • Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Select what you should do next:


Continue dose. Instruct patient medication is to be taken 30 minutes prior to bed. Follow up in 4 weeks
Guidance to Student

Eszopiclone is a medication that has a host of negative side effects. It should not be the first or even second choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider. In this case, the patient is experiencing euphoria to the point of becoming unconscious. It is prudent as the patient's healthcare provider to discontinue this medication and prescribe something different. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. Trazodone is a selective serotonin reuptake inhibitor that is a much more effective choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.


Discontinue dose. Initiate therapy with hydroxyzine 50 mg at bedtime. Follow up in 4 weeks
Guidance to Student

Eszopiclone is a medication that has a host of negative side effects. It should not be the first or even second choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider. In this case, the patient is experiencing euphoria to the point of becoming unconscious. It is prudent as the patient's healthcare provider to discontinue this medication and prescribe something different. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. Trazodone is a selective serotonin reuptake inhibitor that is a much more effective choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.


Discontinue dose. Initiate therapy with trazodone 50 mg nightly at bedtime. Instruct patient he may take up to 100 mg if 50 mg is ineffective. Follow up in 4 weeks
Guidance to Student

Eszopiclone is a medication that has a host of negative side effects. It should not be the first or even second choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider. In this case, the patient is experiencing euphoria to the point of becoming unconscious. It is prudent as the patient's healthcare provider to discontinue this medication and prescribe something different. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. Trazodone is a selective serotonin reuptake inhibitor that is a much more effective choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.


Discontinue zolpidem. Initiate therapy with trazodone 50–100 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks
  • Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness
  • Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Select what you should do next:


Discontinue trazodone, initiate therapy with sonata 10mg nightly at bedtime, follow up in 4 weeks
Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors.

Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.

The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.


Discontinue trazodone. Initiate therapy with hydroxyzine 50 mg at bedtime. Follow up in 4 weeks
Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors.

Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.

The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.


Continue dose. Explain to patient he may split the 50 mg tablet in half. The decreased dose should minimize next day drowsiness. Follow up in 4 weeks
Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors.

Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.

The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.