Insomnia
31-year-old Male

31-year-old Male

 

Decision Point One


Hydroxyzine: 50 mg daily at bedtime

RESULTS OF DECISION POINT ONE

Decision Point Two
Select what you should do next:


Discontinue hydroxyzine. Initiate therapy with temazepam 15 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks
  • Patient states temazepam really helps with sleep and makes him feel great when he washes it down with a beer
  • Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Select what you should do next:


Discontinue temazepam. Initiate therapy with trazodone 50–100 mg nightly at bedtime. Follow up in 4 weeks
Guidance to Student

The mixture of alcohol and benzodiazepines is one that can result in respiratory depression and death. It would be prudent to discontinue any benzodiazepines your patient is on if you are aware, or even have a suspicion, that the patient consumes alcohol. The mixture of hypnotics and alcohol can also cause respiratory depression and death. Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. Alcohol counseling should also be discussed with the patient to rule out any issues.


Continue dose. Counsel patient not to drink with alcohol. Follow up in 4 weeks
Guidance to Student

The mixture of alcohol and benzodiazepines is one that can result in respiratory depression and death. It would be prudent to discontinue any benzodiazepines your patient is on if you are aware, or even have a suspicion, that the patient consumes alcohol. The mixture of hypnotics and alcohol can also cause respiratory depression and death. Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. Alcohol counseling should also be discussed with the patient to rule out any issues.


Discontinue temazepam. Initiate therapy with Sonata 10 mg nightly at bedtime. Follow up in 4 weeks
Guidance to Student

The mixture of alcohol and benzodiazepines is one that can result in respiratory depression and death. It would be prudent to discontinue any benzodiazepines your patient is on if you are aware, or even have a suspicion, that the patient consumes alcohol. The mixture of hypnotics and alcohol can also cause respiratory depression and death. Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. Alcohol counseling should also be discussed with the patient to rule out any issues.


Decrease dose of hydroxyzine to 25 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks
  • Patient states the decrease in dose has helped with the dry eyes, however he is still not sleeping great
  • Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Select what you should do next:


Discontinue hydroxyzine. Initiate therapy with trazodone 50–100 mg nightly at bedtime. Follow up in 4 weeks
Guidance to Student

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. The addition of diphenhydramine would augment the anticholinergic properties of the hydroxyzine that the patient is currently experiencing.


Continue dose. Counsel patient that once his body adjusts to medication more, it should help with insomnia. Follow up in 4 weeks
Guidance to Student

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. The addition of diphenhydramine would augment the anticholinergic properties of the hydroxyzine that the patient is currently experiencing.


Continue dose. Instruct patient to augment with diphenhydramine 25 mg nightly at bedtime, as needed. Follow up in 4 weeks
Guidance to Student

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. The addition of diphenhydramine would augment the anticholinergic properties of the hydroxyzine that the patient is currently experiencing.


Continue dose. Explain that these are common side effects of hydroxyzine

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks
  • Patient states some of the side effects have diminished but still dislikes how it makes him feel the next morning
  • Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Select what you should do next:


Discontinue hydroxyzine. Initiate therapy with trazodone 50–100 mg nightly at bedtime. Follow up in 4 weeks
Guidance to Student

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. It would not be prudent to switch this patient to sonata as SSRI's AND Antihistamines are both safer than hypnotics as hypnotics carry with them the risk of complex sleep behaviors.


Continue dose. Instruct patient to drink water before bedtime to help with dry eyes and mouth. Follow up in 4 weeks
Guidance to Student

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. It would not be prudent to switch this patient to sonata as SSRI's AND Antihistamines are both safer than hypnotics as hypnotics carry with them the risk of complex sleep behaviors.


Discontinue hydroxyzine. Initiate therapy with Sonata 10 mg nightly at bedtime. Follow up in 4 weeks
Guidance to Student

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. It would not be prudent to switch this patient to sonata as SSRI's AND Antihistamines are both safer than hypnotics as hypnotics carry with them the risk of complex sleep behaviors.