CASE 1
Mrs. B. has recently experienced an increase in stress due to relationship problems at home as well as financial stressors. She has had an increase in symptoms of anxiety and notes “sleep changes.” She has difficulty falling asleep and wakes every 2 to 3 hours throughout the night. Often the worries and concerns of the day are present in her thoughts when lying awake in bed.
Mrs. B. feels sleepy during the day and has noted that she is less productive at home and at work. Her nurse practitioner reviewed Mrs. B.’s sleep hygiene and then recommended a 2-week trial
with clonazepam at bedtime, as well as a referral to a psychotherapist for talk therapy to address her problems and concerns. Mrs. B. reported feeling more relaxed after taking the medication before bedtime and was able to fall asleep and remain sleeping for 6 to 8 hours. Feeling more rested during the day helped her to function better at home and at work. She also made an appointment with a therapist to address her problems and concerns and to learn a nonpharmacologic approach for insomnia, including cognitive-behavioral therapy.
report out their findings in detail, including
a. Relationship of the pathophysiology of the diagnosis to the pharmacology of the medications
b. Drug-drug and drug-food interactions
c. Correlated pharmacology with other treatment modalities, especially nutrition.
d. Teaching concerns
e. Adherence issues
Case 1 Questions:
1. Which symptoms are present that indicate a sleep disorder?
2. Which interventions are used to treat the sleep disorder?
3. What are the benefits of the sleep medication?
4. Which adverse events might be watched for?
