Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision Point One
Select what you should do:
Zolpidem: 10 mg daily at bedtime
Trazodone 50 mg po at bedtime
Hydroxyzine: 50 mg daily at bedtime.
Decision Point One
Trazodone 50 mg po at bedtime
RESULTS OF DECISION POINT ONE
• Patient returns to clinic in 2 weeks
• Patient states medication works well but gives him an unpleasant side effect of an erection lasting approximately 15 minutes after waking
• Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
• Patient denies auditory/visual hallucinations and is future oriented
Decision Point One
Trazodone 50 mg po at bedtime
RESULTS OF DECISION POINT ONE
• Patient returns to clinic in 2 weeks
• Patient states medication works well but gives him an unpleasant side effect of an erection lasting approximately 15 minutes after waking
• Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
• Patient denies auditory/visual hallucinations and is future oriented
Decision Point Two
Select what you should do next:
Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with current dose
Discontinue trazodone. Initiate therapy with suvorexant 10 mg daily at bedtime
Decrease trazodone to 25 mg daily at bedtime.
Decision Point Two
Decrease trazodone to 25 mg daily at bedtime
RESULTS OF DECISION POINT TWO
• Patient returns to clinic in 2 weeks
• Patient states trazodone is very effective for sleep
• Patient states sometimes the 25 mg dosage isn’t quite enough to help him sleep through the night
• Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Select what you should do next:
Discontinue trazodone. Initiate therapy with ramelteon 8 mg nightly at bedtime. Follow up in 4 weeks
Continue dose. Encourage sleep hygiene. Follow up in 4 weeks
Discontinue trazodone. Initiate therapy with hydroxyzine 50 mg nightly at bedtime. Follow up in 4 weeks
Decision Point Three
Continue dose. Encourage sleep hygiene. Follow up in 4 weeks
Guidance to Student
Since the patient is already showing a partial response from trazodone, it may not be prudent to switch therapy. A thorough sleep hygiene analysis should always be performed prior to initiation of pharmacotherapy as well as at reassessments. If you find the patient isn’t practicing proper sleep hygiene, you may continue the dose and encourage sleep hygiene. If the patient is practicing good sleep hygiene, you may consider discontinuing trazodone and initiating hydroxyzine. Although there are some negative side effects associated with hydroxyzine such as Xerostomia and Xerophthalmia, it is still a safer medication to prescribe than ramelteon.
