Transition
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Unit 8 Medications for Sleep Disorders —2 Peer Response 600w. due 10-25-23
Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:
• Compare and contrast your initial posting with those of your peers.
• How are they similar or how are they different?
• What information can you add that would help support the responses of your peers?
• Ask your peers a question for clarification about their post.
• What most interests you about their responses?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Ingrid A.
· There are multiple sleep disorders such as insomnia, sleep apnea, restless leg syndrome, hypersomnia, circadian rhythm disorders, and parasomnia which I think is “sleepwalking” or at least very similar to sleepwalking (Sleep Disorders, 2020).
Screening tools to diagnose sleep disorders can be just as gathering information from the patient, like history and physical. There are other screening tools such as actigraphy which is something like a watch the patient must wear and this tracks the movements the patient makes when sleeping and being awake (How is actigraphy used to evaluate sleep?, 2022)
Adding more we also have polysomnography also known as the “sleep study”, and this particular test records brain waves, oxygen level as well as heart rate (Polysomnography (Sleep Study) 2023). Epic (electronic health record) has something called the stop-bang questionnaire and it basically asks questions about snoring, blood pressure, and the size of the neck. There is also something called the Athens Insomnia Scale and Epworth Sleepiness Scale (Sleep disorders: Clinical tools, 2023).
Z-drugs such as zolpidem, zopiclone, and zaleplon are innovative hypnotics that aid with sleep, reduce sleep latency, and improve quality. These drugs are prescription dispensed only and they work by slowing the activity in the brain (Commissioner, 2023).
Benzodiazepines are medications such as lorazepam, diazepam, temazepam, alprazolam, and clonazepam among others that can have potential side effects such as respiratory depression, drowsiness, impaired judgment, nausea and vomiting, confusion, addiction, and even respiratory distress (Brandt & Leong, 2017).
References:
Brandt, J., & Leong, C. (2017). Benzodiazepines – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470159/
Commissioner, O. of the. (2023). Taking z-drugs for insomnia? know the risks. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks
How is actigraphy used to evaluate sleep?. Sleep Foundation. (2022, May 10). https://www.sleepfoundation.org/sleep-studies/actigraphy
Mayo Foundation for Medical Education and Research. (2023, February 17). Polysomnography (Sleep Study). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877#:~:text=Polysomnography%2C%20known%20as%20a%20sleep,measures%20eye%20and%20leg%20movements.
Sleep disorders: Clinical tools. CAMH. (2023). https://www.camh.ca/en/professionals/treating-conditions-and-disorders/sleep-disorders/sleep-disorders—clinical-tools
U.S. National Library of Medicine. (2020, January 3). Sleep disorders. MedlinePlus. https://medlineplus.gov/sleepdisorders.html
Week 8, Medications for Sleep Disorders
What screening tools can be used to affirm your initial diagnosis that a patient may meet the diagnostic criteria for a sleep disorder?
There are different tools for assessing sleep disorders. Among various rating scales, the Pittsburgh Sleep Quality Index (PSQI) was specifically designed to evaluate overall sleep quality and is among the recommended questionnaires for examining global sleep patterns and symptoms related to insomnia (Zitser et al., 2022). It is a self-report questioner and will assess the sleep quality over one month. Another useful scale is the Epworth Sleepiness Scale (ESS), which is a questionnaire designed to assess daytime sleepiness. A higher score on the ESS suggests the need for further evaluation for possible sleep disorders (Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale, 2023).
According to the literature, the gold standard for monitoring sleep and breathing is polysomnography (PSG). PSG observes various physiological factors during sleep, including brain activity, eye movement, heart rate, and muscle activity. It involves the use of special bands around the chest and abdomen, as well as sensors for temperature and airflow in the nose. PSG also utilizes a device to measure airflow and sensors for air pressure in the airway. However, it's important to note that these methods can be invasive and time-consuming to set up and understand (Naik et al., 2023). Home sleep apnea testing (HSAT) is a simplified version of PSG that can be conducted at home and offers several potential benefits compared to traditional PSG, such as increased accessibility, quicker treatment initiation, and cost savings (Johns et al., 2022).
Describe the pharmacological actions of non-z sleep medications?
Non-benzodiazepine (non-Z) sleep medications, such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), function by enhancing the activity of the neurotransmitter known as gamma-aminobutyric acid (GABA) in the central nervous system. GABA is an inhibitory neurotransmitter that promotes relaxation and facilitates sleep. One key distinction between benzodiazepine medications and non-Z medications is their selectivity in targeting GABA receptors (Stahl, 2021).
Benzodiazepines act on various GABA receptor subunits (including alpha 1, alpha 2, alpha 3 and alpha 5 receptors) nonselectively. Benzodiazepines acting on alpha2 and alpha3 receptor subtypes have effects that reduce anxiety, promote muscle relaxation, and enhance the effects of alcohol. On the other hand, the alpha5 subtype, found in the hippocampus, may be implicated in cognitive processes. As a result, benzodiazepines are employed for the treatment of sleep disorders, seizure disorders, and anxiety disorders due to their broader spectrum of activity (Stahl, 2021).
In contrast, non-Z medications selectively target alpha 1 receptors, which are primarily associated with the sleep process. Therefore, non-Z medications are specifically designed to induce and improve sleep without affecting the full spectrum of GABA receptors. Another distinction to note is that benzodiazepines typically have longer half-lives, which means they remain in the body for a more extended period compared to non-Z medications. This difference in half-life can have implications for factors such as prolong sedation and potential for dependence or withdrawal when using these medications. Non- Z medications are usually used for short amount of time and do not cause dependence or withdrawal symptoms (Stahl, 2021).
What problems can occur when benzodiazepines are used to help with sleep?
Benzodiazepines are potent medications known for their effectiveness, but they come with a range of significant concerns and potential problems. They have sedative properties, leading to drowsiness and increased sleepiness in patients. Additionally, benzodiazepines exhibit a prolonged half-life, resulting in an extended duration of action within the body, which can impact a patient's overall quality of life. These medications have been associated with several adverse effects (Stahl, 2021).
Benzodiazepines can impair cognitive function, memory, and coordination, potentially leading to accidents and reduced overall performance. A major concern with benzodiazepines is the development of tolerance. Over time, patients may require higher doses to achieve the same therapeutic effect. This can lead to physical and psychological dependence, as patients become addicted to the sedative properties of the medication (Stahl, 2021).
Abruptly discontinuing benzodiazepines can result in unpleasant withdrawal symptoms, which can be challenging for patients. One study by Ritvo et al. (2023) revealed that over 40% of the respondents reported experiencing 17 or more symptoms persisting for at least one year after discontinuing their use of benzodiazepines. Common side effects associated with benzodiazepines include dizziness, drowsiness, and coordination problems, which can be especially problematic for individuals who need to remain alert and functional. It's essential to be mindful of potential drug interactions, as benzodiazepines can interact with other medications, potentially affecting their effectiveness or causing unexpected side effects (Stahl, 2021)
Given these concerns, it is advisable to use benzodiazepines cautiously and only for short durations. When discontinuing their use, a slow tapering approach is often recommended to minimize the risk of withdrawal symptoms. This ensures that the benefits of these medications are balanced against the potential risks and adverse effects they may cause.
References
Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale (ESS) for sleep apnea headache. (2023).
Sleep Science and Practice, 7, 1-9.
https://doi.org/10.1186/s41606-023-00084-2Links to an external site.
Johns, J. D., Armin, M., Alexandra, W., Jeffrey, K. H., Mikula, S. K., & Hoa, M. (2022). Reliability of home sleep apnea testing for diagnosing obstructive sleep apnea in patients with spontaneous cerebrospinal fluid leaks.
Cureus, 14(10)
https://doi.org/10.7759/cureus.29854
Naik, G. R., Breen, P. P., Jayarathna, T., Tong, B. K., Eckert, D. J., & Gargiulo, G. D. (2023). Morphic sensors for respiratory parameters estimation: Validation against overnight polysomnography.
Biosensors, 13(7), 703.
https://doi.org/10.3390/bios13070703Links to an external site.
Ritvo, A. D., Foster, D. E., Huff, C., Reid Finlayson, ,A.J., Silvernail, B., & Martin, P. R. (2023). Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey.
PLoS One, 18(6) https://doi.org/10.1371/journal.pone.0285584
Stahl, S. M. (2021).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).
Zitser, J., Allen, I. E., Falgàs, N., Le, M. M., Neylan, T. C., Kramer, J. H., & Walsh, C. M. (2022). Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults.
PLoS one, 17 (6) https://doi.org/10.1371/journal.pone.0270095
Think of a situation from clinical when the Provider needed to be informed of a change in patient condition. Using ISBARR write what you would report to the Provider. You can use the ISBARR form for guidance.
Expand on this explanation and provide an example that supports this explanation or respectfully challenging this explanation and providing an example.
Cost Benefit Analysis and its Impact on Efforts to Repeal ACA
The Patient Protection and Affordable Care Act of 2010 was one of the policies in the Obama administration that caused diverse political reactions among the legislators and the public. This policy attempted to address the social injustices in America by prioritizing healthcare delivery, especially to low-income individuals (McIntyre & Song, 2019). Legislators had divided opinions on implementing these policies, as most of them conducted a cost-benefit analysis on its suitability in resolving healthcare issues. The first attempt to replace ACA was in 2017 with the passing of the American Health Care Act (AHCA). Implementing the latter policy would mean that approximately half of the beneficiaries of the ACA would lose access to affordable healthcare services (Issar & Dilling, 2021). The AHCA also proposed a tax credit based on age, an aspect that would increase the cost of healthcare services. Reelection affected the success and implementation of the AHCA to replace ACA. Most citizens supported the ACA, and legislators had no option but to keep it for their reelection, as legislators who opposed it risked losing their seats.
The voters’ views affect the legislators’ positions on the policy as the voters have the power to reelect them. Milstead and Short (2019) ascertain that voters influence important political aspects and determine their implementation or rejection. The best example of the influence of voters on policy issues was the replacement of ACA with AHCA. The voters supported ACA because it increased accessibility and availability of quality healthcare but repelled the AHCA due to the associated taxes and increased healthcare service costs (Wilensky, 2018; Issar & Dilling, 2021). The legislators in the House of Representatives and Senate need the votes to secure their positions, and disagreeing with the voters’ opinions would disadvantage their political careers (Congress.gov, n.d.; United States Senate, n.d.). Therefore, supporting the policy that the citizens support at higher levels increases the chances of legislators retaining their seats, even when they disagree with the policy’s mandates.
Resources to use:
To Prepare:
Resources:
The Assignment: (1- to 2-page Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)Be sure to add a title page, an introduction, purpose statement, and a conclusion. This is an APA paper.Part 1: Legislation GridBased on the health-related bill (proposed, not enacted) you selected, complete the Legislation Grid Template. Be sure to address the following:
Part 2: Legislation Testimony/Advocacy StatementBased on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:
Please read the assignment before accepting or messaging.
1- Discussion Post- Submit your PICOT question. What is the healthcare problem you propose to change? What impact does it have on the patient, community, cost of care, quality of life, readmissions? Discuss your setting.
Health care problem: Inadequate management in heart failure patients
picot question cant be RB approval
2-Discuss which Nursing Theoretical/Change Theory you will use for your Capstone and why.
I NEED ONE PAGE PER EACH QUESTION, MUST BE ORIGINAL WORK EACH PAGE NNED TO HAVE ITS REFERENCES.
due date September 1 , 2023
1.Define psychopharmacology and pharmacodynamics and describe the neuron’s cellular structure. Include the definition of synapses as well as their significance to the nervous and psychological system.
2.Research an article on neuron’s cellular structure works and explain what you found interesting about this topic.
Discussion should be 700 words minimum. References in APA not older than 5 years.
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