Psychopharmacology Case Presentation Signature Assignment NURS 637 Advanced Psychopharmacology By Latasha Scott

[Audio] Psychopharmacology Case Presentation Signature Assignment nurs 637 Advanced Psychopharmacology By Latasha Scott Zaleplon.

[Audio] Zaleplon Class: Non benzodiazepine hypnotic (Schedule IV) Use: Short term treatment of sleep onset insomnia Mechanism: Selective GABA-A receptor agonist (BZ1 subtype) Onset: 15–30 minutes | Half life: ~1 hour Pros: Rapid action, low residual sedation, Lower abuse potential compared to benzodiazepines Cons: Potential for dependence, rebound insomnia Metabolism: Hepatic (aldehyde oxidase); minimal CYP450 involvement.

[Audio] Case Study # 1 Marjorie : Identifying Data & Chief Complaint Name: Marjorie Manrique Age: 35 Ethnicity: Hispanic Source: Self Reliability: High 200: 'I still have nights when I can’t fall asleep.'.

[Audio] HPI & Psychiatric History PTSD, MDD, GAD; improved on buspirone Insomnia worsens with travel/stress Past Medications: Pristiq (discontinued).

[Audio] Medical, Family, Social History Medical: Fibromyalgia, dizziness Family: Mood disorders Social: Lives alone, employed, traveling soon Developmental: Stable Substance Use: None.

[Audio] Mental Status Exam (M-S-E--) Appearance: Appropriate, overweight Mood/Affect: Anxious, congruent Speech: Pressured Thought Process: Logical, no hallucinations Insight/Judgment: Fair No suicidal/homicidal ideation.

Diagnostics. • Labs: WNL • Alert and oriented • Physical Exam: WNL • Urine tox: Negative.

[Audio] Marjorie: Diagnosis & Case Formulation GAD – F41.1 MDD, Recurrent, Severe – F33.2 PTSD, Chronic – F43.12 ICD-10: Same Formulation: Persistent anxiety and insomnia secondary to P-T-S-D.

[Audio] Marjorie: Treatment Plan Zaleplon 5 milligrams PO QHS PRN (#10, no refills) Continue buspirone CBT, E-M-D-R post travel Sleep hygiene counseling Referral: Psychotherapy.

[Audio] Marjorie: Cultural Considerations In many Hispanic cultures, mental health stigma is significant, and discussing psychological symptoms may be perceived as weakness or shameful. There may be a preference for natural remedies or delayed engagement with psychiatric care..

[Audio] Education Education in culturally sensitive manner Acknowledged independence and privacy norms Clarified role of short term P-R-N medication.

[Audio] Marjorie: Assets, Liabilities, & Barriers Assets: Insightful, compliant, motivated Liabilities: Anxiety under stress, P-T-S-D symptoms Barriers: Therapy access during travel.

[Audio] Clinical Justification for the use of Zaleplon Diagnosis driven: Marjorie has a clear diagnosis of sleep onset insomnia associated with P-T-S-D and G-A-D-. Medication history: She has not misused medications and is currently stable on buspirone, a non sedating anxiolytic. Substance use history: She denies any substance misuse and demonstrates insight and adherence to treatment. Low risk of dependency: Given her high reliability, motivation for recovery, and supportive psychotherapeutic care, the short term P-R-N use of Zaleplon is considered safe and effective..

[Audio] Case study #2 Robert: Identifying Data & Chief Complaint Name: Robert H Age: 44 Ethnicity: African American Source: P-C-P referral Reliability: Moderate 200: 'I need something strong to sleep.'.

[Audio] Robert: HPI & Psychiatric History Insomnia with onset and maintenance issues History: Alcohol Use Disorder, B-Z-D misuse Past Meds: Zolpidem (misused), Lorazepam.

[Audio] Robert: Medical, Family, Social History Medical: Hepatic steatosis, chronic back pain Family: Limited info Social: Unstable housing, group therapy Developmental: aces, incarceration Substance Use: A-U-D in remission.

[Audio] Robert: Diagnostics & M-S-E Labs: Mild L-F-T elevation M-S-E--: Disheveled, slow speech, craving noted PE: Hepatomegaly, BMI 31 Urine tox: Negative.

[Audio] Robert: Diagnosis & Case Formulation Alcohol Use Disorder, Early Remission – F10.20 Insomnia, Unspecified – G47.00 ICD-10: Same Formulation: High risk for hypnotic misuse and relapse.

[Audio] Robert: Treatment Plan Avoid Zaleplon (Schedule IV, abuse risk) Continue Trazodone, Gabapentin Start CBT-I Monitor liver function No controlled substances prescribed.

Cultural Considerations: Robert. African American patients often face systemic barriers in mental health care, including mistrust of medical systems, underdiagnosis, and provider bias. Historical injustices contribute to skepticism about psychiatric medications and reluctance to disclose symptoms. Masculine norms in some communities may discourage emotional vulnerability or seeking therapy..

[Audio] Robert: Education Stigma addressed through motivational interviewing Provided education on sleep hygiene and CBT-I Encouraged non pharmacologic adherence.

[Audio] Robert: Assets, Liabilities, & Barriers Assets: Expressed desire to change, attending meetings Liabilities: Craving history, psychiatric comorbidities Barriers: Unstable housing, low trust in providers.

[Audio] Clinical Justification for not prescribing Zaleplon Substance use history: Robert has a documented history of alcohol use disorder, benzodiazepine misuse, and zolpidem misuse—placing him at high risk for relapse. Behavioral red flags: drug seeking behavior. Medical contraindication Mental status findings Potential misuse.

[Audio] Zaleplon Use: Summary Marjorie: Low risk profile, high adherence, clear need Robert: High abuse potential, contraindicated Must evaluate comorbidities and psychosocial context.