250 words, 3 references
CC: KL is a 79 yo man requesting assistance for “something to help with sleep”.
PMH: Coronary artery disease and s/p CABG, hyperlipidemia, hypertension, major depressive disorder, and benign prostatic hypertrophy.
Current medications: Aspirin 81 mg daily, Lisinopril 20 mg daily, Metoprolol succinate 100 mg daily, Simvastatin 20 mg daily, fluoxetine 40 mg hs, and doxazosin 4 mg hs.
Substance Hx: He admits to drinking 2 alcoholic drinks/per night and denies smoking.
Include in your discussion:
- The differences in initial, middle, and terminal insomnia, and how would you best choose pharmacologic treatment for each one of these based on the half-lives of each hypnotic?
- Identify any secondary causes of insomnia.
- What treatment plan do you recommend for KL’s insomnia? (Be specific with your recommendations-which medication and why)
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