Good Essay About Advanced Pharmacology
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As a part of history, we would like to ask ST regarding his medical illness of asthma. The questions should be able to answer the chronicity of the disease, number of attacks each month, severity of those attacks, need of hospitalization in any of the attacks and we would also like to know if this particular disease has changed or altered his quality of life in any way. Is he able to go to work or he has to take an off every now and then because of his illness. Family history of asthma or any other major illness should be explores.
Further, based on the current data, it is highly likely that ST is battling with depression, severity of which is not yet known. There are many factors that are pointing towards a depressive disorder. Therefore, history should also focus on psychiatric evaluation. According to Diagnostic and Statistical manual of mental disorders (DSM-IV, 1994), diagnosis of major depressive disorder can be made if the history is more than two weeks old and patient complains of loss of apetite, depressed mood, disinterest, insomnia and feeling of worthlessness. The manual also mentioned that depressive episode must be accompanied by clinically significant occupational or social distress including financial constraints.
The major factor leading to the symptoms of ST is because a chronic illness like asthma. According to Adams et al. (2006), asthmatic patients are more likely to take days off from work as impairment in work because of their asthmatic symptoms once a week. Australian Institute of Health and Welfare reported in Measuring the Impact of asthma on quality of life (2004) that asthma has the tendency to hamper the quality of life by means of altering the physical, spiritual, social, economic and psychological aspect of life. The first physical sign of impact of asthma on quality of life is disturbed sleep or absolute lack of it.
Besides that, another important factor that can lead to ST’ symptoms is a bad socio-economic status and stress. Talala et al. (2012) and Lallukka et al. (2012) both concluded that low socioeconomic standing in terms of income, employment status is associated with insomnia.
Barlow et al. (2002) suggested self-management approach in patients with chronic illnesses like asthma in this case. Self-management approach comprises of inter-disciplinary group education, based primarily on adult learning, case specific treatment and theorized case management. Therefore, his asthma should be properly addressed with administration of long term and short term control both to decrease the frequency and prevent the acutely exacerbated attacks.
Morin et al. focuses on the no-pharmacologic treatment options for insomnia and suggested that psychological and behavioural interventions are effective treatment modalities. They also concluded that Cognitive Behavioural Therapy (CBT) has opened new avenues in the management of insomnia associated with a chronic illness. They also suggested the use of multicomponent approach in the treatment of insomnia. In this case, ST should strictly adhere to his asthma treatment to improve health related quality of life, maintain sleep diary, eat healthy and on time, exercise daily, drink plenty of fluids and stay well hydrated, and take medicines for his insomnia as prescribed by his physician.
Nonbenzodiazepine drugs like zolpidem, zaleplon and eszopiclone have taken place of benzodiazepines. They decrease sleep latency and increase sleep time and should be given at a dose of 20mg, 20mg and 3mg daily for zaleplon, zolpidem and eszopiclone respectively. Melatonin agonist like ramelteon can also be given at a dose of 8mg daily. There is evidence that low-dose doxepin can also be used to treat insomnia at a dose of 3 to 6mg daily. Next option is hypocretin/orexin antagonists like almorexant which showed response at 400 mg, 200 mg and 100mg in a dose-dependent fashion. Serotonin receptor antagonists like quetiapine and clozapine at a dose of 25mg twice a day and 10mg once day respectively. (Richey et al., 2011)
Adams, R.et al. (2006). Coexistent Chronic Conditions And Asthma Quality Of Life: A Population-Based Study. Chest, 129(2), 285-291.
Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling,48, 177-187.
How does asthma affect HRQoL? (2004). In Measuring the impact of asthma on quality of life in the Australian population (p. 9). Canberra: Australian Institute of Health and Welfare.
Lallukka et al.: Sociodemographic and socioeconomic differences in sleep duration and insomnia-related symptoms in Finnish adults. BMC Public Health 2012 12(565)
Mood Disorders. (1994). In Diagnostic and Statistical Manual of Mental Disorders: DSM-IV.(4th ed.). Washington, DC: American Psychiatric Association.
Morin CM; Bootzin RR; Buysse DJ et al. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998- 2004). SLEEP 2006;29(11):1398-1414
Richey, S. M., & Krystal, A. D. (2011). Pharmacological advances in the treatment of insomnia. Current Pharmaceutical Design, 17(15), 1471-1475.
Talala et al.: Socio-economic differences in selfreported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey. BMC Public Health 2012 12(650)
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