[SOLVED] Discussion

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Discussion #1

Sleep disorders or insufficient sleep is a major problem affecting more than one third of all Americans (Centers for Disease and Prevention, 2016).  A study evaluating medical care between 199-2010 found a disturbing trend with a 13% increase in the number of office visits for primary complaints of insomnia (Ford et al., 2014).  Often, insomnia is treated with hypnotic prescription medications, which have serious potential adverse drug reactions in addition to the potential for developing dependency and tolerance (Woo & Wynne, 2012).  Insomnia medications commonly prescribed are classified as benzodiazepines, benzodiazepine receptor agonists, melatonin receptor agonists, and tricyclic antidepressants (Ford et al., 2014). As prescribers, nurse practitioners (NP) need to obtain a complete assessment on sleeping habits and explore non-medication treatment options with patients first, such as establishing good sleeping hygiene habits.

To help improve sleep quality, patients may ask NP questions about non-pharmaceutical herbal and supplement remedies including melatonin, valerian, kava kava (Homsey, M. &O’Connell, 2010), and chamomile tea (Chang & Chen, 2016).  To evaluate the effects of chamomile tea on sleep quality, fatigue, and depression in postnatal women (who commonly experience disturbed and very poor sleep quality), Chang and Chen (2016) tested a group of 80 Taiwanese women six weeks after childbirth.  Participants were instructed to drink one cup of chamomile tea per day.  Each participant was provided with 14 teabags containing 2 grams of dried German chamomile flowers to be steeped in 400 mL of hot water for 10-15 minutes.  Outcome measures included self-reported sleep scale indexes at pretest, 2-weeks post-test, and 4-weeks post-test.  Participants reported significant improvements in sleep quality, emotional stability, and relaxation as compared with the control group.  There were  no treatment side effects reported in this short-term study.  Based on the Chang & Chen (2016) findings with postpartum women, chamomile tea is something I would advise patients to use as a nonpharmaceutical, safe herbal treatment for insomnia, in addition to improving other sleep related habits.

Reference

Centers for Disease Control and Prevention. (2016). 1 in 3 adults don’t get enough sleep. Retrieved from https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html

Discussion #2

Herbal recommendation for depression

Depression is a serious medical illness that involves the brain’s thought process and is a very commonly treated ailment in primary care.  People are affected differently by the condition and therefore there are some individual who prefer non-drugs approach to help them feel better and manage the condition (Linden, 2011).  There are natural remedies and home remedies which are often used which has proven to be effective and is often referred to as complementary and alternative medicine (CAM).  CAM are health treatment which are not considered standard Western medical practice.  St. John’s Wort also known as hypericum perforatum is a flowering plant which has been used as a common herbal supplement for depression (Yarnell, 2015).

Herbal medication or treatment is an art of science which is used for health promotion and illness prevention.  This form of science has deep history to European Renaissance where herbs were classified based on their therapeutic properties and constituents of the plant (Woo & Robinson, 2016).  Pharmacognosy is defined as a branch of pharmacology which studies the medical substances which is taken from plants, molds, fungi, insects and animals for their medicinal purposes (Woo & Robinson, 2016).

Several studies have shown that St. John’s wort has been around for more than 2,000 years and the plant is believed to medicinal values that is mystical and protective.  It is commonly used for depression and symptoms such as anxiety, tiredness, loss of appetite, trouble sleeping and moodiness.  This herbal treatment is discovered to have less side effects than most prescribed antidepressants, however it does interact with other medications.  Scientist are yet to provide evidence of how St. John’s wort works.  It is the belief that the herb acts similarly to selective serotonin reuptake inhibitors (SSRI) such as Prozac, Zoloft and Celexa (Yarnell, 2015).  Another concern about the usage of herbs is that Federal drug administrators (FDA) regulations are not the same for herbal supplements as they are for manufactured drugs.  St John’s wort interacts with oral contraceptive, anti-seizure medications and anticoagulants.  It also interferes with anti-rejection, heart, HIV and cancer medications (Woo & Robinson, 2016).

As a provider and prescriber, the information and knowledge attained from the research articles would have influenced the action which I would take.  Herbal medication is development and usage can be recommended based on the conditions of growth, harvesting, processing, storing and shipping.  Plants which are grown wildly are not in a controlled environment and therefore can affect the potency of the herb (Woo & Robinson, 2016).  I would not want to recommend patients to use the herb without knowledge of how it was prepared for the market.  The lack of evidence on the benefits of St. John’s wort on depression and the potential adverse effects on anticoagulant and other medications would also negatively influence my decision.

References:

Linden, B. (2011, March). Non-pharmacological management of depression. British Journal of Cardiac

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