Reply in a well-developed paragraph (300-350 words) to each Response , integrating an evidence-based resources.  Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.  Response 1 The purpose of this week’s discussion post is to describe two diagnoses and the medications used for their symptoms. This week I will be focusing on migraines and insomnia. Both conditions are neurological by nature and have negative effects on people’s lives. They interfere with activities of daily living as well as mental and physical health. Migraines are defined as either a classic migraine that has momentary focal symptoms-with aura or a common migraine that has specific symptoms- without aura (Woo & Robinson, 2020). Although the exact catalyst for migraines is not clear there are various theories that help to navigate the course of treatment. Some theories include heightened brain activity from genetics, intracranial vasodilation, and a sensitivity to trigeminovascular systems which causes alterations in structure and function (Woo & Robinson, 2020). Treatment course depends on if migraines are acute or chronic and if the patient has success with preventing or aborting symptoms. One drug class used for acute/abortive migraines are analgesics (Woo & Robinson, 2020). Aspirin and Naprosyn are often used as first line recommendations for acute migraines. It was found that the use of high dose aspirin (900-1,300mg) was successful in aborting, as well as preventing, the symptoms of an acute migraine attack without associated nausea (Alpert, 2020). Aspirin helps alleviate symptoms by interfering with prostaglandins and platelet activity as well as possibly effecting the serotonin activity (Woo & Robinson, 2020). Of course, high doses of aspirin have a long list of warning to teach the patient. Gastrointestinal bleeding, ulcers, and discomfort should be educated and reported. Aspirin is also contradicted in pregnancy, children, prior to surgeries, with any active bleeds or ulcers, and caution with hepatic dysfunction (Woo & Robinson, 2020). The patient should report any signs of bleeding, dizziness, hearing issues, or new pain. The use of aspirin should also be avoided if taking anticoagulants, antihypertensives, NSAIDs, and glucocorticoids (Woo & Robinson, 2020). Naprosyn or naproxen is the other analgesic that is used for the treatment of migraines. Naproxen is used for menstrual specific migraines as well and is contradicted in the last trimester of pregnancy (Woo & Robinson, 2020). Caution should be taken with naproxen with comorbidities such as kidney disease, ulcers, and gastritis. This medication has similar side effects and interactions as aspirin. Gastrointestinal bleeds being the most common. Medication interactions include antihypertensive, antithrombotic, antidepressants, and corticosteroids (Cooney et al., 2015). Being a COX inhibitor, naproxen works for migraines by dec.

1. Reply in a well-developed paragraph (300-350 words) to each
Response , integrating an evidence-based resources.
Respectfully agree and disagree with your peers’ responses and
explain your reasoning by including your rationales in your
explanation.
Response 1
The purpose of this week’s discussion post is to describe two
diagnoses and the medications used for their symptoms. This
week I will be focusing on migraines and insomnia. Both
conditions are neurological by nature and have negative effects
on people’s lives. They interfere with activities of daily living
as well as mental and physical health.
Migraines are defined as either a classic migraine that has
momentary focal symptoms-with aura or a common migraine
that has specific symptoms- without aura (Woo & Robinson,
2020). Although the exact catalyst for migraines is not clear
there are various theories that help to navigate the course of
treatment. Some theories include heightened brain activity from
genetics, intracranial vasodilation, and a sensitivity to
trigeminovascular systems which causes alterations in structure
and function (Woo & Robinson, 2020). Treatment course
depends on if migraines are acute or chronic and if the patient
has success with preventing or aborting symptoms. One drug
class used for acute/abortive migraines are analgesics (Woo &
Robinson, 2020). Aspirin and Naprosyn are often used as first
line recommendations for acute migraines. It was found that the
use of high dose aspirin (900-1,300mg) was successful in
aborting, as well as preventing, the symptoms of an acute
migraine attack without associated nausea (Alpert, 2020).
Aspirin helps alleviate symptoms by interfering with

2. prostaglandins and platelet activity as well as possibly effecting
the serotonin activity (Woo & Robinson, 2020). Of course, high
doses of aspirin have a long list of warning to teach the patient.
Gastrointestinal bleeding, ulcers, and discomfort should be
educated and reported. Aspirin is also contradicted in
pregnancy, children, prior to surgeries, with any active bleeds
or ulcers, and caution with hepatic dysfunction (Woo &
Robinson, 2020). The patient should report any signs of
bleeding, dizziness, hearing issues, or new pain. The use of
aspirin should also be avoided if taking anticoagulants,
antihypertensives, NSAIDs, and glucocorticoids (Woo &
Robinson, 2020). Naprosyn or naproxen is the other analgesic
that is used for the treatment of migraines. Naproxen is used for
menstrual specific migraines as well and is contradicted in the
last trimester of pregnancy (Woo & Robinson, 2020). Caution
should be taken with naproxen with comorbidities such as
kidney disease, ulcers, and gastritis. This medication has
similar side effects and interactions as aspirin. Gastrointestinal
bleeds being the most common. Medication interactions include
antihypertensive, antithrombotic, antidepressants, and
corticosteroids (Cooney et al., 2015). Being a COX inhibitor,
naproxen works for migraines by decreasing pain and
inflammation.
Another drug class utilized for migraines are beta blockers. One
beta blocker used for migraines include propranolol which is a
beta-1 and beta-2 antagonist. This drug works by preventing
chronic migraines from occurring and the exact reason how is
not clear, but it is believed it is from effecting the
catecholaminergic system and brain serotonin receptors (Linde
& Rossnagel, 2017). This medication would begin with a 3
month trial and be reassessed every 6 months (Woo &
Robinson, 2020). Propranolol can cause a decrease in heart rate
as well as respiratory distress so should be avoided in patients
with underlying respiratory illnesses or preexisting heart
conditions such as bradycardia. Adverse drug reactions include

3. lethargy and depression (Woo & Robinson, 2020). These drugs
should also be used in caution with diabetics and be tapered.
Another beta blocker that acts only on the beta-1 receptor is
metoprolol. Metoprolol is selective for beta-1 so cardiac
comorbidities should try alternative methods as this can cause
more issues such as bradycardia (Woo & Robinson, 2020). This
drug also has many drug interactions because it is metabolized
through CYP450.
Insomnia is difficulty falling or remaining asleep which
consequently results in a decrease in ability to function during
the daytime (Krystal et al., 2019). There are many causes of
insomnia including medication reactions, hormone imbalances,
mental illness, diabetes, chronic pain, and stress. Because the
pathology of insomnia is multifaceted there are numerous
medications recommended depending on the cause. One
medication group are benzodiazepines. Benzodiazepines work
by targeting the GABA receptors which induce sedation and a
disease in anxiety (Krystal et al., 2019). Alprazolam or Xanax is
known as one of the short-acting benzodiazepines used for
insomnia. Another long-acting benzodiazepine utilized is
clonazepam. Both medications have the same mechanism of
action as stated above. And there are similar interactions as
well. All benzodiazepines are CNS-depressants and can cause
dependency (Woo & Robinson, 2020). Xanax has a higher
prevalence of this than that of a long-acting medication such as
clonazepam. These medications can cause respiratory
depression, cardiac rates to slow, dizziness, altered mental
status, hypotension, or depression (Woo & Robinson, 2020).
Clonazepam has a side effect of increased salivation. These
medications should not be taken with other depressants or
digoxin (Woo & Robinson, 2020).
The other class of medications that is utilized for insomnia are
antidepressants. Trazadone is one of the most used
antidepressants for insomnia and is no longer used as much for

4. depression (Jaffer et al., 2017). Trazadone is a serotonin
antagonist and reuptake inhibitors (SARI) and interferes with
the serotonin receptor as well as the histamine 1, and alpha
receptors (Jaffer et al., 2017). The main side effects of this
medication are sedation, headaches, dizziness, and tolerance.
Less commonly trazadone can cause dry mouth, hypotension,
QT prolongation, suicidal ideation, and hallucinations (Shin,
2020). Caution should be taken with MAOIs, triptans, TCA, and
fentanyl. This drug is also metabolized by the liver and kidneys
so those functions should be monitored (Shin, 2020). Another
antidepressant that can be used for insomnia treatment is
sertraline (Zoloft). This medication is in the selective serotonin
reuptake inhibitors (SSRIs) class of antidepressants and works
by inhibiting the serotonin reuptake which increases serotonin
levels (Singh, 2020). This mediation has a lot of side effects
including fainting, GI upset, perspiration, xerostomia, altered
mental status, hallucinations, sexual dysfunctions, and
drowsiness (Singh, 2020). There is also an increased risk for
bleeds, prolonged QT intervals, suicide ideation, and should be
taken in caution with elderly populations (Singh, 2020).
Because of all these risks this would not be a first line choice
for an off-label use such as insomnia but does benefit certain
people.
Response 2
A seizure is a transient disruption in brain electrical function
which are classified differently (McCance, Huether &
Rote,2014). Seizures happen when two events occur in a group
of neurons. A burst of action is produced by depolarization of
the neuron caused by extracellular calcium that opens the
sodium channel, which generates repetition (McCance, Huether
& Rote,2014). The firing increases and the amplitude becomes
greater. The discharge goes to the neurons surrounding and
spreads through corticocortical synapses (McCance,

5. Huether&Rote,2014). The firing will spread through pathways
to areas in the brain like the basal ganglia, thalamus, and the
brainstem, which comes to a tonic phase of muscle contraction
and increased muscle tone , and loss of consciousness(
McCance,Huether &Rote,2014). There are different types of
seizures, they are classified by symptoms and site of origin.
Seizures can be initiated due to hypoglycemia, fatigue,
emotional and physical stress, lack of sleep, hyponatremia,
environmental stimuli, stimulants, alcohol withdrawal,
hyperventilation, or blinking lights (McCance, Huether
&Rote,2014). Epilepsy is a diagnosis for when seizures continue
to reoccur for no known reason, the cause cannot be found
(McCance, Huether & Rote,2014).
The three major drug classes of antiepileptic drugs to treat
seizures are hydantoins, iminostilbenes, and succinimides
(Woo& Robinson,2016).
Examples of hydantoins are phenytoin or Dilantin (mostly
used), ethotoin or peganone, and fosphenytoin or cerebyx.
These drugs work by stabilizing electrical discharge in the brain
by effecting the influx of sodium into the neuron during
depolarization, which slows the spread and disruption in
electrical function (Woo & Robinson,2016). The rate is usually
oral, and these medications are absorbed slowly in the small
intestine but enters the brain quickly. These medications are
good because levels can be measured for a therapeutical goal of
10-20mcg/ml. When administering hydantoins iv, they must be
administered with caution and not too fast because it can cause
cardiovascular reactions. Patients should not be prescribed iv if
they have sinus bradycardia, sinoatrial block, second- and third-
degree blocks, and must be used in caution with patients who
have liver disease or renal disease (Woo & Robinson,2016).
Side effects of hydantoins are agitation, confusion, dizziness,
ataxia, headache, drowsiness, nausea, vomiting, anorexia.
Patients should be educated to take exactly as prescribed and

6. not to miss any doses. Patients should not stop this medication
abruptly. Patients should be advised that their urine may change
in color to pink or red, or reddish brown and not to be alarmed
(Woo & Robinson,29016).
Examples of iminostilbenes are carbamazepine or Tegretol,
oxcarbazepine or Trileptal and treat epilepsy, bipolar disorder,
and some neuralgias (Woo & Robinson,2016). These
medications depress transmission in the nucleus of the
thalamus, slowing the spread of abnormal activity (Woo &
Robinson,2016). Carbamazepine can decrease WBC’s and
depress bone marrow leading to leukopenia, thrombocytopenia,
and aplastic anemia (Woo & Robinson,2016). CBC should be
monitored closely. Side effects of Carbamazepine include
thyroid function impairment, and hepatic damage. LFT and TSH
should be monitored closely. Most common side effects include,
dizziness, diplopia, fatigue, nausea (Woo & Robinson,2016).
When patients are prescribed carbamazepine, they should be
taught to report sore throat, bruising, and fever. The medication
can cause fatigue so they should be on alert to be careful as
these medications can be sedating (Woo & Robinson,2016).
Bells Palsy
Bell's palsy is the most common cause of acute spontaneous
peripheral facial paralysis which is unilateral. Common
symptoms include the eyebrow sagging, inability to close the
eye, and drooping at the affected corner of the mouth, which is
drawn to the unaffected side (Ronthal & Greenstein,2020). The
etiology of Bells Palsy remains unknown (McCance, Huether &
Rote,2014). Bells Palsy could be caused by herpes simplex
reactivation in facial cranial nerve VII (McCance, Huether &
Rote,2014).
Treatment for Bells Palsy includes short term oral

7. glucocorticoid. Prednisone 60 mg daily x 5 days followed by a
5-day taper of 10mg per day until completed is recommended
(Ronthal & Greenstein,2020). Glucocorticoids inhibit the
immune and inflammatory by their actions at several sites (Woo
& Robinson,2916). When using short term patient may
experience insomnia, mood swings and dyspepsia (Ronthal &
Greenstein,2020). If a patient has diabetes, they should be
educated that the patient will experience hyperglycemia
(Ronthal & Greenstein,2020). In severe cases of Bells Palsy, the
patient face will be asymmetric at rest, no motion to forehead,
and incomplete closure of the eye (Ronthal & Greenstein,2020).
With severe cases it is recommend to co -administer anti-viral
medication valacyclovir with prednisone. It is unclear if anti-
viral therapy adds benefit with new onset bells palsy. It is not
recommended to treat with anti-viral medication alone (Ronthal
& Greenstein,2020). Mild cases of Bells Palsy should be treated
with prednisone alone. Mild case consists of normal facial
symmetry at rest and slight weakness noted in face (Ronthal &
Greenstein,2020).
Valacyclovir is rapidly converted to acyclovir after
administration, the mechanism of action is the same as
acyclovir. It is active against the herpes simplex virus. It
distributes to areas in the brain, the lung, herpetic lesions,
saliva, semen, and kidney (Woo & Robinson,2016). Renal
failure has been reported, use with caution in patients with
kidney disease. Thrombotic thrombocytopenic purpura has been
reported. There are few side effects with acyclovir, but some
include headache, rash, and nausea vomiting (Woo &
Robinson,2016). Education includes should be taken at the
earliest sign of disease; medication should be taken with plenty
of fluids to maintain hydration to help avoid renal failure (Woo
& Robinson,2016).