Case Study: Zusa Sadelars

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Case Study: Zusa Sadelars

Zusa Sadelars has been diagnosed with post-traumatic stress disorder (PTSD) and should be considered for some medications in order to treat her nightmares. One of the medications that can be used to treat Zusa’s nightmares is prazosin. The drug is used for treatment and management of benign prostatic hyperplasia, hypertension, Raynaud’d phenomenon, and PTSD. It used as a non-label drug for treatment of PTSD nightmares. Prazosin is a quizoline derivative, which acts as a competitive-alpha-1- antagonist. Prazosin is administered orally. Initiation dose is 1mg and the maintenance dose range from 2 to 6mg nightly. In military personnel higher doses up to 16mg nightly have been used (Basquez & Pippin, 2020). Prazosin is used for treatment of PTSD-associated nightmares due to its presumed role in disruption of consolidation of fear memories and by reducing the primitive fear response (El-Solh, 2018).

Serious adverse effects associated with prazosin include syncope, intraoperative Floppy iris syndrome, first dose hypotension, and orthostatic hypertension. Common adverse effects include headache, drowsiness, dizziness, lack of energy, weakness, nausea and palpitations. Less common side effects may include constipation, diarrhea, vomiting, edema, orthostatic hypotension, edema, depression, urinary frequency, nervousness, nasal congestion, and vertigo (Basquez & Pippin, 2020). Prazosin can also lead to sudden loss of consciousness; particularly, if used a dosage of 2 mg or greater (El-Solh, 2018). It is contraindicated in case of previous anaphylaxis with the use of the drug (Basquez & Pippin, 2020).

Terazosin can also be used as a non-label medication for management of nightmares associated with PTSD. It is also indicated for management of essential hypertension and benign prostatic hyperplasia. Terazosin is a long-acting selective-alpha 1adrenergic receptor antagonist. It can be used at a dose of 1 to 6 mg orally per day. Terazosin is well tolerated generally but can cause adverse effects such as dizziness, weakness, headache, nasal congestion, postural hypotension, first-dose syncope, and orthostatic hypotension. It is contraindicated in case of previous terazosin hypersensitivity or allergy (Yang & Raja, 2020). In a trial, terazosin reduced PTSD-associated nightmares by 64% with a dose 2mg to 5mg (El-Solh, 2018).

Clonadine is another medication that may be considered for treatment of Zusa’s PTSD-associated nightmares. Clonadine is an alpha-2-adrenergic receptor agonist, which has been reported to reduce nightmares in patients with traumatic brain injury and comorbid PTSD.  Data indicating effectiveness of clonidine in treatment of PTSD-associated nightmares is limited. It can be used at a dose of 2mg per day (El-Solh, 2018).

Several antipsychotic medications may also be used treat PTSD-associated nightmares. Risperidone is a typical antipsychotic with lower affinity for dopamine 2 receptor and high affinity for serotonin receptors. It exhibits alpha 2- and alpha 1-noradreneric antagonism. It can treat PTSD-associated sleep disturbances such as nightmares (El-Solh, 2018). Quetiapine and olanzapine can also be used to management of sleep disorders, insomnia, and PTSD symptoms in combat veterans/ Quetiapine and olanzapine are atypical antipsychotics that possess anti-serotonergic and antidopaminergic properties and demonstrate high affinity for alpha 1 receptors and histamine H1 receptors. They can help to ameliorate insomnia complaints and nightmares in patients with PTSD (El-Solh, 2018). A combination of any of the above appropriate medications may be used to treat Zusa’s nightmares associated with PTSD.