Temazepam Refill Consultation Notes

Patient Assessment for Temazepam Refill

Initial Interaction

• Confidentiality: Ensure privacy and discretion.
• Empathy: Show understanding and compassion.
• Open-Ended Questions: Use questions that require more than a yes/no answer to gather comprehensive information, such as "How can I help you?"

Establishing Context

• Acknowledge it's the first time meeting the patient.
• Explain the need to ask questions to understand the situation better and make an appropriate decision regarding her medication.
• Obtain the patient's consent to proceed with the questions.

Medication History

• Medication Inquiry:
  • Ask the patient what medication she is requesting a refill for (temazepam).
  • Inquire how long she has been using it (one year).
  • Ask why it was initially prescribed.
• Dosage and Tolerance:
  • Determine if the patient has ever had to increase the dose to achieve the same effect.
  • Explore if she has ever stopped taking the medication.
  • If she has stopped, ask about the duration and any withdrawal symptoms experienced.
    • Examples of withdrawal symptoms: irritability, anxiety, sleeping problems.

Sleep Problems Exploration

• Sleep Initiation:
  • Ask if the patient has difficulty falling asleep.
  • Determine if she wakes up in the middle of the night and struggles to return to sleep.
  • Inquire about nightmares.
• Nocturnal Issues:
  • Ask about urinary problems (frequency, nocturia).
  • Inquire about snoring or gasping during sleep (potential sleep apnea).
  • Ask about pain in the legs.

Sleep Environment

• Sleep Schedule:
  • Determine when the patient goes to bed and falls asleep.
  • Assess the average number of hours of sleep she gets.
• Environmental Factors:
  • Inquire about the sleep environment.
  • Ask about pets, room darkness and quietness, and presence of children.

Psychological Assessment

• Six Psychological Questions (Modified):
  • Mood.
  • Appetite.
  • Suicide: Ask if the patient has thoughts of harming herself or others, previous attempts, or plans.
  • Hallucinations: Ask if she hears, feels, or sees things that others do not.
  • Delusions: Ask if she has any ideas that others find strange.
  • Mania: Rule out mania by asking if there have been times she felt extremely happy and energetic with little need for sleep.
    • MDD questions which include concentration, tiredness, guilty.

Additional Contextual Questions

• HEEADSSS Assessment:
  • Home situation.
  • Education.
  • Employment.
  • Anhedonia: Determine if the patient still enjoys activities she used to.
  • Drugs, alcohol, and other substances: Inquire about the use of drugs, alcohol, medications, smoking, and energy drinks.
  • Systemic Issues: Explore any weather preferences.
  • Sexual History: Ask about any changes in her sex life.

Explaining the Sleep Problems

• Express concern about the patient's sleep and temazepam usage.
• Explain to the patient that temazepam is not the best option for her sleeping problem
• Underlying Causes:
  • Acknowledge the patient's low mood and appetite.
  • Acknowledge the patient's tiredness and concentration proble.
  • Major Depressive Disorder (MDD): Attribute the sleep problems partly to MDD.
    • Symptoms: low mood, low appetite, anhedonia, tiredness, and concentration problems.
  • Stress: Identify stress as a contributing factor.
  • Caffeine and Alcohol: Note the patient's consumption of coffee and alcohol.
• Temazepam Risks:
  • Dependence: Explain that the body becomes used to the medication.
  • Tolerance: Explain that tolerance means the patient would require a higher dose for the same effect.
  • Withdrawal Symptoms: Describe the potential symptoms upon abrupt cessation.
    • Examples: irritability, anxiety, and sleeping problems.