| Course | D345 Psychopharmacology for Advanced Psychiatric Mental Health Practice |
|---|---|
| Task | Task 2 |
| Paper type | Documented prescribing rationale |
| Length | About 800 words, 3 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D345 Task 2
Documented Prescribing Rationale: Low-Dose Doxepin for Sleep-Maintenance Insomnia in a 72-Year-Old Woman After a Partial Response to CBT-I
Student Name
Leavitt School of Health, Western Governors University
D345: Psychopharmacology for Advanced Psychiatric Mental Health Practice, Task 2
Course Instructor
Month Day, Year
Documented Prescribing Rationale: Low-Dose Doxepin for Sleep-Maintenance Insomnia in a 72-Year-Old Woman After a Partial Response to CBT-I
Patient and Problem
The patient is a composite 72-year-old retired teacher with chronic insomnia disorder: difficulty staying asleep, waking at 2 or 3 a.m. at least four nights a week for 14 months, with daytime fatigue and irritability. She has no depression on screening (Patient Health Questionnaire-9 score of 4) and no symptoms of sleep apnea on a structured questionnaire, and her partner reports no snoring. Medical history: hypertension treated with amlodipine, osteoarthritis of the knees and a fall in the garden last year without injury. She drinks one glass of wine with dinner two or three nights a week. She completed six sessions of cognitive behavioral therapy for insomnia (CBT-I), which improved sleep onset and total sleep time, but she still wakes in the early morning three nights a week and asks whether a medicine could help.
Why Medication Is Being Considered Now
CBT-I is the recommended initial treatment for chronic insomnia in all adults (Qaseem et al., 2016), and it came first here. The same guideline recommends shared decision-making about adding medication for adults in whom CBT-I alone has not been successful, discussing benefits, harms and costs of short-term use. Her remaining symptom is specifically sleep maintenance, which narrows the choice of agent.
Options Considered and Set Aside
Benzodiazepines such as temazepam, and the nonbenzodiazepine receptor agonists zolpidem and eszopiclone: effective for some patients, but the Beers Criteria advise avoiding them in older adults because of increased risk of cognitive impairment, delirium, falls, fractures and motor vehicle crashes (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023). With a previous fall and knee arthritis, the fall risk is decisive. Set aside.
Diphenhydramine and other over-the-counter sleep aids: strongly anticholinergic, with risks of confusion, constipation and urinary retention in older adults, and listed as potentially inappropriate by the Beers Criteria. Set aside, and she will be advised to avoid them.
Trazodone: widely used off-label, but the sleep medicine guideline suggests not using it for chronic insomnia, and it can cause orthostatic hypotension and falls (Sateia et al., 2017). Set aside.
Suvorexant: suggested by the guideline for sleep maintenance insomnia (Sateia et al., 2017), but it is costly, she has limited drug coverage, and next-day drowsiness can occur. Kept as a second option.
Low-dose doxepin, 3 mg: suggested by the guideline for sleep maintenance insomnia (Sateia et al., 2017). At this dose it acts mainly as a selective histamine H1 receptor antagonist, and the anticholinergic effects seen at antidepressant doses are minimal. It is available as a low-cost generic and does not carry the same dependence concerns as benzodiazepines. Chosen.
Decision
Doxepin 3 mg by mouth, taken 30 minutes before bedtime, on nights when she can allow at least seven hours in bed. She will continue the CBT-I techniques, especially a consistent wake time and leaving the bed when awake for more than 20 minutes. The prescription is for 30 tablets with one refill, to be reviewed in four weeks.
What the Patient Was Told
The medicine is a very small dose of an old drug that helps keep you asleep in the second half of the night. Take it only when you can stay in bed for seven hours, not after 1 a.m. It works best if you keep your sleep routine. You may feel a little drowsy in the morning at first; do not drive until you know how it affects you. Avoid wine on the nights you take it, and avoid over-the-counter sleep aids, which can combine with it and make you unsteady. Get up slowly at night, use a night light and keep a clear path to the bathroom. Call if you feel confused, very dizzy, constipated or unable to pass urine.
Monitoring for Response and Safety
Response: a two-week sleep diary before and after starting, recording wake time, nighttime awakenings and daytime fatigue, with a goal of early waking on no more than one night a week. Safety: at four weeks, ask about morning drowsiness, dizziness, falls or near-falls, confusion, constipation and urinary symptoms; check orthostatic blood pressure; and review all medicines and alcohol use. If response is inadequate at four weeks, reassess for sleep apnea, mood changes and pain before considering suvorexant. The goal is to taper and stop the medication within three to six months if sleep is stable, keeping CBT-I skills as the long-term treatment. The rationale, the options set aside and the stopping plan are documented in the chart so that any clinician covering her care can see why this agent was chosen and when it should end.
References
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-133. https://doi.org/10.7326/M15-2175
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307-349. https://doi.org/10.5664/jcsm.6470
What the D345 Task 2 instructions ask
The second D345 task asks you to document the reasoning behind a prescribing decision. Most versions ask for the patient and problem, why medication is being considered, the options considered and set aside with reasons, the decision, patient education and monitoring for response and safety. The case should include factors that make the choice difficult, such as age, comorbidities or prior treatment. Evaluators look for guideline-based reasoning, alternatives weighed with specific reasons, education written for the patient, and monitoring tied to the drug's known risks. A decision presented without the alternatives considered will not show the reasoning the task is designed to assess. Many versions also ask how the decision will be reviewed.
How this D345 Task 2 example is built
The rationale begins with the patient's insomnia pattern and history of treatment. A section explains why therapy came first and why medication is now reasonable, citing guidelines. Options are weighed one by one, with the reason each was set aside, such as fall and cognitive risk in older adults. The decision states the drug, timing and conditions of use. Patient education is written as the patient would hear it. Monitoring separates response, measured by a sleep diary, from safety, including next-day sedation, falls and anticholinergic effects. Sources include geriatric prescribing criteria, sleep medicine guidance and physician practice guidelines. The alternatives section reads as a short comparison, one option per paragraph.
Where the D345 Task 2 rubric puts the marks
D345 Task 2 aspects are rated competent, approaching competence or not evident. A patient and problem aspect checks for relevant clinical detail. An indication aspect asks why medication is appropriate now. An alternatives aspect rewards options weighed with specific reasons. A decision aspect wants the choice stated clearly and supported by evidence. An education aspect looks for accurate, plain-language teaching. A monitoring aspect asks for response and safety measures. Evaluators check that the reasoning reflects current guidelines, including cautions for older adults, and that sources are authoritative. Rationales that show why the chosen option is safer for this particular patient than the alternatives are credited most. A rationale that states when the medication would be stopped shows mature prescribing judgment.
D345 Task 2 help: what sends it back
Prescribing rationales come back most often when alternatives are not discussed. Name at least three options and explain why each was or was not chosen. Second, the indication is weak, such as starting medication without trying first-line therapy. Show the sequence. Third, education is written in clinical terms. Rewrite it for the patient. Fourth, monitoring covers response but not safety. Add the risks specific to the drug and patient. Finally, cite current guidelines for special populations, such as geriatric prescribing criteria, since evaluators expect those cautions to shape the choice. Include the date you plan to review the decision with the patient.
Get a D345 Task 2 example written to your instructions
Send the D345 Task 2 instructions and rubric aspects, plus the case parameters your task specifies. We build a composite example to those aspects, with the alternatives weighed, the consent conversation recorded and monitoring attached, and return it in 24-48h. The first custom sample is free, and it stays a reference for later courses.
More D345 papers
Other NP track sample papers
- D120 Task 2 Applied Care Plan
- D344 Task 1 Psychiatric Evaluation Write-up
- D346 Task 1 Adult Treatment Plan
- D119 Task 1 Pediatric Case Analysis
D345 Task 2 questions, answered
How is Task 2 different from the mechanism paper?
The first task explains a class from the pharmacology upward and carries no patient. The second sets a single composite patient before the writer and expects a defended decision with monitoring attached. The pharmacology becomes evidence rather than subject matter, and most of the space goes to comparison, consent and follow-up rather than to receptor action.
Do examples include specific doses?
They stay at the level of documented reasoning: what was chosen, why it beat the alternatives for this composite patient, what was disclosed and what would be monitored. We do not publish dosing that a reader could act on, and an example is never a substitute for the prescribing references and supervision your placement provides.
Should non-pharmacological options appear in a psychopharmacology task?
Usually yes, unless your instructions rule them out. A rationale that never considered therapy, sleep, substance use or social circumstances looks narrower than the reasoning the task expects, and evaluators often read for whether the decision was made in context. Naming what else was offered, and why medication was still chosen, strengthens the argument rather than diluting it.
How is D345 Task 2 different from the mechanism paper?
Task 1 explains how a drug class works; Task 2 documents why a specific drug was chosen for a specific patient over the alternatives, with education and monitoring.
Where can I find a free D345 Task 2 sample paper?
The documented rationale is reproduced above with notes on each part. Share your D345 instructions and case, and your first tailored rationale is prepared at no charge.