JCC is a 49-year-old male patient who has been taking the below medications for at least a year. His medical history is significant for hypertension, insomnia and anxiety disorder. 

Current medications: 

  • Losartan 100 mg daily 
  • Amlodipine 5 mg daily 
  • Vortioxetine 20 mg at bedtime 
  • Diazepam 5 mg TDS 
  • Melatonin 2 mg at bedtime
  • Mirtazapine 45 mg at bedtime
  • Zolpidem 10 mg at bedtime PRN 

a) Despite the drug treatment for insomnia, JCC complains that he often has problems of waking too early and waking a few times at night. Describe any pharmacological modifications to his current medications that can improve his sleep. (6 marks) 

b) Lemborexant belongs to the class of dual orexin receptor antagonists and is available in Hong Kong. Discuss why it may be more suitable for JCC when compared to his current regimen. (6 marks)

c) Suggest an initial dose of Lemborexant and provide TWO important counselling points to JCC. (3 marks) . 

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