NURSING 6005Pharm

Angela is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with NSAIDs. She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty. Assessment: At her annual medical checkup appointment, she told her primary care provider that she seemed to be tired all the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She denied that she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children. She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life: “My husband and kids would go on fine if I died and probably wouldn’t miss me that much.” The primary care provider asks Angela to fill out a Beck’s Depression Scale, which indicated she has moderate depression. What medication would you first prescribe to this patient? Depressed mood correlates with difficulty processing in the areas of the amygdala and the prefrontal cortex. “Sleep and appetite are linked to dysfunction in the hypothalamus; fatigue is linked to NE and DA dysregulation in the prefrontal cortex and nucleus accumbens. Guilt, suicidality, and worthlessness theoretically are linked to dysregulation in the prefrontal cortex and the amygdale,” (p.899, Woo & Robinson, 2015). Paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) encompass the class known as SSRIs, which is what I feel Angela would benefit from the most. An SSRIs fundamental mechanism of action is blocking the transport mechanism that returns unbound 5HT left in the synaptic cleft into the presynaptic neuron, thereby terminating the transmission of the message carried by that receptor making more 5HT available to bind to the postsynaptic serotonin receptor (Woo & Robinson, 2015). She comes back in 2 weeks and states she has not noticed any change in her mood since starting on the medication. What would be your response? All clients must be counseled during any therapeutic change and with the addition of new prescription medications, especially those that require sustained pharmacological therapeutic windows in order to achieve beneficial effects. Symptoms should improve upon peak dosage onset at approximately weeks 2 – 4; with sleep notably reported the last symptom to show improvement (Woo & Robinson, 2015). Furthermore, throughout every office follow-up with Angela, depressive/suicidal ideations/actions will be evaluated. What are the possible problems with the medication you prescribed? As with nearly any medication, drug-drug interactions can occur, especially when SSRIs are used in conjunction with other medications that increase serotonin levels in the brain; such as: other antidepressants, prescription opioids, migraine medications, cocaine, and St. John’s Wort. If one or more of these drugs are used with an SSRI, a high level of serotonin in the brain This study source was downloaded by from CourseH on 03-19-2022 16:27:37 GMT -05:00