We need to taper the drug over several weeks.
THE DISCUSSION RESPONSE QUESTION
THE DISCUSSION RESPONSE QUESTION
Review and reflect on the decision steps in the interactive media piece below on DEPRESSION.
Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_03/index.html
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.
Respond to the following discussion post on DEPRESSION by providing recommendations for alternative drug treatments to address the patient’s pathophysiology.
Support your response by 2 or more credible resources within the last 5yrs. (I or 2 from learning resources plus 1 or 2 from outside).
GRADING RUBRIC:
• The response exhibits synthesis, critical thinking, and application to practice settings.
• Provides clear, concise opinions and ideas that are supported by at least three scholarly sources. (I or 2 from learning resources plus 1or 2 from outside).
• Demonstrates synthesis and understanding of learning objectives.
• Communication is professional and respectful to colleagues.
• Response is effectively written in standard, edited English.
DISCUSSION #3
carmelite clemmer
RE: Discussion – Week 8 – Main Post
COLLAPSE
I chose the Adult-Geriatric Depression scenario. A Hispanic male is complaining of depression and some slight aches. Patients can have general aches and nonspecific symptoms when they have depression.
#1- I chose to start him on Zoloft 25mg daily.
He returned to the clinic after 4 weeks with a 25% decrease in symptoms but complains of ED.
#2- I chose to continue to the same dose, and when the patient returned he said he stopped taking the drug because he did not like the erectile dysfunction and it effected his self esteem.
#3- I chose to restart the Zoloft at 50% of the initial dose. Because it did have a 25% decrease of symptoms on initial administration. (If it did nothing for his symptoms, I would choose another drug in that same class). I was hoping that the ED was dose dependent and we might have a relief of ED but also a decrease in depression.
Current guidelines state that if Zoloft doesn’t work we should try another SSRI prior to switching classes. (Laureate Education, 2019a)
I went back and redid the scenario and at step #2, I chose to decrease his current dose of Zoloft to 12.5mg daily.
He came back 4 weeks later and depressive symptoms worsened but ED has decreased
Step 3- I chose to increase the dosage back to 25mg daily but there was not guarantee that side effects will return. If ED did return at 25mg, the scenario said that it would be appropriate to change to Paxil 20mg with the hope that ED would not be one of those side effects. We would not want to switch classes unless we have tried another drug in that class. (Laureate Education, 2019a)
SSRIs are usually our go- to medication for initiating treatment. SSRIs treat depression with minimal side effects. They inhibit the reuptake of serotonin in the brain. This creates a surplus of serotonin.
SSRIs are protein bound and are almost completely absorbed through oral medication. They are usually metabolized in the liver and peed out in the urine. (Lippincott Williams & Wilkins, 2017)
We would start on a low (if elderly/decreased drug clearance) to average dosage and go from there.
We need to make sure that we are not prescribing SSRIs with MAOIs. This could cause serotonin syndrome. (Volpi-Abadie, 2013).
Monitor for side effects of anxiety, arrythmias, somnolence, Sexual disfunction, skin rashes. Hypoglycemia can occur with fluoxetine (also has long half-life). (Lippincott Williams & Wilkins, 2017)
If SSRIs are stopped abruptly, the patient can get SSRI discontinuation syndrome. This can happen in 1/3rd of patient that stop the drug abruptly. This is apparent with dizziness, vomiting, nausea, vertigo, muscle pains, anxiety, memory issues and more. We need to taper the drug over several weeks. (Lippincott Williams & Wilkins, 2017)
Orthostatic hypotension can happen with citalopram and paroxetine. (Lippincott Williams & Wilkins, 2017)
Laureate Education. (Producer). (2019a). Adult geriatric depression [Interactive media file] Baltimore, MD: Author.
Lippincott Williams & Wilkins. (2017). Pathophysiology made incredibly easy! (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
Volpi-Abadie, J., Kaye, A. M., & Kaye, A. D. (2013). Serotonin syndrome. The Ochsner journal, 13(4), 533–540.
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
• Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)
• Chapter 25, “Antidepressants” (pp. 247–265)
• Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)
• Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)
• Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)
• Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)
REQUIRED AND INTERACTIVE MEDIA PIECES
Adult geriatric depression
Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression. cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_03/index.html
Attention deficit hyperactivity disorder
Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder. cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_09/index.html
Bipolar therapy
Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy. cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html
Generalized anxiety disorder
Laureate Education (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder. cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_05/index.html
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