A 56 yr. old woman signs up with you as his new primary care physician. Her previous diagnosis included hyperlipidemia, hyperglycemia, moderate obesity and hypertension.

A 56 yr. old woman signs up with you as his new primary care physician. Her previous diagnosis included hyperlipidemia, hyperglycemia, moderate obesity and hypertension. His medications include: Paroxetine 20 mg for 10 years; Quetiapine 150 mg daily for 2 yrs.; Irbesartan 300 mg daily for 1 yr.; and Atorvastatin 10 mg daily for 1 yr.

Labs: FBS = 126, HgbA1C = 6.2, total cholesterol = 200, LDL = 105, HDL = 35, Tg =286. His present height equal 5’9” and weight = 210 lbs. His BP is 140/84.

She tells you that about 10 yrs. ago she became depressed and was started on Paroxetine and gained 30lbs after 1 yr. Her mood at that time was much improved and remained that way for about 2 yrs. At that time, Quetiapine was added, and she achieved remission of her depression. Six months after this she gained another 20lbs, developed mild hypertension, hyperglycemia and hyperlipidemia. All other lab including thyroid testing was normal. She tells you that she has a craving for carbohydrates and does little exercise since developing depression about 15 yrs. ago.

? Questions:

What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.

If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?