Instructions:
-List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
-Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
-Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
-List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
-List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
-For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
-Include any “check points†(i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Case Study:
-Case: An elderly widow who just lost her spouse.
-Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the -following medications:
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
Treatment for a Patient with a Common Condition
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
Treatment for a Patient with a Common Condition
The patient in the case study is presented with symptoms of depression. Some of the questions to ask the patient include: Do you take your medications as required? What is your attitude towards your treatment regimen? Whom do you live with? Since the patient is suffering from a certain chronic illness, medication adherence is very important for her to improve (LeMoult, & Gotlib, 2019). These three questions test her medical compliance, and the answers she provides will be used to develop patient education for her.
It is important to involve other people who might be useful in helping the patient improve her health status. Some of the people to ask questions about her include her personal care physician or nurse, children, family members, and very close friends (McIntyre et al., 2020). These individuals might have detailed or tangible information about the patient, hence, they are in a better position to provide reliable and meaningful answers. Some of the questions to ask these people include: does the patient take her medications are required? How does she talk about her medical condition? Do you help the patient with her medications and other duties? (McIntyre et al., 2020). These questions are important because they revolve around understanding medication adherence and the kinds of support offered to the patient by the individuals.
Physical examination may include assessing past illnesses, sleep habits, depressive symptoms, lifestyle, and medical history. Things like mood changes, concentration, and fatigue should be taken into consideration (LeMoult, & Gotlib, 2019). Lab tests may include a thyroid test and a complete blood count to detect any abnormalities. DSM can be used to affirm psychiatric diagnosis.
Based on the provided information, differential diagnoses for the patient would include dysthymia, major depressive disorder, and c Cyclothymia. Both Cyclothymia and dysthymia have almost similar symptoms to those of depression. However, the most likely diagnosis for the patient is major depressive disorder (Malhi & Mann, 2018). Her medical history makes her more vulnerable to depression. She complains of insomnia, a depressive symptom. She also takes Sertraline 100mg daily, which is a medication used to treat depression.
The two pharmacological agents to treat the major depressive disorder include sertraline (Zoloft) and imipramine (Tofranil). Zoloft is the most preferred drug for the patient because it is safer with fewer side effects than imipramine (Malhi & Mann, 2018). Zoloft is classified as a selective serotonin reuptake inhibitor (SSRI), with few side effects. On the other hand, imipramine is one of the tricyclic antidepressants, known to cause more severe side effects.
Zoloft, just like any other drug, should be taken with caution to avoid drug interactions and side effects. Zoloft is contraindicated in patients treated with those treated with methylene blue injection as well as those taking pimozide (McIntyre et al., 2020). Additionally, patients who are allergic to Zoloft should not take the drug. Furthermore, patients who have taken MAO within the past 14 days should be barred from using Zoloft. Taking the drug in these situations can lead to severe side effects.
A proper follow-up plan is essential to ensure proper recovery, support, and medication compliance. To ensure proper follow-ups, the patient should return to the hospital on week 4, week, 8, week 12, and week 16 (LeMoult, & Gotlib, 2019). There should be four weeks until the patient has achieved more than 50 % symptom improvement.
References
LeMoult, J., & Gotlib, I. H. (2019). Depression: A cognitive perspective. Clinical Psychology Review, 69, 51-66. https://doi.org/10.1016/j.cpr.2018.06.008
Malhi, G. S., & Mann, J. J. (2018). Depression. The Lancet, 392(10161), 2299-2312. https://doi.org/10.1016/S0140-6736(18)31948-2
McIntyre, R. S., In Rong, C., In Subramaniapillai, M., & In Lee, Y. (2020). Major depressive disorder. Elsevier.