Sample Answer for NURS 6630 Drug Management of Major Depressive Disorder Co-occurring with Alcohol Abuse Included After Question
When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.
To prepare for this Assignment:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages
Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
- Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
A Sample Answer For the Assignment: NURS 6630 Drug Management of Major Depressive Disorder Co-occurring with Alcohol Abuse
Title: NURS 6630 Drug Management of Major Depressive Disorder Co-occurring with Alcohol Abuse
Drug Management of Major Depressive Disorder Co-occurring with Alcohol Abuse
Alcohol abuse and major depressive disorders occur commonly in the population. These disorders, from time to time occur together. When they occur together, they display a dreadful outcome (Baranyi et al., 2022). An integrated approach to the treatment of these patients is paramount. The purpose of this paper is to discuss the neurobiology, symptoms, and the appropriate drug therapy for patients with Major Depressive Disorder co-occurring with Alcohol Abuse.
Explain the Appropriate Drug therapy for Major Depressive Disorder co-occurring with Alcohol Abuse
A combination of naltrexone and sertraline has been proven ideal for the treatment of co-occurrence of alcohol abuse and major depressive disorder. This combination delays the reversion to alcohol abuse, is highly efficacious, marked improvement in mood in comparison to other drug therapies, and had fewer side effects (Stubbs et al., 2022).
Which Drugs are contraindicated
Benzodiazepines- such as diazepam- are contraindicated as they lower the seizure threshold hence the patient is at an increased risk of falls, intellectual impairment, increased risk aspiration, and low efficacy, in the long run, cross-tolerance of the benzodiazepines and alcohol hence propensity to abuse the drugs, and withdrawal effects after stoppage of the drug.
Bupropion lowers the seizure threshold. Mirtazapine and tricyclic antidepressants when used in the setting of alcohol abuse, they act synergistically to increase the sedative effects of alcohol. Duloxetine is hepatotoxic and may propel liver disease in the setting of chronic alcohol abuse.
What is the Timeframe that the Patient should see the Resolution of symptoms
- With adherence to medication and abstinence from alcohol, symptoms abate starting from two weeks post initiation of therapy (Close, 2019).
List four Predictors of Late Onset Generalized Anxiety Disorder
- They include chronic disease conditions like COPD, mental retardation, presence of other mental illnesses like depression, lack of support and affection during childhood, poverty, unpropitious events in life, and separation.
List four Potential Neurobiological causes of Psychotic Major Depression
- They include hypersensitized response to stress, serotonin dysfunction, disrupted dopamine feedback system in the nigrostriatal pathway, and noradrenaline dysfunction.
List at least five Symptoms of Major Depression
- The presence of all three of a low mood, anhedonia, and anergia plus at least any three of disturbed sleep, lack of appetite, ideations of self-harm, worthlessness, reduced self-esteem, reduced attention and pessimism about the future.
List three Classes of Drugs that Precipitate Insomnia with a corresponding example for each class, be specific
- Selective Serotonin Reuptake Inhibitors such as fluoxetine.
- Dopamine receptor agonists such as pramipexole.
- Alpha-blockers such as alfuzosin.
References
Baranyi, G., Fazel, S., Langerfeldt, S. D., & Mundt, A. P. (2022). The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis. The Lancet Public Health, 7(6), e557–e568. https://doi.org/10.1016/s2468-2667(22)00093-7
Close, L. (2019). Depression & Substance Abuse Treatment Plans, Medication, Therapy. American Addiction Centers. https://americanaddictioncenters.org/treating-depression-substance-abuse
Stubbs, K. R., Van Bezooyen, J., & Tang, Y. (2022, January 1). Chapter 31 – Managing treatment-resistant depression with comorbid substance use disorders (J. Quevedo, P. Riva-Posse, & W. V. Bobo, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128240670000311