Sample Answer for NURS 6521 PHARMACOLOGY week 8 Included After Question
NURS 6521 PHARMACOLOGY week 8
INSTRUCTION
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit
PLEASE SEE MY CLASSMATE NO 1 POST BELOW TO RESPOND TO
A Sample Answer For the Assignment: NURS 6521 PHARMACOLOGY week 8
Title: NURS 6521 PHARMACOLOGY week 8
Case Study: Adult Geriatric Depression
The case study patient (CSP) is a 70-year-old Hispanic American male who was referred to the clinic by his primary care provider to rule out depression. There is no other significant past medical history and health concerns other than occasional back pain and shoulder stiffness, which he associates with his work as a laborer in a warehouse. The CSP immigrated to the United States as a teenager and always felt like an ‘outsider.’ He stated that he had few friends but described his home life as good. He reported a recent 15-pound weight gain, reduced interest in daily activities, difficulty sleeping, and diminished concentration at work.
The CSP is alert and oriented to person, place, time, and event during the mental status exam. Speech is clear but soft; emotional expression and eye contact were low. The CSP is verbalizing feelings of depression. He denies visual and auditory hallucinations, delusional, paranoid thoughts, and current suicidal thoughts. Judgment and insight are intact, and he obtained a score of 51 on the Montgomery-Asberg Depression Rating Scale, which indicates severe depression.
Treatment Decisions Recommendations
First, in decision point one, the CSP is started on Zoloft (sertraline) 25 mg po once daily. He described a 25% reduction of symptoms on the four-week follow-up appointment and is concerned about the new-onset erectile dysfunction. Second, in decision point two, his current dose of Zoloft (sertraline) was augmented with Wellbutrin IR (bupropion) 150 mg po once daily in the morning. After four weeks, this intervention improved his depressive symptoms and decreased sexual dysfunction; however, the CSP started experiencing nervousness and agitation. Lastly, in decision point three, Wellbutrin IR (bupropion) was changed to Wellbutrin XL (bupropion) 150 mg po once daily in the morning to attenuate the neurological adverse effects.
Drug’s Pharmacotherapeutic Effects Impact on Patient’s Pathophysiology
A depressive mood state is believed to be one of the core symptoms of major depressive disorder. Saiz-Ruiz et al. (2011) explained that several neuroimaging studies revealed a link between depressive mood state and altered neuronal activity in the prefrontal anterior cingulate and orbitofrontal cortices. Depressed mood is related to the low serotonin levels (5-hydroxytryptamine [5-HT]), norepinephrine, and dopamine. Accordingly, drugs that elevate these levels demonstrated improvement of depressive symptoms. For instance, Zoloft (sertraline) is an antidepressant associated with a family of selective serotonin inhibitor reuptake inhibitors (SSRIs). Rosenthal and Burchum (2018) discussed that SSRIs prevent the neuronal uptake of 5-HT, which amplifies its concentration in the synapse and increases its postsynaptic receptor activation.
Zoloft (sertraline) has linear pharmacokinetics and has peak plasma levels of 4-6 hours after a single oral dose. The agent is highly bound to plasma protein (approximately 98%) and has a half-life of 24 hours (Saiz-Rodriguez et al., 2018). The common side effects include gastrointestinal disturbances, anxiety, sexual incapacity, altered cognition, and possible serotonin syndrome. Saiz-Rodriguez et al. (2018) claimed that 40% of patients do not achieve a positive response to SSRI, and 50% do not attain remission. Practice guidelines usually endorsed SSRIs as a first-line pharmacological treatment due to their tolerability rather than superior efficacy (Patel et al., 2016).
Alternatively, Wellbutrin (bupropion) is a monocyclic phenylethylamine of the aminoketone group, a structure unique from other antidepressants. Saiz-Ruiz et al. (2011) described that the drug’s direct action inhibits neuronal reuptake of norepinephrine and dopamine. Furthermore, the drug does not have anticholinergic and direct sympathomimetic effects, and its cardiac depressant activity is ten times lower than tricyclic antidepressants (Saiz-Ruiz et al., 2011). Wellbutrin (bupropion) is not associated with sexual side effects but carries a low risk of psychotic symptoms (delusions, hallucinations). Other side effects include agitation, jitteriness, mild cognitive impairment, insomnia, and gastrointestinal distress (American Psychiatric Association, 2010).
Drug’s Pharmacotherapeutic Effects Impact on the Treatment Plan
The pharmacotherapeutic side-effects of antidepressant medications are attributed to approximately 30% of non-compliant cases (Balikci et al., 2013). The authors discovered that at least half of the individuals on SSRI therapy experienced significant side-effects that lead to nonadherence or discontinuation of the treatment. SSRIs such as Zoloft (sertraline) can result in erectile or ejaculatory dysfunction in men and decreased libido in both sexes (American Psychiatric Association, 2010). This side effect can be concerning and needs to be addressed to improve treatment outcomes. The American Psychiatric Association (2010) stated that administering Wellbutrin (bupropion) 150 mg orally twice a day is an effective rescue drug to mitigate the sexual adverse effects.
Subsequently, concurrent use of Wellbutrin (bupropion) and SSRI may increase the risk of seizures, as both agents are linked with lowering the seizure threshold. Their additive effects may cause tremors, anxiety, and panic symptoms, and psychotic reactions. Interestingly, Wellbutrin (bupropion) is a potent inhibitor of cytochrome P450 2D6, an enzyme responsible for SSRIs’ metabolism (Munhoz, 2004). This mechanism indicates that the concomitant use of Wellbutrin (bupropion) and SSRI may cause SSRI accumulation, thus enhancing its serotonin activity. It is recommended to monitor patients’ responses closely for any evidence of serotonin syndrome and seizures while on this combined drug therapy.
Serotonin syndrome is a rare but fatal adverse effect of SSRIs that occurs 2 to 72 hours after the treatment. Signs and symptoms include altered mental status, loss of coordination, myoclonus, hyperreflexia, extreme sweating, tremor, and elevated temperature (Rosenthal & Burchum, 2018). The syndrome is usually dissipated when the drug is discontinued. Similarly, seizures are of significant concern in Wellbutrin (bupropion) therapy. Rosenthal and Burchum (2018) suggested that to reduce the risk; the drug should not be given in high doses (above 450 mg per day), avoid rapid titration, and prevent drug administration in high-risk individuals (head trauma, history of seizure, and CNS tumor).
References
American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder (revision). The American Journal of Psychiatry, 157(4), 1–45.
Balikci, A., Uzun, O., Erdem, M., Doruk, A., Cansever, A., & Ates, M. A. (2013). Side effects that cause noncompliance to antidepressant medications in the course of outpatient treatment. Bulletin of Clinical Psychopharmacology, 24(1), 69–75. https://doi.org/10.5455/bcp.20120827114140
Munhoz, R. P. (2004). Serotonin syndrome induced by a combination of bupropion and SSRIs. Clinical Neuropharmacology, 27(5), 219–222. https://doi.org/10.1097/01.wnf.0000142754.46045.8c
Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016). Bupropion: A systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic Advances in Psychopharmacology, 6(2), 99–144. https://doi.org/10.1177/2045125316629071
Rosenthal, L., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
Saiz-Rodríguez, M., Belmonte, C., Román, M., Ochoa, D., Koller, D., Talegón, M., Ovejero-Benito, M. C., López-Rodríguez, R., Cabaleiro, T., & Abad-Santos, F. (2018). Effect of polymorphisms on the pharmacokinetics, pharmacodynamics, and safety of sertraline in healthy volunteers. Basic & Clinical Pharmacology & Toxicology, 122(5), 501–511. https://doi.org/10.1111/bcpt.12938
Saiz-Ruiz, J., Gibert, J., Gutiérrez Fraile, M., Bobes, J., Vallejo, J., Iglesias, C., & Iriarte, V. (2011). Bupropion: Efficacy and safety in the treatment of depression. Actas Espanolas de Psiquiatria, 39(1), 1–25.
A Sample Answer 2 For the Assignment: NURS 6521 PHARMACOLOGY week 8
Title: NURS 6521 PHARMACOLOGY week 8
This is a great discussion, Amy. Depression is a psychological disorder that impacts different individuals. Depression is characterized by different factors including anxiety. Depressed individuals often deviate from normal behaviors. The patient mentioned above is suffering from the psychological disorder, depression (Jha et al., 2019). From the diagnosis, there are no signs of other complications. And from the conditions expressed, the patient is suffering from depression. The score obtained from the scale of measurement indicates that there is a high level of depression. There are different medication to the depression. In the above case, the patient requires different medication to restore emotional feelings. The prescription of Zoloft 25 mg po per day is necessary for the individuals who are depressed. The medication can reduce the symptoms by 25%. Also, the use of Wellbutrin IR is another alternative medication that can be used to reduce symptoms of depression. The pharmacotherapeutic side-effects of antidepressant medications are attributed to approximately 30% of non-compliant cases (Casseb, Kaster, & Rodrigues, 2019). Concurrent use of Wellbutrin (bupropion) and SSRI may increase the risk of seizures, as both agents are linked with lowering the seizure threshold. Their additive effects may cause tremors, anxiety, and panic symptoms, and psychotic reactions.
The application of antidepressants is common in the treatment of depression. However, in some cases, these antidepressants may not cure depression; they can only reduce symptoms associated with the condition (Pazini, Cunha, & Rodrigues, 2019). In most cases, the first antidepressant applied may work perfectly, however, with time, the effect may reduce significantly. Antidepressants are also associated with the different side-effects. Apart from medication, there are different interventions that can be applied in the management of depression. First, continuous counselling is necessary in ensuring that an individual regain their normal health conditions.
References
Casseb, G. A., Kaster, M. P., & Rodrigues, A. L. S. (2019). Potential role of vitamin D for the management of depression and anxiety. CNS drugs, 33(7), 619-637. https://link.springer.com/article/10.1007/s40263-019-00640-4
Jha, M. K., Qamar, A., Vaduganathan, M., Charney, D. S., & Murrough, J. W. (2019). Screening and management of depression in patients with cardiovascular disease: JACC state-of-the-art review. Journal of the American College of Cardiology, 73(14), 1827-1845. https://www.jacc.org/doi/full/10.1016/j.jacc.2019.01.041
Pazini, F. L., Cunha, M. P., & Rodrigues, A. L. S. (2019). The possible beneficial effects of creatine for the management of depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 193-206. https://doi.org/10.1016/j.pnpbp.2018.08.029