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.
The interactive depression scenario described a 70-year-old male who presented with complaints of depression (Laureate Education, 2019). He also reported shoulder pain related to warehouse labor, experiencing the death of his mother at a young age, being an outsider at school, anhedonia, recent weight gain, insomnia, and poor concentration (Laureate Education, 2019). On exam, he had poor eye contact, soft speech, constricted affect without evidence of psychosis or suicidal/homicidal ideation (Laureate Education, 2019). For the first decision, I chose to start the patient on Zoloft 25 mg oral daily. When the patient returned four weeks later with a 25 percent improvement of depressive symptoms and a new onset of erectile dysfunction, I chose to add Wellbutrin IR 150 mg in the morning. When the patient came in four weeks later with the continued decrease of depressive symptoms, no erectile dysfunction, and feelings of increased nervousness, I chose to change the Wellbutrin order to Wellbutrin XL 150 mg oral in the morning.
Pharmacotherapeutic Impact on Pathophysiology
When choosing initial treatment options for depression, the classes of medications have similar efficacy, so it is best to focus on safety and medication tolerance (Rosenthal & Burchum, 2018). Therefore, I chose to start with a Selective Serotonin Reuptake Inhibitor (SSRI), recognized as the safest and most tolerated medications for treating major depression (Rosenthal & Burchum, 2018). The pathophysiology of these medications is unclear; however, the theory suggests that these medications compensate for serotonin deficiency in the synapse (Holck, Wolkowitz, Mellon, Reus, Nelson, Westrin, & Lindqvist, 2019). Serotonin is needed to regulate sleep, mood, and cognition (Holck et al., 2019). By increasing the amount of Serotonin in the synapse, this patient’s depressive symptoms decreased. In the second decision, I chose to add Wellbutrin IR to the patient’s medication regimen to help treat his erectile dysfunction symptoms. Wellbutrin is an atypical antidepressant where the mechanism of action is also not understood (Rosenthal & Burchum, 2018). However, the effects may be related to blocking the reuptake of dopamine, which regulates behavior and influences learning, and norepinephrine, which plays a role in getting the brain and body ready for action (Berke, 2018; Rosenthal & Burchum, 2018). While Wellbutrin helps depression, it also seems to help with sexual desire (Rosenthal & Burchum, 2018). Fortunately, this additional medication helped the patient in the scenario. After four weeks of taking both drugs, he had a continued decrease in depressive symptoms and no longer struggled with sexual dysfunction. In my third decision, I chose to change the Wellbutrin order to extended-release since the patient was experiencing restlessness symptoms. The immediate-release may have been too much, too fast for the patient as it reaches its peak two hours after administration (Rosenthal & Burchum, 2018). Extended-release Wellbutrin reaches its peak at five hours with a half-life of approximately 21 hours (Food and Drug Administration, n.d.). This change will help to settle the experienced side effects of the medication.
Treatment Plan The effect of Zoloft and Wellbutrin on the patient’s pathophysiology will impact the patient’s treatment plan. Common side effects of SSRIs include weight gain, insomnia, sexual dysfunction, and increased risk of suicide (Rosenthal & Burchum, 2018). I already addressed sexual dysfunction by adding Wellbutrin, but the monitoring for the other side effects is also essential for safety and compliance purposes. The patient already has had a significant amount of weight gain and complains about insomnia. Therefore, follow up appointments are necessary for close monitoring of these possible side effects. Treatment should include education about proper diet and activity to regulate weight. The provider should also assess the patient’s sleep to ensure the medication is helping rather than worsening the amount and quality of sleep. It is also crucial for the provider to educate the patient on the increased risk of suicide and encourage the patient to seek help immediately if he starts having these thoughts. The provider should assess the patient for suicidal ideation frequently.
Wellbutrin is usually well tolerated; however, it carries a risk for seizures and psychotic symptoms. Therefore, the provider should assess for any seizure risk factors such as a history of seizures, a head injury, an eating disorder, or a CNS tumor (Rosenthal & Burchum, 2018). The provider should also assess the patient for psychotic symptoms at each follow-up visit, such as hallucinations or delusional thoughts (Rosenthal & Burchum, 2018).
Berke, J.D. (2018). What does dopamine mean? Nature Neuroscience, 21(6), 787-793. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29760524Food and Drug Administration. (n.d.). Wellbutrin XL. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021515s026s027lbl.pdfHolck, A., Wolkowitz, O. M., Mellon, S. H., Reus, V. I., Nelson, J. C., Westrin, Å., & Lindqvist, D. (2019). Plasma serotonin levels are associated with antidepressant response to SSRIs. Journal of Affective Disorders, 250, 65–70. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2019.02.063Laureate Education (Producer). (2019). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
At Myrestlab.com, we always work diligently to provide our customers with high-quality nursing assignment help services. We ensure that all papers by our writers possess 100% originality. We also guarantee all students of 100% privacy and confidentiality when working with us.
At Myrestlab.com, our mission is to provide quality services to all students. We, therefore, guarantee money-backs for the rare occasions of satisfaction. Your satisfaction is our goal.Read more
All our nursing assignment help services are 100% original. Each of our professional writers develops custom papers from scratch to reduce the chances of plagiarism. In addition to this, we always run completed papers through advanced anti-plagiarism checkers for 100% originality.Read more
Our free revision guarantee is a courtesy service by Myrestlab.com to ensure that we achieve 100% customer satisfaction rates. In case you feel unsatisfied with the outcome of your paper, you can always request for free unlimited revisions. We recommend a revision request within 14 days after the delivery date for short papers and 30 for dissertations.Read more
Myrestlab.com also guarantee 100 privacy and confidentiality. We do not share any of our customers’ personal details with third parties. We have also fitted our websites with security features to ensure secure connections. Our security features also prevent damages that might occur through attacks by outsiders.Read more
By ordering a paper through My Rest Lab, you agree to receive nursing assignment help services offered by our nursing assignment writers. Our assignment help experts will always endear to provide quality services as promised. We always expect maximum cooperation from our students to help us achieve our mission and vision.Read more