Prior to beginning work on this discussion, read the required chapters from the text and review the required articles for this week. Over the course of the past weeks, we have considered the use of medications in the treatment of various psychological disorders. This discussion will provide you with an opportunity to give an informed appraisal on the use of drugs to treat disorders and defend your stance based on your judgment of the literature. In your initial post, describe what you believe are the greatest strengths and weaknesses of using the medications to treat psychological disorders. Evaluate the employment of psychoactive drugs in the treatment of disorders over the lifespan from both an ethical and risk-benefits perspective. Summarize the theories of psychiatric disease and the scientific rationale behind its treatment through the employment of drug therapies. Explain what you believe to be the greatest challenges in the use of psychoactive medications over the next several years. Support your statements with references and logical arguments.
Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine the potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.
To Prepare
Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history with GAD.
The QUESTION
1. Discuss the pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD.
2. Compare and contrast different treatment options that can be used
Soap note This will include three differential diagnoses with rationales for each, listed in order of likelihood or significance. The case study write-up should include at least 2 credible sources
Title page
Brief introduction to the patient
Learning Issues- do you need more information in order to develop a plan? If so, what information do you need or want?
Assessment in SOAP format:
Subjective- include HPI, past medical history and medications
Objective-physical exam findings, labs findings, or test results.
Assessment- include 3 differential diagnoses including ICD-10 codes
Plan- including what labs, tests are the next steps as well as the treatment plan for each diagnosis. Remember to include pharmacologic and non-pharmacologic treatments.
Brief conclusion
Reference page
Case 2
8:00 AM Harold Baron Age 56 years Opening Scenario Harold Baron is a 56-year-old African American man on your schedule for an annual health-care visit. He wants to start an exercise program. He has been seen in your practice for the past three years for episodic visits but has never been seen for health maintenance. History of Present Illness “I feel that I’m getting older and I’ve put on a few pounds, so I think I should start exercising. I’ll probably just start out with brisk walking, but I’d like to get up to running a few miles a day. I feel very healthy.” Medical History Denies chronic illness: No history of heart disease, HTN, or diabetes. Tonsillectomy and adenoidectomy as a child. Denies previous colonoscopy (screening or diagnostic) Immunizations: Reports usual childhood immunizations; denies hepatitis A or B immunization; unsure of last tetanus immunization Has never received seasonal influenza immunization. Last laboratory tests more than five years ago, per patient; unsure what was tested but were “all normal.” Family Medical History MGM: Died at age 82 (breast cancer) MGF: Died at age 77 (myocardial infarction) PGM: Died at age 80 (complications of type 2 DM) PGF: Died at age 74 (stroke) Mother: 81 years old (type 2 DM) Father: Died at age 80 (stroke two years ago) Brother: 58 years old (type 2 DM) 5 Daughter: 32 years old (A&W) Son: 30 years old (A&W) Four grandchildren: None with health problems Social History Married for 34 years; works full time as administrator in a post office, extensive computer use; no recreational exercise; quit smoking 15 years ago (25 pack-year history) Alcohol: Three ounces per week (glass of wine) Caffeine: Two cups of coffee per day Safety: Wears seatbelt; does ride bicycle in summer on occasion and wears helmet; does not ride motorcycles; does not wear sunscreen Medications One multivitamin “for men” daily, last dose this AM Vitamin D 1000 IU daily, last dose this AM Acetaminophen 325 mg, two tablets once or twice daily for one to three days per week for knee pain, last dose two days ago Allergies NKDA Review of Systems General: Good energy level, denies fatigue; sleeps approximately seven hours a night; denies snoring, difficulty initiating or maintaining sleep; wakes rested and denies daytime drowsiness Integumentary: Denies new lesions, itching, or rashes HEENT: Denies history of head injury; denies eye pain, excessive tearing, blurring, or change in vision; denies tinnitus or vertigo; denies frequent colds, seasonal allergies, or sinus problems; dental examination with cleaning every six months; wears nonprescription glasses for reading only; eye examination (without dilation) 12 months ago Neck: Denies lumps, swollen glands, goiter, or pain Cardiovascular: Denies chest pain, shortness of breath, or elevated blood pressure; denies swelling in extremities. Denies excessive bruising, enlarged lymph glands; denies history of transfusions Respiratory: Denies shortness of breath, cough, dyspnea, wheeze, orthopnea, snoring Gastrointestinal: Denies nausea or vomiting, constipation, or diarrhea; denies heartburn, belching, bloating, stomach pain, black or clay-colored stools; denies having had a colonoscopy 6 Genitourinary: Denies dysuria, frequency, urgency, difficulty starting or stopping stream, and any sexual dysfunction; libido normal Musculoskeletal: Right knee pain (4 out of 10) described as achy noted with prolonged walking, standing, climbing stairs; gradual onset present intermittently for past year; denies trauma to knee; denies swelling, redness, warmth; denies any other joint pain/ache; denies back pain Neurological: Occasional (fewer than once per week) mild headache (bilateral frontal pressure) relieved by acetaminophen 325 mg; denies severe headaches; denies numbness/tingling, weakness; denies history of seizures, head trauma Endocrine: No polyuria, polyphagia, polydipsia; denies history of thyroid disorder Physical Examination Vital signs: Temperature 98.4°
You are a nurse at an outpatient clinic and are presented with a 68-year-old female client. She is experiencing the following symptoms: decreased appetite, disturbed sleep pattern, fatigue, difficulty concentrating, disordered thought process, anhedonia, guilt, and low self-esteem. The doctor diagnoses the client with major depressive disorder. Answer the following questions:
What medication do you think is likely to be prescribed for this client and why?
What are some important teachings you would give this client when administering the first dose?
When following up with the client 2 months later. What are some changes you may expect to see with the client? If the client is not displaying the expected outcomes, what are some possible alternatives for the client?
