Wk 8 responses nurs 6521 | NURS 6521 – Advanced Pharmacology | Walden University

Beth Martin Generalized Anxiety Disorder-Beth MartinCOLLAPSE

The scenario I chose was the gentleman that had been suffering from generalized anxiety disorder, was using alcohol to cope with job stressors, and felt chest tightness and feelings of impending doom. Generalized anxiety disorder is known as excessively worrying about multiple events, usually lasting 6 months or more (Haseth, Solem, Soro, et al., 2019).I chose to start the patient on Zoloft 50 mg out of the three choices given. I chose Zoloft as this is an SSRI, which means it works by slowing the reabsorption of serotonin in the brain. Serotonin regulates mood such as depression and anxiety and how it works in the brain (Cuncic, 2020). 

The patient presented back into clinic four weeks later with a decreased feeling of stress in the past 5 days. Based on the Ham -A score the patient has had a partial response to treatment with a score of 18 (Laureate Education, n.d.). I then decide to increase the Zoloft dose to 75 mg daily to help with the positive effects of the medication and reduced anxiety symptoms. The patient returns to clinic in another 4 weeks with even less symptoms and a HAM-A score of 10 ( Laureate Education,2019b).  

At this appointment, I now decide to keep his medications the way they are and not increase the dosage or make any more changes. It can take weeks to see the full effects of SSRIs and the higher the dosage the higher chance of serotonin syndrome, which is a build-up of too much serotonin in the system which can cause a multitude of symptoms including but not limited to; high blood pressure, confusion, muscle rigidity, fever, diarrhea, hallucinations, and restlessness. The provider must be cognizant of this when adjusting any SSRI medications and sing the lowest amount of medication for the greatest benefit. Adding on another medication like Buspar is not necessary at this time and avoiding polypharmacy with all patients is important to keep adverse effects low ( laureate Education, 2019b). 

Cuncic, A. (2020, March 26). Zoloft as treatment for social anxiety disorder. VeryWell Mind. https://www.verywellmind.com/zoloft-social-anxiety-disorder-treatment-3024977

Haseth, S., Solem, S., Sørø, G., Bjørnstad, E., Grøtte, T., & Fisher, P. (2019).Group metacognitive therapy for generalized anxiety disorder: A pilot feasibility trial. Frontiers in Psychology, 10.
https://doi.org/10.3389/fpsyg.2019.00290

Laureate Education (2019b) http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_05/index.html

Nneka Awuruonye Main Post Week 8 disscussionCOLLAPSE

With depression it occurs without the person’s knowledge.  Signs and symptoms can be very prominent and shown to other people.  Depression is one of the most common psychiatric disorders (Rosenthal & Burchum, 2021).  People are being diagnosed with depression daily and only about 35% of depressed people rarely see a mental health provider.  Diagnoses are usually made if symptoms are presented throughout the day and almost everyday for about a two weeks time span.  Depression can be diagnosed as mood disorders that could bring on symptoms over time such as lack of interest in activities, low energy, extreme sadness, and loss of appetite.  Depression can go unresolved for a period of time compared to grief and sadness.   One of the scenarios that I have chosen pertained to the 70 year old hispanic male that had depression.  In order to treat the patient’s symptoms, I have to assess him and ask him a slew of questions pertaining to his condition and how he feels about the situation he is currently in.  During the medical exam the patient took the “Montgomery-Asberg depression rating scale” and it indicated that he was in severe depression with a score of 51.  One of the medications that I have found to be effective is Zoloft 25 mg that can be used to help with depression.  According to Sertraline (generic): Zoloft (Brand) (2014), Sertraline is in a class called serotonin reuptake inhibitors (SSRI).  Zoloft blocks the uptake of serotonin within the human platelets.  It is shown to control the central nervous system.  It allows for the brain to increase the amount of serotonin, absorb it and cause a mood-booster within the patient (Zoloft, 2008).  This essentially helps increase the patient’s attitude and decrease depression.  I would make sure that he is not taking any other type of medications that would interfere and cause an interaction with each other.  After about 4 weeks since the patient developed erectile dysfunction and decreased 25% of his depression, I would order Wellbutrin IR 150mg.  At the next appointment due to the patient becoming jittery the form of medication would be to order Ativan 0.5 mg TID/PRN orally.  Ativan is a benzodiazepine and approved for treatment of anxiety associated with depression (Lorazepam (ativan), 2019).  According to the interactive it suggested changed the Wellbutrin to extended release so that it would not interact with zoloft and produce a jitteriness side effect.  

References

Lorazepam (ativan) (2019).  National Alliance on Mental Health. Retrieved January 18, 2021 from  https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Lorazepam-(Ativan)

Sertraline (generic): ZOLOFT (Brand). (2014). Brown University Child & Adolescent Psychopharmacology Update, 16, 1–2.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Zoloft (2008). Label. Retrieved January 18, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019839s070,020990s032lbl.pdf

three sources for each discussion, thanks