Problem
A 62-year-old female with a pre-established diagnosis of Major Depressive disorder. She states: "I don't think the medication is working." She presents today with complaints of low mood, difficulty with sleep, lack of motivation and thoughts of "wishing I was not here." She denies any intent or plan. However, she does have a history of suicide attempt 5 years ago. The client is currently taking Lexapro (escitalopram) 20 mg daily. Per old records she has taken Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). She states they have not been effective. She has no known allergies. The client has a history of being non-compliant with diet and exercise. Her past medical history includes nerve pain from Sciatica. She denies any cardiac or respiratory issues. There is no history of seizures or head injuries. Her vital signs are all WNL.
Utilizing the information in the scenario you chose, include the following topics in your paper:
I. Discuss each of the classes of medications that may be used for your client's diagnosis.
i. Briefly discuss the pharmacodynamics and pharmacokinetics of the drug class.
ii. Explain why this class of medication may or may not be an appropriate choice for your patient.
II. Identify which specific medication or medications you would prescribe for your client. (Note: the maximum number of specific medications we would expect you to discuss is two. Depending on the research you present you may only need to discuss one. If you do need to include two medications, be sure they are safe to administer concurrently.)
i. Using evidence based practice, explain the rational for the choice of medication or medications.
ii. Discuss the FDA and off-label indications associated with the medication(s) that you are prescribing.
iii. Include explanation of receptor sites as you discuss the mechanism of action, side effects and possible adverse reactions.
III. Discuss monitoring and education
i. Using current research, discuss any monitoring (i.e., labs, VS, etc.) suggested for the medication(s) you have chosen.
ii. Include patient education that is important to discuss. Be sure to include black-box warnings.
IV. Discuss expected outcomes and prognosis, based on evidenced practice.