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Third trimester of pregnancy with major depressive disorder and social anxiety disorder

 

Select a vulnerable patient from the list provided.
Consider age, birth-assigned sex, FDA approvals, and risk and side-effect consideration.
Select the most appropriate medication for your selected patient based upon the information provided.
Review the textbook for commonly prescribed antidepressants, Fast Facts for Psychopharmacology for Nurse Practitioners.
Conduct research through the
Review prescriber information for professionals of the medications.
Note: These can be located free online with web search.
Review national guidelines for prescribing for these vulnerable individual
THE ASSIGNMENT
Step 1: Choose one of the following vulnerable patients to create a Medication Guide for the patient:
Patient 1: 26-year-old female with a diagnosis of major depressive disorder and social anxiety disorder who is increasing in isolation and poor self-care. She is in her third trimester of pregnancy.
Patient 2: 16-year-old male with a diagnosis of major depressive disorder, severe. He has seen a therapist weekly for the past 6 months and has had minimal change in symptoms. He has expressed thoughts of wanting to die.
Patient 3: 72-year-old male with diagnosis of major depressive disorder and panic disorder. He has cardiac history and takes antihypertensive medications.
Patient 4: 8-year-old Asian female with a diagnosis of severe depressive disorder presents to the office with a report of worsening symptoms. She has never taken psychotropic medication before.
Step 2: Create a Medication Guide for a patient. In your guide, you should provide the following specific instructions for the patient:
Describe the chosen classification of medications, from the classification category, for your chosen vulnerable patient. Explain your rationale for your choice.
Explain what dose you would start the chosen medication with and the frequency.
Discuss how the medication works to treat their symptoms.
Explain how long they should take the medication.
Discuss the typical or common side effects of the medication.
Explain the urgent or emergent considerations for the patient taking the medication.
The Medication Guide should also include:
Directions you would provide the patient on how to take the prescribed medication
Instructions on what the patient should do if a medication dose is missed
List of any other medications, over-the-counter medications, and/or supplements/herbals the patient should avoid while taking the prescribed medication
List of foods the patient should avoid when taking this medication
Date when the patient should return for follow-up visit with you
Discussion about the legal and ethical considerations for the medication being prescribed
Answers in consideration of Social Determinants of Health on how you would:
Assist the patient who cannot not afford to pay financially for the medication you are recommending/prescribing; and/or
Has difficulty with transportation that impacts their ability to present for regular appointments with you
Discuss how financial hardship and lack of transportation could relate to Social Determinants of Health, as well as why they are important considerations for you as a prescriber
NURS_6630_Week3_Assignment_RubricNURS_6630_Week3_Assignment_RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeSelected patient guide describes how the medication works, length of use, side effects, and other considerations. The student patient guide addresses all of the specific information for the patient as outlined in the Assignment directions.

 

Sample Answer

 

Medication Guide for Patient 1: 26-year-old female in third trimester of pregnancy with major depressive disorder and social anxiety disorder

Chosen Medication: Selective Serotonin Reuptake Inhibitors (SSRIs)

Rationale for Choice:

SSRIs are the first-line treatment for major depressive disorder and anxiety disorders due to their relatively favorable safety profile in pregnancy compared to other classes of antidepressants. They have shown efficacy in treating these conditions with a lower risk of adverse effects on the fetus.

Dosing and Frequency:

Start with a low dose of the chosen SSRI, such as sertraline, at 25 mg once daily and then gradually increase as tolerated under close monitoring by a healthcare provider.

Mechanism of Action:

SSRIs work by increasing the levels of serotonin in the brain, which helps to regulate mood and reduce symptoms of depression and anxiety.

Duration of Treatment:

The patient should continue taking the medication for at least 6-12 months after symptom improvement to prevent relapse.

Common Side Effects:

Common side effects of SSRIs include nausea, headache, insomnia, and sexual dysfunction. These usually improve over time as the body adjusts to the medication.

Urgent Considerations:

It is essential to monitor closely for any signs of worsening depression, suicidal ideation, or unusual changes in behavior, especially during the first few weeks of treatment.

Directions for Taking Medication:

– Take the medication at the same time each day.
– Do not crush or chew the medication.
– Inform your healthcare provider if you experience any side effects.

Missed Dose Instructions:

If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose. Do not double the dose to make up for a missed one.

Avoidance List:

– Avoid alcohol consumption while on the medication.
– Inform your healthcare provider about any other medications or supplements you are taking to check for potential interactions.

Follow-Up Visit:

Schedule a follow-up visit with your healthcare provider in 2 weeks to assess the response to the medication and adjust the dose if needed.

Legal and Ethical Considerations:

As a prescriber, it is crucial to ensure informed consent from the patient regarding the risks and benefits of medication use during pregnancy and to adhere to legal regulations concerning prescribing medications in this vulnerable population.

Social Determinants of Health:

– For patients facing financial hardship, explore options for financial assistance programs or generic versions of the medication.
– For patients with transportation issues, consider telehealth appointments or provide resources for transportation services to improve access to care.

Importance of Social Determinants of Health:

Financial hardship and lack of transportation can significantly impact a patient’s ability to adhere to treatment and access necessary healthcare services, highlighting the importance of addressing these social determinants to enhance health outcomes and equity in care provision.

 

 

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