Pharmacology Paper APA Format I need to have finished

NURS615 Pharmacology 5W SU 17 Assignment 4.2: Nervous System Case Study/ Chapter 15 & 19

Case Study

Marsha Lansing, a 30 year old female, comes to the clinic where you work as a nurse practitioner reporting daily headaches and feelings of irritability and sadness. She also reports difficulty concentrating and getting out of bed some days. She states that she lives a very stressful life and finds herself worrying constantly about work, home, finances, family and pets. She is anxious and alert during the exam. Her physical exam is within normal limits.

Her laboratory results are as follows:

TSH: 2.6 U/mL (Thyroid-stimulating hormone (TSH) (serum) reference range (0.5-4.7)

Calcium: 9 mg/dL (reference range (8.5 - 10.3 mg/dL)

Hgb: 13 mg/dL (reference range (12 - 15.6 g/dL)

Glucose: 86 mg/dL (reference range 80 mg/dL to 120 mg/dL)

Case Study Questions

ID Diagnosis

DX based on case scenario and clinical presentation: Adult onset depression, anxiety with tension headache. No other previous medical history revealed during interview including cardiac problems and electrolyte imbalance. Also, no psychiatric previous history revealed during assessment and interview. No current indication of suicidal thoughts and denies self-harm during clinical assessment.

Through additional lab work negative pregnancy test (sound practice on women of childbearing years). Chemistry Panel and Complete Blood Count (CBC) was obtained with normal findings.

1. What is your treatment plan for Ms. Lansing?

(I am placing the patient on a Selective Serotonin Reuptake Inhibitor (SSRI) Citalopram (Celexa common name) for depression and anxiety. Other drugs in this class are contains fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Prescriptive dose according to FDA is initial dose is 20 mg once daily, with an increase to a maximum dose of 40 mg/day at an interval of no less than one week (FDA, Celexa 2016)

I am scheduling a 2-week follow-up office visit. Check to see her progress on the medication, checking for adverse effects, compliance with recommended therapy and patient questions.

Pharmacodynamics Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Citalopram is known as a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain. (WebMD-Celexa 2017)

All the SSRIs affect the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning remaining serotonin to the presynaptic cell. Citalopram and escitalopram are probably the closest to a true serotonin selective reuptake inhibitor. Through this mechanism, more serotonin is available to bind with the postsynaptic receptors. (TAKEN DIRECTLY FROM MY BOOK p 250 Woo & Robinson)

1. What is the action, use, adverse effects, contraindications and drug interactions of the medication that you will prescribe for Ms. Lansing? You see Ms. Lansing back in 2 weeks and she tells you that she has been taking St. John’s Wort and melatonin since the last visit.

Action: Antidepressants

SSRIs affect the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning remaining serotonin to the presynaptic cell. Through this action, more serotonin is available to bind with the postsynaptic receptors causing an increase in serotonin in the brain.

USE:

Used to treat depression increase mood, promote a sense of wellness, and decrease anxiety through pharmaceutical intervention

Adverse Effects:

mild nausea, diarrhea, upset stomach, dry mouth; cold symptoms such as stuffy nose, sneezing, sore throat, cough; increased sweating or urination, weight changes; or. decreased sex drive, impotence, or difficulty having an orgasm

Contraindications: high doses associated with heart irregularities so doses over 40 milligrams (mg) a day should be avoided, according to the FDA and the manufacturer. Don’t combine with other antidepressant and over the counter natural drugs such as St. John Wort.

Drug Interactions

Celexa interacts with numerous other drugs and over the counter medications from common cold meds, acetaminophen to other antidepressants. Approximately

MAOIs intended to treat psychiatric disorders, avoid using within 14day window of use of Celexa to avoid the possibility of a dangerous medical condition known as Serotonin syndrome. The high accumulation of serotonin in the body. Clinical presentation of Serotonin syndrome anxiety agitation sweating, disorientation

1. What effect will these herbal medications have on the medication that you prescribed?

Serotonin syndrome. Rarely, an antidepressant can cause high levels of serotonin to accumulate in your body. Serotonin syndrome most often occurs when two medications that raise the level of serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort. Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and a rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

1. What patient teaching will you provide to Ms. Lansing?

(Black Box Warning on Anti-depressants-suicide precautions although she is 30 years of age important from safety standards)

Take medication with food to reduce some of the GI problems like nausea associated with the therapeutic dosage.

While taking Celexa avoid taking other prescription medications including over the counter cold medicines, and pain relievers. Approximately 1047 medication are known to interact with Celexa.

Possible adverse reactions notify me if they occur. Most adverse reactions subside in 2 weeks.

Avoid getting pregnant at this time. Educate my patient about the use of condoms during this anti-depressive treatment. I also would acknowledge that condoms have an 82% effectiveness. I would also take with my patient about the possibly placing her on some other form of birth control including IUD, a low dose birth control pill or contraceptive implant (Planned Parenthood 2017).

Don’t stop taking abruptly to avoid Withdrawal-like symptoms can include:

General feeling of uneasiness

Nausea

Dizziness

Lethargy

Flu-like symptoms (Mayo Clinic, SSRIS 2016)

Educate on do not consume alcohol while taking Celexa because possible Central nervous system impact such as dizziness, drowsiness and decrease alertness. Also avoid operating machinery and driving until there is a follow-up assessment of how the medication has affected you (WebMD-Celexa 2017)

References:

FDA, 2016 Celexa (citalopram) [Package Insert] Revised: 07/2014 Accessed 06 June 2016 Forest Laboratories, Inc. https://www.drugs.com/pro/celexa.html Citalopram and Escitalopram: A Summary of Key Differences and Similarities. Pharmacology Institute 2015 Accessed 01 June 2017

Woo, Teri Moser; Robinson, Marylou V. Pharmacotherapeutics For Advanced Practice Nurse Prescribers (Page 250). F.A. Davis Company. Kindle Edition. (MY TEXT BOOK)

http://www.webmd.com/drugs/2/drug-8603/celexa-oral/details Celexa 2017

http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825?pg=1June 24, 2016

Planned Parenthood 2017/What is the Safety of Condoms: https://www.plannedparenthood.org/learn/birth.../condom/how-effective-are-condoms