Essay: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Order Instructions:

The Assignment
Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.

Instruction: When you provide me 6 pages of discussion on diagnosis and only 1 page on your decisions during the decision tree, you will probably fail the assignment. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) and why you did not choose the other options (I want you to defend your decision as if you were in open court- with clinically relevant and patient specific data). I would like 7 references cited with every assignment. I deduct 1 point per reference missing. Credible reference material only will be accepted. Sites such as WebMD and drugs.com (among others) will not be counted. Caution: DO NOT USE THE START OVER BUTTON AND DO THIS ASSIGMMENT MULTIPLE TIMES. That is not the point nor is it the assignment. If you do use the START OVER button, I do not want your paper to reflect this. I have had students do it multiple times and address each time in their paper. You will receive a ZERO on the assignment if you do this- no exceptions.

Answer

Decision One

When the 32-year-old Hispanic American male was presented to me, my first decision involved a prescription of Effexor XR 37.5mg to be taken orally daily for four weexxxxxxxxxxxxxxxxxxenlafaxine hydrochloride – an antidepressant that belongs to a category of medications referred to as Serotinin-Noradrenaline Reuptake Inhibitors – is one of the key components that make up Effexor XR (Wyeth Pharmaceuticals Inc., 2004). Previous clinical studies on this drug reveal that Effexor XR has an active metabolite (O-desmethylvenlafaxixxxxxxxxxxxxxxxich facilitates the inhibition of norepinephrine and neuronal serotonin absorption. It also facilitates the reabsorption of weak inhibitors of dopamine. Venlafaxine component affects certain chemicals in the human brain that tend to be unbalanced in patients suffering from depression. As such Effexor XR is prescribed to patients with severe depressive disorder, panic disxxxxxxxxxxxxxxxxxxxxxxcts of this drug last for three days after ingestion. This means that the chances of depression relapse are minimal.

Expectations

By prescribing Effexor XR 37.5 mg I hoped to achieve satisfactory results. First of all, since this drug has venlafaxine component, I expected the severity of depression to reduce by at least 4 points (Federal Drug Assoxxxxxxxxxxxxxxxxxxxipated that the symptoms would start to improve within 14 days. The full beneficial implications of Effexor ought to have been felt by the end of the fourth week.

Difference between Expectations and Outcomes

To start with, by prescribing a lower dosage of Effexor XR (37.5mg), I expected the severity of depression to reduce by axxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx preclinical trials of the drug show that 136 mg daily is the optimum dosage of the medication. My decision to administer a lower dosage was informed by the fact that I was determined to reduce the possibility of triggering hypersensitive reactions (Federal Drug Association, 2012). Apparently, there was no change in depressive symptomxxxxxxxxxxxxxxxxxxxxxxxx addition, given O-desmethylvenlafaxine is an active metabolite, I expected the patient to experience mild side effects of the drug such as nausea, myoclonus, hyperthermia, delirium, and vomiting. The outcome was totally the oppxxxxxxxxxxxxxxxxxxxxxxdifferences between expectations and outcome can be attributed to the lower dosage of Effexor XR.

Decision Two

Following the inability of Effexor XR 37.5mg to treat the symptoms of depression presented by the patient, I found it necessary to change the medication to Cymbalta 30 mg orally xxxxxxxxxxxxxxxxxxxxxxxxxmber of reasons informed my decision. First, Cymbalta is more effective in the treatment of depression symptoms compared to Effexor XR. It is used in the treatment of acute depression (symptom remission), preventing depression relapse (continuation phase), as well as eliminating the possibility of recurrence or new episodes of depression (maintenance phase) (EMEA, xxxxxxxxxxxxxxxxxxxCymbalta has duloxetine component which is more effective in inhibiting the absorption of norepinephrine and neuronal serotonin compared to venlafaxine. On the same note, the drug has no substantial affinity for cholinergic, histamine, glutamate, opioid, adrenergic, dopaminergic as well as GABA receptors.

Expectations

When I decided to change the patient’s medication from Effexor XR to Cymbalta 30 mg orally daily, I hoped to achieve a more effective solution for the depression dixxxxxxxxxxxxxxxxxxxxxxen that Cymbalta is more effective in blocking the absorption of serotonin and norepinephrine, I anticipated better rxxxxxxxxxxxxxxxxxxxxxxitionally, Cymbalta has no active metabolite and therefore I expected an insignificant possibility of triggering adverse symptoms (Knadler et al., 2011).

Difference between Expectations and Outcomes

While I expected the depression symptoms to resolve, the patient reported significant improvement on shoulder stiffness and back pain. Interestingly, I did not foresee this turn of events especially considering that there is no known correlation xxxxxxxxxxxxxxxxxxxxx and the ability to alleviate pain. In my view, the insignificant response with regard to depression was occasioned by the low dosage xxxxxxxxxxxxxxx

Decision Three

Considering that the initial prescription of Cymbalta 30mg managed to relieve back pains and shoulder stiffness, I found it prudent to prescribe a higher dose of the same drug (60 mg orally xxxxxxxxxxxxxxxxxxxxx fact that the patient started with 30mg daily meant that his body was ready for a higher dose of the same medication (Eli Lily and Company, 2007).

Expectations

First of all, I expected to achieve satisfactory results with regard to the depression symptoms by the end of the four weeks of strict compliance with the prescription xxxxxxxxxxxxxxxxxxxx score of less than 10 points in the Montgomery Asberg Depression Rating Scale was anticipated (Montgomery & Asberg, 1979). More fundamentally, I foresaw a scenario where the higher dosage of xxxxxxxxxxxxxxxxx Cymbalta would facilitate a complete inhibition of the absorption of serotonin and norepinephrine in the xxxxxxxxxxxxxxxx

Difference between Expectations and Outcomes

There was no notable difference between my expectations and the outcomes of this decision. The patient recorded significant improvement as anticipated. However, in order to ensure complete recovery, it was necessary for the patient to continue with the medication for additional four weeks.

Ethical Considerations