Choose a vulnerable patient and develop a 2- to 3-page Medication Guide for them and their family. In your guide, you will consider their ages, birth-assigned sex, FDA approvals, and considerations for increased or decreased risk for side effects. You will choose the most appropriate medication for each of these individuals. Support your answers with evidence-based, peer-reviewed scholarly literature. APA style format title page, citations and references will apply.
Resources
• Conduct research through the FDA website https://www.fda.gov/drugs.
• 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 individuals:
o Depression Treatments for Adults https://www.apa.org/depression-guideline/adults
o Depression Treatments for Older Adults https://www.apa.org/depression-guideline/older-adults
o Depression Treatments for Children and Adolescents https://www.apa.org/depression-guideline/children-and-adolescents
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:
o Assist the patient who cannot not afford to pay financially for the medication you are recommending/prescribing; and/or
o 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.
Medication Guide for a 72-Year-Old Male with Major Depressive Disorder and Panic Disorder
Patient Information
- Name: Mr. J.D.
- Age: 72
- Gender: Male
- Diagnosis: Major Depressive Disorder (MDD) and Panic Disorder
- Medical History: Cardiac history; currently takes antihypertensive medications.
Medication Classification and Rationale
Chosen Medication: Sertraline (Zoloft)
Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for major depressive disorder and anxiety disorders, including panic disorder. SSRIs are generally considered first-line treatments due to their efficacy and favorable side effect profile compared to older classes of antidepressants, especially in older adults.
Rationale:
- Sertraline has a well-established safety profile in older adults.
- It has a low potential for drug interactions with antihypertensive medications, making it a suitable choice for Mr. J.D., who has a cardiac history.
Dosage and Frequency
- Starting Dose: 25 mg once daily.
- Adjustment: The dose may be increased to 50 mg after one week based on tolerability and symptom response.
- Frequency: Once daily, preferably in the morning to minimize insomnia.
Mechanism of Action
Sertraline works by inhibiting the reuptake of serotonin in the brain, which increases serotonin levels in the synaptic cleft. This action helps improve mood, alleviate anxiety symptoms, and reduce panic attacks over time.
Duration of Treatment
Mr. J.D. should continue taking sertraline for at least 6-12 months after achieving symptom remission to prevent relapse. Ongoing evaluation will determine whether to continue or taper the medication based on his clinical status.
Common Side Effects
Common side effects of sertraline may include:
- Nausea
- Diarrhea
- Insomnia or drowsiness
- Dry mouth
- Sexual dysfunction
While most side effects are mild and transient, it is important for Mr. J.D. to report any persistent or bothersome symptoms to his healthcare provider.
Urgent/Emergent Considerations
Mr. J.D. should seek immediate medical attention if he experiences:
- Increased suicidal thoughts or behaviors
- Severe allergic reactions (rash, itching, swelling)
- Signs of serotonin syndrome (agitation, hallucinations, rapid heartbeat, fever, muscle rigidity)
Directions for Use
- Take sertraline once daily with or without food.
- Swallow the tablet whole; do not chew or crush.
Missed Dose Instructions
If a dose is missed, Mr. J.D. should take it as soon as he remembers. If it is almost time for the next dose, skip the missed dose and resume the regular schedule. Do not take two doses at once.
Medication Interactions
Mr. J.D. should avoid the following:
- Other Medications: Monoamine oxidase inhibitors (MAOIs) within 14 days of starting sertraline due to the risk of serotonin syndrome.
- Over-the-Counter Medications: Avoid NSAIDs (e.g., ibuprofen) unless approved by a healthcare provider due to the risk of bleeding.
- Supplements/Herbals: Avoid St. John’s Wort, which can increase serotonin levels and lead to serotonin syndrome.
Foods to Avoid
No specific food restrictions are necessary with sertraline; however, Mr. J.D. should maintain a balanced diet to promote overall health and well-being.
Follow-Up Visit
Mr. J.D. should return for a follow-up visit in 4 weeks to assess his response to treatment, monitor side effects, and adjust the dosage if necessary.
Legal and Ethical Considerations
Prescribing sertraline requires informed consent from Mr. J.D., explaining potential benefits, risks, and side effects. As an older adult, he should be fully informed about the treatment plan, adhering to ethical principles of autonomy and beneficence.
Social Determinants of Health Considerations
1. Financial Hardship:
- If Mr. J.D. cannot afford the medication, options include:- Utilizing patient assistance programs provided by pharmaceutical companies.
- Exploring generic alternatives that are often more affordable.
- Discussing with a social worker about local resources or community programs that provide financial assistance for medications.
2. Transportation Challenges:
- If transportation is an issue, I would recommend:- Telehealth options for follow-up appointments if feasible.
- Connecting him with community resources providing transportation services for medical appointments.
Importance of Social Determinants of Health
Understanding social determinants of health is crucial for effective prescribing practice. Financial limitations can directly impact medication adherence and overall health outcomes, while transportation issues can hinder access to necessary follow-up care. Addressing these factors ensures comprehensive care that extends beyond pharmacological treatment alone.
References
American Psychological Association. (2021). Depression Treatments for Older Adults. Retrieved from https://www.apa.org/depression-guideline/older-adults
FDA. (2020). Zoloft (Sertraline) Prescribing Information. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020251s069lbl.pdf
National Institute of Mental Health. (2021). Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
This medication guide provides comprehensive information for Mr. J.D. and his family regarding the prescribed medication, ensuring they understand how to manage his depression and anxiety effectively while considering his unique circumstances as a vulnerable patient.