Prescribing Medications and Identifying Side Effects

Pharmacology Case Studies

Scenario 1

Diagnosis: Sandra is likely experiencing Major Depressive Disorder (MDD) with coexisting anxiety, given her symptoms of persistent sadness, anxiety, and an “empty mood” (Walter et al., 2023). Her increased smoking indicates a need to manage both her mood and nicotine dependence.

Treatment:

Antidepressant: First-line treatment would involve initiating a selective serotonin reuptake inhibitor (SSRI), which can treat both depression and anxiety.

Medication: Sertraline 50 mg PO daily

· Route: Oral

· Frequency: Once daily

· Special Instructions: Take in the morning to avoid insomnia

· # Dispensed: 30 tablets (30-day supply)

· Refills: 1

· Tapering: Start at 50 mg. Depending on the response, it may be titrated up to 100 mg after 4-6 weeks (Sørensen et al., 2022).

Smoking Cessation: Recommend smoking cessation to address both health concerns and to improve her mental health (White et al., 2023).

Medication: Nicotine replacement therapy (NRT) via a patch

· Order: Nicotine transdermal patch 21 mg/24 hours

· Route: Transdermal

· Frequency: Change every 24 hours

· Special Instructions: Rotate application sites; discontinue smoking upon starting therapy

· # Dispensed: 30-day supply

· Refills: 1

Current Medications:

Pantoprazole: Continue for GERD.

HCTZ: Review her blood pressure and consider switching or adjusting HCTZ to control her hypertension more effectively since SSRIs can increase BP.

Education: Educate Sandra on:

· SSRI side effects, such as nausea, dizziness, and sexual dysfunction.

· Importance of smoking cessation for cardiovascular and mental health.

· Importance of adherence to medication and follow-up visits.

Labs:

· Baseline liver function tests (LFTs) to monitor for potential hepatotoxicity with sertraline.

· Comprehensive Metabolic Panel (CMP) for HCTZ and BP management.

References

Sørensen, A., Juhl Jørgensen, K., & Munkholm, K. (2022). Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review. Therapeutic advances in psychopharmacology, 12, 20451253211067656.

Walter, H. J., Abright, A. R., Bukstein, O. G., Diamond, J., Keable, H., Ripperger-Suhler, J., & Rockhill, C. (2023). Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 62(5), 479-502.

White, S. A., Stone, E., Murphy, K. A., Daumit, G. L., & McGinty, E. E. (2023). Smoking cessation medication prescribing for smokers with and without mental illness. Psychiatric Services, 74(4), 332-340.

Scenario 2

Diagnosis: Based on JR’s symptoms of pain, numbness, tingling, and balance issues, the working diagnosis is Diabetic Peripheral Neuropathy (DPN), commonly associated with diabetes (American Diabetes Association, 2022).