Reply To My Peers
Reply to my peers
- What medication would you first prescribe to this patient?
SSRI’s are commonly the initial drug of choice for patients with depression and many of the anxiety disorders (Woo et al., 2020). These drugs demonstrate equal efficacy to the nonspecific SNRI’s with a safe and lower side effect profile (Woo et al., 2020). Sertraline (Zoloft) would be the treatment of choice. Angela would be started on Zoloft 50mg PO daily. The medication must be started in low doses and the doses must be titrated, depending on the response and the side effects experienced (Grover et al., 2017).
- She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?
Educating Angela on Zoloft and how long it may take to see results is key and should be initiated prior to starting any Antidepressant and re-educated throughout visits. During acute treatment phase of depression, it is important to monitor the patient’s response to ensure the treatment has been given for a sufficient duration, frequency and dose (Woo et al., 2020). A patient needs about 4 to 8 weeks of optimal dosing of medication to appropriately evaluate whether there is a partial response or no response at all (Woo et al., 2020). If there is some improvement in mood and symptoms, increasing the dose is may be effective.
- What are the possible problems with the medication you prescribed?
Zoloft is the most effective and safe of all SSRI’s. Of course, patient’s must be educated on the FDA Black Box warning for any antidepressant: possibility for increase thoughts of suicide. Zoloft can cause birth defects; women of childbearing age should be advised to use birth control to prevent pregnancy. Angela is 54 but should still be educated on this if she has yet to go through menopause.
- How long should you continue the treatment regimen?
Patients taking SSRI’s like Zoloft start to see improvement in mood/symptoms after 4 to 8 weeks of treatment (Woo et al., 2020). At times longer if the dose has to be titrated up. Patients show not stop treatment quickly after symptoms improve due to having depression return. It is recommended for patients to stay on their antidepressants after symptoms improve for 6 months to a year. Discussing tapering off any antidepressant is extremely important. Discontinuation syndrome may occur when a patient takes an NNSRI or an SSRI for more than 5 weeks and the dose is sharply reduced or stopped suddenly (Woo et al., 2020). Symptoms include agitation, anxiety, balance problems, nightmares, dizziness, diarrhea, nausea, vomiting, electric shock-like sensations, and flu-like symptoms (Woo et al., 2020).
Grover, S., Gautam, S., Jain, A., Gautam, M., & Vahia, V. N. (2017). Clinical practice guidelines for the management of Depression. Indian Journal of Psychiatry, 59(5), 34. https://doi.org/10.4103/0019-5545.196973
Woo, T. M., Wynne, A. L., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced Practice Nurse prescribers. F.A. Davis Company.
Medication Prescribed for the Patient
The patient would be prescribed serotonin reuptake inhibitors (SSRIs) to manage her depression. SSRIs are effective antidepressants that work by improving the mood of the patient appetite (Godlewska et al., 2016). Their mechanism of action involves prevention or serotonin reuptake, thus increasing its levels in the brain. Serotonin also called a feel good hormone, which helps improve the mood of the patient. Fluoxetine would be the prescribed SSRI. The patient would be started on a low dose of 20mg, taken orally once daily (Micheli et al., 2018). The helps improve mood, increase appetite, and improve her sleep cycle. The dose can be increased after a few weeks if the patient does not show any improvement of her depression symptoms.
Response to Delayed Medication Effects
It would be important to inform the patient that the medication can take between 4-6 weeks before its therapeutic effects are achieved. The patient would be advised to continue taking the medication for a few more weeks. A follow up would be scheduled in 2-4 weeks to assess the response and effectiveness of the medication Micheli et al., 2018). Absence of improvements at that point would necessitate dose increment or change of medication.
Possible Problems with The Medication Prescribed
One possible thing that could be the problem of the medication is its side effects. Possible side effects of Fluoxetine include insomnia, headache, dizziness, anxiety, feeling tired, nausea, loss of appetite, and hot flashes. These effects may worsen her depression symptoms including sleeping disorders, fatigue, and loss of appetite (Godlewska et al., 2016). Additionally, Fluoxetine may interact with the current NSAIDs being taken by the patient, which can increase the risk of gut bleeding. Caution should be taken especially when taking the drugs. There should be a reasonable time interval to avoid drug interactions (Woo & Robinson, 2016).
Duration of Treatment Regimen
The patient would take the current Fluoxetine dose of 20mg for 4-6 weeks. A maintenance dose of 20-60mg would be prescribed depending on the patient’s response Micheli et al., 2018). The maintenance would last 6 months to one year for effective depression management, and to ensure the patient would not go back to depression.
Godlewska, B. R., Browning, M., Norbury, R., Cowen, P. J., & Harmer, C. J. (2016). Early changes in emotional processing as a marker of clinical response to SSRI treatment in depression. Translational psychiatry, 6(11), e957-e957.
Micheli, L., Ceccarelli, M., D’Andrea, G., & Tirone, F. (2018). Depression and adult neurogenesis: positive effects of the antidepressant fluoxetine and of physical exercise. Brain research bulletin, 143, 181-193.
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers with davisplus resources (4th ed.).
The Impact Of Living
With A Long-Term Condition Exam (We Deliver Top Grades)
There is increasing
prevalence of people with long term conditions within the UK population
(Department of Health, 2012). Long term conditions are chronic diseases which
cannot be cured; however, they can be managed by medication and other
treatments (The King’s Fund, 2017). Treatments given to patients for long term
conditions seem to be more effective when their focus is on promoting overall
wellbeing and functional independence, instead of solely focusing on treating
medical symptoms (The King’s Fund, 2013). Therefore, this essay will discuss
the impact of living with a long-term condition. The chosen condition for this
essay is arthritis as approximately ten million people in the UK have this
condition (NHS, 2016). Specific reference will be given to the most common form
of arthritis, osteoarthritis (NHS, 2016). The physical, social and
psychological impact of arthritis will be discussed. Furthermore, the essay
will explore further complications of this condition.
The initial impact of
osteoarthritis on an affected joint is the degeneration of the cartilage
lining. As joint cartilage allows bones to glide over each other, degenerated
cartilage causes the joint to have difficulty in performing its usual movements
(NHS, 2016). Also, as the cartilage of the affected joint gradually thins out,
the tendons and ligaments of the joint have to work harder to create movement,
which results in joint inflammation and the formation of Osteophytes. This
eventually results in the bones of the affected joint rubbing against each
other (NIH, 2016): hence patients of osteoarthritis often report pain as a
major issue. However, the intensity of pain experienced by patients varies and
it is influenced by a variety of factors including medical conditions, age,
psychosocial factors and physical changes, including which joint is affected by
the condition (Arthritis Foundation, 2016; Backman, 2006). Knee osteoarthritis
patients often report intermittent weight-bearing pain which later changes into
a more persistent pain (Neogi, 2013).
can severely impact the physical ability of patients. This includes difficulty
in walking and climbing stairs (Motiwala et al,
2016). As joint mobility is maintained by physical activity, limited movement
or maintaining the same position for prolonged periods of time can cause joint
stiffness (Kalunian, 2014; NIAMS, 2016). Joint
stiffness can cause the individual to take longer to perform their daily living
activities, such as getting out of bed in the morning. It can be difficult for
an osteoarthritis patient to manage the conflicting demands of staying mobile
whilst experiencing pain. The impact of limited movement significantly affects
all the dimensions of Health-Related Quality of Life, including a possible
impact on the emotional and mental health of the patient. Hence, improvements
in emotional and mental health were recognized in patients who had undergone a
successful total knee anthroplasty operation and no
longer faced the barriers of Knee osteoarthritis (Fernandez-Cuadros,
movement can influence the individual’s involvement in society, such as not
being able to physically attend or perform leisure and social activities
(Vaughan, 2016). Limitations may include events which are important to their
happiness and wellbeing such as participating in religious programs (Aghdam et al, 2013). This can influence the individual’s
self-esteem and self-image (Sheehy et al, 2006) and possibly cause the
individual to experience negative emotional states of depression and anxiety
(Murphy et al, 2012). Despite a lack of research having been conducted on the
psycho-social consequences of osteoarthritis, it seems like ageing adults may
be at higher risk of developing depression, and they may also be more likely to
experience a higher intensity of pain in comparison to those who are not
depressed (Dziechciaż et al, 2013). A patient
suffering from co-morbidities such as chronic depression and a form of
arthritis is more likely to have worse health outcomes than their counterparts
who suffer from only one condition (Margaretten et
al, 2011). If the individual is diagnosed with chronic depression, they are
also likely to be subject to more pharmacological interventions such as
anti-depressants as well as pain management medication. This puts the
individual at increased risk of adverse effects of medication (EUMUSC, 2013).
Employed individuals with osteoarthritis need to ensure that
their abilities balance the external environmental factors of their workplace.
This will more likely allow the individual to work and manage their symptoms in
comparison to an unfavorable situation which may cause an individual’s symptoms
to further deteriorate (Hubertsson, 2015). Most
individuals with osteoarthritis continue to suffer with pain throughout their
life, and over time their function decreases (Saulescu,
2016). This can result in them being unable to work due to very poor mobility.
Hence, unemployment can cause financial distress and complications for the
individual. Also, they may require support and care from others. Often, care is
provided informally by relations and a formal care plan is usually not in place
(Barker et al, 2016). Despite this care being beneficial to the individual with
osteoarthritis, it can negatively create stress and impact upon the lives of carers.
Current research still has not successfully identified why the
pain experienced by osteoarthritis patients is extensively varied (University
of Manchester, 2014). Therefore, the impact of living with osteoarthritis can
differ incredibly amongst sufferers. This is reflected in a study which
analyzed pain experienced by depressed and non-depressed women with
fibromyalgia and/or osteoarthritis. The study suggested that depression did not
change the pain experienced; however depressed women recovered only when they
experienced positive moods in comparison to their counterparts who recovered in
both positive and negative moods (Davis et al, 2014). Hence, exploring the
impact of osteoarthritis on the psychological wellbeing of a patient can be
extremely important in managing the condition. This can encourage the
individual to form truer attitudes towards their functional capability and gain
a better understanding of the disease (Purdy et al, 2014). osteoarthritis
patients may choose to access psychological therapies such as talking therapies
to support them with managing depression (NHS, 2015b; Arthritis Research UK,
2016a). Symptoms of anxiety and sleep disturbances have also been reported by
patients’ (Harris et al, 2012; Busija et al, 2013).
Sleep disturbances have been associated with pain and depression
amongst patients with knee osteoarthritis (Parmelee, 2015). Patients
experiencing high levels of pain are more likely to have sleep disturbances,
hence putting them at higher risk of developing depression. Long term sleep
deprivation can also impact bodily immunity, hence putting individuals at
higher risk of developing infections (Ibarra-Coronado et al, 2015).
Furthermore, recent research suggests that sleep deprivation can trigger immune
system abnormalities, hence possibly causing autoimmune disease (Sangle et al, 2015). Therefore, the impact of
osteoarthritis can lead to further complications on the health and wellbeing of
Possible complications of osteoarthritis include developing gout
(Arthritis Research UK, 2016b). gout can be an extremely painful disease due to
the sudden pain attacks the individual experiences (NHS, 2015a). The management
of gout includes lifestyle changes e.g. dietary changes to prevent further
attacks from the condition. Hence, an individual suffering from osteoarthritis
and gout has the difficulty of managing their pain as well as making specific
lifestyle changes. Maintaining a healthy weight is important for the management
of both conditions and beneficial to the overall health and wellbeing of the
patient. arthritis generally seems to be more prevalent in individuals with
limited physical activity or who are obese (Furner et al, 2011). Hence,
overweight patients with osteoarthritis need to lose weight to reduce the
stress on weight-bearing joints to promote mobility and reduce the risk of
developing further health problems (NIAMS, 2016). However, maintaining a
healthy weight can be extremely difficult for an individual who is suffering from
pain, depression, anxiety and sleep disturbances as their physical limitations
and emotional state may act as a barrier. osteoarthritis is also a leading
cause of disability worldwide. Patients of osteoarthritis are at an increased
risk of mortality due to the risk of developing comorbidities (EUMUSC, 2013).
To summarize, the impact of living with
osteoarthritis varies amongst sufferers. Due to osteoarthritis being a
progressive disease all individuals suffer from the degeneration of the
cartilage lining, which can cause physical changes such as the rubbing of bones
and osteophytes. The impacts of these physical changes are joint inflammation
and stiffness, which predominantly determine the severity of pain experienced
by the individual and their ability to function. Individuals often face
limitations in the daily living activities they can perform. The pain
experienced by individuals varies and it is dependent on a variety of factors
including age. However, further research is needed on why some individuals
experience greater pain than others. osteoarthritis can also have psycho-social
impact on the individual through sleep disturbances, depression and anxiety.
Sleep disturbances can negatively impact the immune system, making the
individual more vulnerable to developing infections. There is a strong
association between depression and arthritis: hence individuals suffering from
both are more likely have worse health outcomes.