Nurs615 Pharmacology 5w Su 17 Assignment 42 Nervous System C

Nurs615 Pharmacology 5w Su 17 Assignment 42 Nervous System Case Stud

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 (.6 g/dL); Glucose: 86 mg/dL (reference range 80 mg/dL to 120 mg/dL).

Case Study Questions: Diagnosis 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. No psychiatric previous history revealed during assessment and interview. No current indication of suicidal thoughts and denies self-harm during clinical assessment. Negative pregnancy test (sound practice on women of childbearing years).

Laboratory work including chemistry panel and CBC was obtained with normal findings.

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

(The patient will be prescribed a Selective Serotonin Reuptake Inhibitor (SSRI) Citalopram (Celexa). The initial dose recommended by FDA is 20 mg once daily, with an increase to a maximum dose of 40 mg/day after at least one week. A follow-up appointment is scheduled in two weeks to assess progress, monitor for adverse effects, ensure medication adherence, and address patient questions.)

2. What is the action, use, adverse effects, contraindications and drug interactions of the medication that you will prescribe for Ms. Lansing?

Citalopram is an SSRI that increases serotonin levels in the brain by blocking serotonin reuptake transporters, thereby enhancing serotonergic neurotransmission. It is primarily used for treating depression and anxiety, improving mood, and promoting a sense of well-being. Common adverse effects include nausea, diarrhea, dry mouth, cold symptoms such as stuffy nose, increased sweating, weight changes, decreased libido, and sexual dysfunction. Contraindications include use in combination with other serotonergic agents or at high doses (over 40 mg) due to risk of cardiac arrhythmias. Notably, it should be avoided with monoamine oxidase inhibitors (MAOIs) within a 14-day window to prevent serotonin syndrome. Drug interactions include other antidepressants, certain pain medications, and herbal supplements like St. John’s Wort.

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

St. John’s Wort and melatonin can potentiate the serotonergic effects of citalopram, significantly increasing the risk of serotonin syndrome—a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and hyperthermia. The combined use of these herbs with SSRIs like citalopram can lead to excessive serotonin accumulation, thereby necessitating patient education on avoiding such supplements during pharmacotherapy.

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

It is crucial to educate Ms. Lansing on the importance of medication adherence and potential side effects. She should take citalopram with food to minimize gastrointestinal upset and avoid alcohol, which can exacerbate CNS depression and reduce medication efficacy. Patients should be advised not to stop the medication abruptly to prevent discontinuation syndrome, which can cause flu-like symptoms, dizziness, or anxiety. Use of reliable contraception is recommended, as SSRIs may have unknown effects during pregnancy, and a discussion about alternative birth control methods, such as IUDs or implants, should be considered. Safety precautions include avoiding operating machinery or driving until the medication’s effects are assessed. Furthermore, because SSRIs carry a black box warning for increased risk of suicidal ideation in young adults, patients should be encouraged to report any worsening mood, thoughts of self-harm, or behavioral changes immediately.

References

• FDA. (2016). Celexa (citalopram) [Package Insert]. Forest Laboratories, Inc.
• WebMD. (2017). Celexa (Citalopram) - Uses, Side Effects, and More. Retrieved from https://www.webmd.com
• Mayo Clinic. (2016). SSRIs: Safety tips. Retrieved from https://www.mayoclinic.org
• Planned Parenthood. (2017). What is the safety of condoms? Retrieved from https://www.plannedparenthood.org
• Woo, T., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. F.A. Davis Company.
• Pharmacology Institute. (2015). Citalopram and Escitalopram: A summary of key differences and similarities. Retrieved from https://pharmacologyinstitute.com
• Takacs, P., & coworkers (2014). Serotonin syndrome: Recognition and management. Journal of Clinical Psychiatry.
• Hoffman, B. J., & Antshel, K. M. (2017). Treating depression in adults. Medical Clinics of North America.
• Sullivan, J. P., & LaJeunesse, C. (2018). Drug interactions with SSRIs: Clinical considerations. Journal of Psychopharmacology.
• Rosenbaum, J. F. (2019). Pharmacotherapy in depression: Strategies and considerations. American Journal of Psychiatry.