Richard Is A 54-Year-Old Male With Schizophrenia ✓ Solved

Richard is a 54-year-old male who suffers from schizophrenia

Richard is a 54-year-old male who suffers from schizophrenia. After exhausting various medication options, you have decided to start him on Clozapine. Which of the statements below is true regarding Clozapine? a. Regular blood monitoring must be performed to monitor for neutropenia. b. Clozapine can only be filled by a pharmacy that participates in the REMS program. c. Bradycardia is a common side effect of Clozapine. d. A & B e. All of the above

Which of the following statements are true? a. First-generation (typical) antipsychotics are associated with a higher incidence of EPS. b. Second-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects. c. There is evidence that atypical antipsychotics are significantly more effective than typical antipsychotics in the treatment of cognitive symptoms associated with schizophrenia. d. A & B e. A, B, and C

Cindy is a 55-year-old patient who presents with symptoms consistent with Generalized anxiety disorder. The patient has an unremarkable social history other than she consumes two or three glasses of wine per night. Which of the following would be an appropriate therapy to start this patient on? a. Xanax 0.25mg BID PRN Anxiety b. Escitalopram 10mg daily c. Buspirone 10mg BID d. Aripiprazole 10mg daily

Mirza is a 75-year-old patient with a long history of schizophrenia. During the past 5 years, she has shown significant cognitive decline consistent with dementia. The patient has been well controlled on a regimen of risperidone 1mg BID. As the PMHNP, the most appropriate course of action for this patient is: a. Increase the risperidone to 1mg QAM, 2mg QPM b. Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna. c. Discontinue risperidone and initiate therapy with clozapine. d. Augment the patient's risperidone with brexpiprazole.

The patient in the previous question states, "I can't even last 1 more day without feeling like my insides are going to explode with anxiety." The most appropriate course of action would be: a. Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect. b. Prescribe a short-term course of low dose benzodiazepine, such as alprazolam. c. Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine. d. Recommend in-patient mental health for the foreseeable future.

Thomas is a 28-year-old male who presents to the clinic with signs and symptoms consistent with MDD. He is concerned about starting antidepressant therapy, however, because one of his friends recently experienced erectile dysfunction when he was put on an antidepressant. Which of the following would be the most appropriate antidepressant to start Thomas on? a. Vilazodone b. Sertraline c. Paroxetine d. Citalopram

Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn't work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” The best response is: a. 3 or 4 days b. 1 or 2 weeks c. 3 or 4 weeks d. 10 weeks

Jane is a 17-year-old patient who presents to the office with signs consistent with schizophrenia. She states multiple times that she is concerned about gaining weight, as she has the perfect prom dress picked out and she finally got a date. Which of the following is the least appropriate choice to prescribe Jane? a. Aripiprazole b. Olanzapine c. Haloperidol d. Brexpiprazole

John is a 41-year old-patient who presents to the clinic with diarrhea, fatigue, and recently has been having tremors. He was diagnosed 19 years ago with bipolar disorder and is currently managed on Lithium 300mg BID. As the PMHNP, you decide to order a lithium level that comes back at 2.3mmol/l. What is the most appropriate course of action? a. Investigate other differential diagnoses for his symptoms. b. Tell John to skip his next four Lithium doses and resume therapy. c. Tell John he needs to go to the hospital and call an ambulance to bring him. d. Prescribe loperamide to treat the diarrhea and ropinirole to treat the tremors.

Jordyn is a 27-year-old patient who presents to the clinic with GAD. She is 30 weeks pregnant and has been well controlled on a regimen of sertraline 50mg daily. Jordyn says that "about once or twice a week my husband really gets on my nerves and I can't take it." She is opposed to having the sertraline dose increased due to the risk of further weight gain. You have decided to prescribe the patient a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepines to prescribe to this patient? a. diazepam b. alprazolam c. clonazepam d. lorazepam

Rebecca is a 32-year-old female who was recently prescribed escitalopram for MDD. She presents to the clinic today complaining of diaphoresis, tachycardia, and confusion. The differential diagnosis for this patient, based on the symptoms presenting, is: a. Panic disorder b. Gastroenteritis c. Abnormal gait d. Serotonin syndrome

Mark is a 46-year-old male with treatment-resistant depression. He has tried various medications, including SSRIs, SNRI, and TCAs. You have decided to initiate therapy with phenelzine. Which of the following must the PMHNP take into consideration when initiating therapy with phenelzine? a. There is a minimum 7-day washout period when switching from another antidepressant to phenelzine. b. Patient must be counseled on dietary restrictions. c. MAOIs may be given as an adjunctive therapy with SSRIs. d. A & B e. All of the above

Melvin is an 89-year-old male who presents to the clinic with signs/symptoms consistent with MDD. Which of the following would be the LEAST appropriate medication to prescribe to this elderly patient? a. nortriptyline b. amitriptyline c. desipramine d. trazodone

Earle is an 86-year-old patient who presents to the hospital with a Community Acquired Pneumonia. During stay, you notice that the patient often seems agitated. He suffers from cognitive decline and currently takes no mental health medications. Treatment for the CAP include ceftriaxone and azithromycin. The LEAST appropriate medication to treat Earle's anxiety is: a. sertraline b. duloxetine c. citalopram d. venlafaxine

Martin is a 92-year-old male who presents to the clinic with signs/symptoms consistent with MDD. The patient suffers from glaucoma and just recently underwent surgery for a cataract. Which of the following is the LEAST appropriate course of therapy when treating the MDD? a. sertraline b. amitriptyline c. duloxetine d. vilazodone

Sam is a 48-year-old male who presents to the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy? a. duloxetine b. sertraline c. mirtazapine d. buproprion

Steve is a 35-year-old male who presents to the primary care office complaining of anxiety secondary to quitting smoking cold turkey 2 weeks ago. The patient has a 14-year history of smoking two packs per day. The patient has an unremarkable social history other than a recent divorce from his wife, Brittany. Which of the following would be the LEAST effective medication to treat Steve's anxiety? a. Buproprion b. Sertraline c. Varenicline d. Alprazolam

Amber is a 26-year-old female who presents to the clinic 6 weeks postpartum. The patient states that she has been "feeling down" since the birth of her son. She is currently breastfeeding her infant. You diagnose the patient with Postpartum depression. Which of the following is the LEAST appropriate option in treating her PPD? a. paroxetine b. escitalopram c. citalopram d. sertraline

Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension? a. haloperidol b. lorazepam c. benztropine d. chlorpromazine

Jason is a 6-year-old child whose mother presents to the clinic with him. The mother says that “he's not himself lately." After a thorough workup, you diagnose the patient as having GAD. Which of the following medications would be the LEAST appropriate to prescribe to this child? a. Sertraline b. Paroxetine c. Venlafaxine d. Buspirone

Paper For Above Instructions

Clozapine is a unique medication reserved for treatment-resistant schizophrenia and is pivotal due to its effectiveness, albeit with significant risk management requirements. Key considerations when starting Clozapine include regular blood monitoring to detect potential neutropenia (a significant drop in white blood cells that can lead to serious infection) and the necessity for the pharmacy to be enrolled in the Risk Evaluation and Mitigation Strategy (REMS) program to ensure patient safety (Muench & Hamer, 2010). In this regard, options A and B are valid; hence the correct answer is D (A & B).

In contrast to these atypical medications, first-generation antipsychotics are associated with extrapyramidal symptoms (EPS) due to their dopamine antagonist properties, while second-generation antipsychotics carry a higher risk of metabolic adverse effects (Kaplan & Sadock, 2015). Evidence suggests that atypical antipsychotics are not only preferred for their metabolic profile but may indeed be more effective concerning cognitive impairments related to schizophrenia (Miyamoto et al., 2012). Thus, option E (A, B, and C) is the answer to this segment.

Addressing anxiety disorders such as Generalized Anxiety Disorder (GAD) requires careful consideration of the therapeutic options available, particularly for patients with a history of alcohol use. In the case of Cindy, starting her on Escitalopram offers a balanced approach that can manage anxiety without the potential for dependence associated with benzodiazepines, particularly amid her alcohol consumption (Baldwin et al., 2014).

For Mirza's treatment, adjusting her current medication regimen may enhance control over her schizophrenia symptoms alongside her cognitive decline. In this case, prescribing a long-acting injectable such as Invega Sustenna would be prudent given the challenges frequently associated with adherence in the aging population (Muller & Ascher-Svanum, 2015).

The immediate anxiety relief expressed by the preceding patient could necessitate a short-term benzodiazepine prescription, particularly alprazolam, which is known for its rapid onset of action (Schmidt et al., 2018). This course of action can alleviate acute anxiety symptoms while awaiting the longer-term effects of prescribed SSRIs.

In situations concerning young adults reportedly affected by Major Depressive Disorder (MDD), selecting an antidepressant that minimizes the risk of sexual dysfunction is crucial. Vilazodone is known to possess a lower incidence of sexual side effects, making it an ideal candidate for Thomas (Cymbalista et al., 2013).

Switching Stephanie from paroxetine to vortioxetine necessitates educating her regarding the expected lag time for therapeutic effects, which typically ranges from 3 to 4 weeks (Quintana et al., 2015).

Given Jane's concern about weight gain, prescribing Haloperidol—an older antipsychotic notorious for metabolic side effects—would be least appropriate, necessitating a more modern approach with agents like Aripiprazole or Brexpiprazole that carry a superior side effect profile (Citrome, 2017).

As for John, the lithium level indicating toxicity would merit immediate hospitalization (the answer being C) for comprehensive care and potential interventions for his developing symptoms (Kastango et al., 2020).

Pregnancy presents unique challenges when treating anxiety disorders. Varenicline, indicated for smoking cessation, is inappropriate as it carries risks during pregnancy, while alternatives such as lorazepam may offer more targeted relief without adversely affecting fetal development (Mills et al., 2020).

For Rebecca, her symptoms point towards serotonin syndrome, a potentially life-threatening condition resulting from increased serotonergic activity in the CNS, requiring prompt identification and management (Silberstein, 2015).

When discussing phenelzine with a patient, counseling about dietary restrictions is non-negotiable to prevent hypertensive crises (Trevisan et al., 2021) and provides an essential component of patient education when transitioning to MAOIs.

The treatment of Melvin requires consideration of medication tolerability, particularly avoiding amitriptyline given potential anticholinergic effects, which may exacerbate comorbid conditions in the elderly (Wang et al., 2021).

For Earle, SSRI selection must also consider concurrent pharmacotherapy for CAP; hence, prescribing venlafaxine could interact unfavorably with ceftriaxone (Han et al., 2017).

In managing Martin’s MDD and glaucoma, Sertraline is advantageous given its favorable safety profile in terms of ocular health, whereas amitriptyline poses risks of increased intraocular pressure (Galani et al., 2018).

Caution is warranted when treating Sam due to potential drug interactions; hence bupropion may not be ideal as a first-line agent for both MDD and GAD (Gonzalez et al., 2019).

For Steve, considering the least effective treatment options, Buproprion might be less suitable for anxiety management than SSRIs or benzodiazepines (Katz et al., 2020).

In treating Amber's postpartum depression, Paroxetine should be avoided because it may pose risks during breastfeeding, with SSRIs like sertraline generally considered safer (Levant et al., 2021).

Severe postural hypotension is a known concern with certain medications, particularly Haloperidol, emphasizing caution in elderly or fragile patients to minimize adverse effects (Davies et al., 2020).

Last but not least, when treating pediatric anxiety cases like Jason’s, Paroxetine should be approached cautiously due to safety concerns, while Buspirone, being an anxiolytic with a more benign profile, may be more appropriate (Rynn et al., 2016).

References

  • Baldwin, D. S., et al. (2014). Generalized anxiety disorder: A review of the current evidence-based treatment options. Primary Care Companion for CNS Disorders, 16(1).
  • Cymbalista, F., et al. (2013). Vilazodone in the treatment of major depressive disorder: A systematic review. Clinical Psychopharmacology and Neuroscience, 11(1), 1-8.
  • Citrome, L. (2017). Aripiprazole: A novel treatment for schizophrenia. CNS Spectrums, 22(6), 376-384.
  • Davies, R., et al. (2020). Clinical review: An update on postural hypotension management in the elderly. Age and Ageing, 49(3), 405-411.
  • Galani, V., et al. (2018). The role of serotonin in glaucoma: Implications for treatment of depression in patients. Expert Opinion on Pharmacotherapy, 19(9), 879-891.
  • Gonzalez, M. A., et al. (2019). Treating anxiety and depression in primary care: The role of pharmacotherapy. American Family Physician, 100(7), 435-442.
  • Han, A., et al. (2017). Drug interactions: An overview for practitioners. Current Clinical Pharmacology, 12(3), 132-147.
  • Kastango, K. B., et al. (2020). Lithium toxicity: Prevention and management. The Journal of Clinical Psychiatry, 81(5), 20m13318.
  • Katz, A., et al. (2020). Treating anxiety disorders in primary care: An update. American Family Physician, 102(7), 437-448.
  • Levant, R. F., et al. (2021). Breastfeeding and mental health medications: A review. Maternal and Child Health Journal, 25(4), 553-564.
  • Mills, N. L., et al. (2020). Managing GAD during pregnancy: Evidence-based guidelines and safety considerations. Journal of Affective Disorders, 265, 201-209.
  • Muench, J., & Hamer, R. M. (2010). Clozapine and blood monitoring: A review of safety. Psychiatric Services, 61(11), 1105-1110.
  • Quintana, D. S., et al. (2015). The timeline for response to vortioxetine. Journal of Clinical Psychiatry, 76(7), 671.
  • Rynn, M. A., et al. (2016). Pediatric anxiety disorders: Diagnosis and treatment. Child and Adolescent Psychiatric Clinics of North America, 25(1), 1-18.
  • Schmidt, A., et al. (2018). The role of alprazolam in managing acute anxiety: A clinical review. Journal of Clinical Psychiatry, 79(5).
  • Silberstein, S. D. (2015). Serotonin syndrome: A critical review. Current Neurology and Neuroscience Reports, 15(12), 83.
  • Trevisan, C. M., et al. (2021). MAOIs and dietary restrictions: An important clinical consideration. American Journal of Psychiatry, 178(5), 470-478.
  • Wang, C., et al. (2021). Anticholinergic burden in older adults: Implications for prescribing. American Journal of Geriatric Pharmacotherapy, 19(1), 29-38.

Related Assignments