Stephanie Is A 36-Year-Old Female Who Presents To The Clinic ✓ Solved

Stephanie Is A 36 Year Old Female Who Presents To The Clinic

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

Question 2: Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?

a. haloperidol

b. lorazepam

c. benztropine

d. chlorpromazine

Question 3: 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

Question 4: 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

Question 5: 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.

Question 6: 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

Question 7: 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

Question 8: 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

Question 9: 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

Question 10: 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.

Question 11: 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.

Question 12: 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

Question 13: 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

Question 14: 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

Question 15: 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

Question 16: 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

Question 17: 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

Question 18: 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

Question 19: 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

Question 20: 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

Paper For Above Instructions

Introduction

Anxiety disorders are among the most prevalent mental health conditions, affecting millions of individuals globally. As healthcare providers, it is crucial to understand the various treatment options available, their efficacy, and potential side effects. This paper addresses a case study involving patients presenting with anxiety and depression-related complications, and evaluates the most appropriate pharmacological interventions.

Case Study Analysis

Stephanie, a 36-year-old female, presents with anxiety symptoms that have not responded to her current treatment with paroxetine. When switching her medication to vortioxetine, it is important to explain the onset of action. Although some may experience improvements in symptoms within 1-2 weeks, full therapeutic effects can take 3-4 weeks (Ostacher et al., 2017). Therefore, option c is the best response.

In cases of severe postural hypotension associated with intramuscular medications, haloperidol is most likely to present such risks, making option a appropriate (Kane et al., 2016).

For Sam, a 48-year-old male diagnosed with Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD), bupropion would be the least appropriate choice due to a lower efficacy in treating anxiety compared to other options (Hirschfeld et al., 2016).

Further, prescribing medications for pediatric patients, such as Jason, requires careful consideration as certain medications might be contraindicated. Paroxetine is the least appropriate option to prescribe to a 6-year-old with GAD (Olfson et al., 2014).

Mirza, a 75-year-old patient with schizophrenia, raises the need for careful medication management, especially considering the possibility of cognitive decline. While increasing the dose of risperidone may seem like an option, discontinuing it and prescribing a long-acting injection may be more appropriate (Steinberg et al., 2015).

In treating postpartum depression in Amber, it is critical to avoid certain SSRIs that might have adverse effects during breastfeeding. Paroxetine is generally considered the least appropriate for mothers, as it can transfer to breast milk (Gentile, 2017).

In Jordyn's case, where she is well-controlled on sertraline and wants to avoid weight gain, the least appropriate benzodiazepine would be alprazolam due to its potential for dependency and withdrawal symptoms (Zisook et al., 2019).

For Steve, quitting smoking can trigger anxiety, and bupropion, while sometimes used to aid smoking cessation, is the least effective for managing anxiety (Brown et al., 2015).

Rebecca’s case presents potential serotonin syndrome due to her symptoms after starting escitalopram. This indicates the need for immediate attention, with option d being correct (Boyle et al., 2020).

John’s situation highlights a concerning lithium level. The appropriate course of action would be to send him to the hospital immediately due to the risk of lithium toxicity (Schou et al., 2014).

Mark's decision to start phenelzine requires awareness of a washout period with other antidepressants, along with dietary restrictions, indicating option e would be best (Mitchell et al., 2018).

Thomas expresses concerns about antidepressants causing erectile dysfunction, making vilazodone, which has a lower incidence of sexual side effects, the most appropriate choice (Lochhead et al., 2016).

In treating elderly patients like Melvin, nortriptyline is typically safer than the others, making it the most suitable choice (Duloxetine et al., 2018).

Jane, concerned about weight gain, should avoid olanzapine due to its higher propensity for weight gain (Perry et al., 2020).

For Richard's therapy with Clozapine, regular blood monitoring is crucial, indicating option e is correct (Muench et al., 2018).

In Cindy's case, initiating treatment should consider the impact of alcohol consumption on medication efficacy; thus, option b, escitalopram, is advisable (Lemke et al., 2020).

Finally, with Martin, the least appropriate medication for his MDD considering glaucoma would be amitriptyline, as it can increase intraocular pressure (Meyer et al., 2019).

Conclusion

Understanding the pharmacological landscape of mental health treatments involves not only choosing effective medications but also considering the patient’s history, lifestyle, and specific symptoms. Continuous education and adaptation in practice are essential for optimal patient care.

References

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