The Assignment
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Step 1: Choose one of the following vulnerable patients to create a Medication Guide for the patient:
Patient 1: 26-year-old female with a diagnosis of major depressive disorder and social anxiety disorder who is increasing in isolation and poor self-care. She is in her third trimester of pregnancy.
Patient 2: 16-year-old male with a diagnosis of major depressive disorder, severe. He has seen a therapist weekly for the past 6 months and has had minimal change in symptoms. He has expressed thoughts of wanting to die.
Patient 3 : 72-year-old male with diagnosis of major depressive disorder and panic disorder. He has cardiac history and takes antihypertensive medications.
Patient 4 : 8-year-old Asian female with a diagnosis of severe depressive disorder presents to the office with a report of worsening symptoms. She has never taken psychotropic medication before.
Patient Guide for a 72-year-old male with diagnosis of major depressive disorder and panic disorder – NURS-6630 Week 3 Assignment
Medication Guide for Patients with Major Depressive and Panic Disorder
Chosen Medication: Sertraline (Zoloft)
Sertraline is a selective serotonin reuptake inhibitor (SSRI) whose mechanism of action enhances the activity of a chemical called serotonin in the brain. Sertraline has been selected as a medication for the patient since it is effective in treating major depressive disorder (Luo et al., 2023). Sertraline is well-tolerated, especially among older adults (Srifuengfung et al., 2023). Due to the patient’s cardiac history, SSRIs are preferred over other antidepressants since they have a lower risk of cardiac side effects. Sertraline has a lower risk of drug interactions with antihypertensive medications and is thus recommended for patients with a cardiac history due to the established safety profile (Gutlapalli et al., 2022).
Medication Classification and Rationale
Initial Dose : 25 mg orally once daily
Adjustment : Increase the dose gradually by 25 mg weekly as tolerated, up to 50 mg daily.
Frequency : Ensure you take the medication simultaneously daily, preferably in the morning.
Sertraline’s Mechanism of Action
Sertraline’s mechanism of action involves increasing serotonin levels in the brain. Serotonin is a neurotransmitter that plays a significant role in mood regulation. In their study, Edinoff et al. (2021) noted that the primary mechanism of SSRIs, a class category to which sertraline belongs, is to inhibit the presynaptic reuptake of the serotonin transporter, which leads to a rise in serotonin levels at the postsynaptic membrane within the serotonergic synapse. By improving the level of serotonin activity, sertraline plays a critical role in enhancing mood, lowering anxiety, and alleviating symptoms of depression and panic disorder.
Duration of Treatment
The duration of the treatment will be based on the response and the severity of the symptoms. Continue taking the medication as prescribed, even when you start feeling better. Sertraline treatment is expected to last between six to 12 months from the first episode of depression (Luo et al., 2023). In this case, due to the recurrent depression, longer-term treatment with the medication may be necessary. Ensure you do not stop taking the medication without consultation with the healthcare provider.
Common Side Effects
While sertraline tends to be generally better tolerated than other antidepressants, it is also associated with common side effects. The common side effects associated with sertraline include nausea, vomiting, insomnia, headache, diarrhea, sexual dysfunction, and weight gain or loss (Edinoff et al., 2021). In their study, Renemane and Rancans (2024) noted that while sertraline is preferred due to its efficacy, safety, and tolerability, it is linked to several side effects such as nausea, insomnia, sexual dysfunction, diarrhea, dizziness, dry mouth, and fatigue, which ranges between mild to moderate but tends to reduce over time.
Urgent Consideration
Seek immediate medical attention in case you experience the following symptoms:
Severe allergic reactions: Possible signs of allergic reactions include rash, itching, swelling, severe dizziness, and difficulty breathing.
Serotonin syndrome: While this is a rare condition, it is potentially a life-threatening condition that can be experienced due to excess serotonin in both peripheral (PNS) and central nervous systems (CNS) (Scotton et al., 2019). The condition presents several symptoms, including agitation, confusion, fever, sweating, and muscle rigidity. If these symptoms occur, it is essential to seek immediate medical attention.
Sertraline-induced hypersensitivity pneumonitis is a granulomatous non-If-mediated hypersensitivity reaction of the alveoli and distal bronchioles that may present as an acute subacute or chronic effect. In their study, Virdee et al. (2019) noted that sertraline is an aetiological factor for the condition.
Suicidal thoughts or behaviors: It is essential to monitor possible signs of suicidal thoughts or behavior, especially in the early stages of the treatment.
Specific Instructions for the Patient
Taking the Medication
Take sertraline orally once daily as per the prescription
You can take it with or without food.
Do not double dose.
Missed Doses
If you miss a dose, take it as soon as you remember unless it is close to the time for the next dose.
Do not double the dose to make up for the missed dose.
Avoidance
Other medications : Inform your doctor about all other medications you may be taking, including over-the-counter drugs, herbal supplements, and prescription medications.
Alcohol: Avoid excessive alcohol consumption while taking sertraline since it may worsen the risk of side effects.
Grapefruit and grapefruit juice : These products may interfere with sertraline’s metabolism and increase blood levels.
Follow-up
Follow-up appointment to be scheduled in 4 weeks.
Legal and Ethical Considerations
The medication is prescribed based on evaluating the patient’s condition and medical history.
The medication should only be used as prescribed and not shared with others.
Your medication information and treatment plan are maintained confidential per HIPAA regulations.
Social Determinants of Health Considerations
Financial Assistance
In case of difficulty in affording this medication, it may be essential to explore other options including but not limited to:
Use of generic alternatives
Patient assistance programs provided by various pharmaceutical companies
Transportation issues
In case of possible challenges with transportation, consider the following
Telehealth for follow-up appointments
Coordination with local community services offering transportation assistance
Extending the durations for prescriptions to reduce the frequency of the visits.
Social Determinants of Health, including financial stability and access to transportation, significantly impact a patient’s ability to adhere to treatment plans. Taking these factors into account helps to promote medication adherence, ensure regular follow-up care, and enhance the success of the treatment plan.
References
Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., … & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: a narrative review. Neurology International , 13 (3), 387–401. https://doi.org/10.3390/neurolint13030038
Gutlapalli, S. D., Prakash, K., Swarnakari, K. M., Bai, M., Manoharan, M. P., Raja, R., … & Alfonso, M. (2022). The risk of fatal arrhythmias associated with sertraline in patients with post-myocardial infarction depression. Cureus , 14 (9). https://doi.org/10.7759/cureus.28946
Luo, X., Zhu, D., Li, J., Ren, M., Liu, Y., Si, T., & Chen, Y. (2023). Selection of the optimal dose of sertraline for depression: A dose-response meta-analysis of randomized controlled trials. Psychiatry Research , 115391. https://doi.org/10.1016/j.psychres.2023.115391
Renemane, L., & Rancans, E. (2024). Sertraline induced acute hepatocellular liver injury in a patient with major depressive disorder: a case report. Frontiers in Psychiatry , 15 , 1456455. https://doi.org/10.3389/fpsyt.2024.1456455
Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin syndrome: pathophysiology, clinical features, management, and potential future directions. International Journal of Tryptophan Research , p. 12 , 1178646919873925. 10.1177/1178646919873925
Srifuengfung, M., Pennington, B. R. T., & Lenze, E. J. (2023). Optimizing treatment for older adults with depression. Therapeutic Advances in Psychopharmacology , 13 , 20451253231212327. https://doi.org/10.1177/20451253231212327
Virdee, G., Bleasdale, J., Ikramullah, M., & Graham-Clarke, E. (2019). Sertraline-induced hypersensitivity pneumonitis. BMJ Case Reports CP , 12 (12), e230724. https://doi.org/10.1136/bcr-2019-230724 Patient Guide for a 72-year-old male with diagnosis of major depressive disorder and panic disorder – NURS-6630 Week 3 Assignment
Patient Guide
Understanding that prescribing medication is not the same for all individuals is imperative to becoming a safe and effective psychiatric nurse practitioner. In clinical practice, you will see many patients in different stages of their lives and need to consider these in developing your prescribing treatment plan.
For this Assignment, you will choose a vulnerable patient and develop a 2- to 3-page Medication Guide for them and their family. In your guide, you will consider their ages, birth-assigned sex, FDA approvals, and considerations for increased or decreased risk for side effects. You will choose the most appropriate medication for each of these individuals. Support your answers with evidence-based, peer-reviewed scholarly literature. APA style format title page, citations and references will apply.
Note: You will not set up this Medication Guide as a paragraph-formatted paper but, instead, as a creative, visually appealing guide.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare for this Assignment:
Select a vulnerable patient from the list provided.
Consider age, birth-assigned sex, FDA approvals, and risk and side-effect consideration.
Select the most appropriate medication for your selected patient based upon the information provided.
Review the textbook for commonly prescribed antidepressants, Fast Facts for Psychopharmacology for Nurse Practitioners.
Review the textbook Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Chapters assigned
Conduct research through the FDA website Links to an external site. .
Review prescriber information for professionals of the medications.
Patient Guide for a 72-year-old male with diagnosis of major depressive disorder and panic disorder – NURS-6630 Week 3 Assignment
Note: These can be located free online with web search.
Review national guidelines for prescribing for these vulnerable individuals:
Depression Treatments for Adults Links to an external site.
Depression Treatments for Older Adults Links to an external site.
Depression Treatments for Children and Adolescents Links to an external site.
The Assignment
Step 1: Choose one of the following vulnerable patients to create a Medication Guide for the patient:
Patient 1: 26-year-old female with a diagnosis of major depressive disorder and social anxiety disorder who is increasing in isolation and poor self-care. She is in her third trimester of pregnancy.
Patient 2: 16-year-old male with a diagnosis of major depressive disorder, severe. He has seen a therapist weekly for the past 6 months and has had minimal change in symptoms. He has expressed thoughts of wanting to die.
Patient 3 : 72-year-old male with diagnosis of major depressive disorder and panic disorder. He has cardiac history and takes antihypertensive medications.
Patient 4 : 8-year-old Asian female with a diagnosis of severe depressive disorder presents to the office with a report of worsening symptoms. She has never taken psychotropic medication before.
Step 2: Create a Medication Guide for a patient. In your guide, you should provide the following specific instructions for the patient:
Describe the chosen classification of medications, from the classification category, for your chosen vulnerable patient. Explain your rationale for your choice.
Explain what dose you would start the chosen medication with and the frequency.
Discuss how the medication works to treat their symptoms.
Explain how long they should take the medication.
Discuss the typical or common side effects of the medication.
Explain the urgent or emergent considerations for the patient taking the medication.
The Medication Guide should also include:
Directions you would provide the patient on how to take the prescribed medication
Instructions on what the patient should do if a medication dose is missed
List of any other medications, over-the-counter medications, and/or supplements/herbals the patient should avoid while taking the prescribed medication
List of foods the patient should avoid when taking this medication
Date when the patient should return for follow-up visit with you
Discussion about the legal and ethical considerations for the medication being prescribed
Answers in consideration of Social Determinants of Health on how you would:
Assist the patient who cannot not afford to pay financially for the medication you are recommending/prescribing; and/or
Has difficulty with transportation that impacts their ability to present for regular appointments with you
Discuss how financial hardship and lack of transportation could relate to Social Determinants of Health, as well as why they are important considerations for you as a prescriber.
By Day 7 of Week 3
Submit by Day 7 of Week 3 .
submission information
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To submit your completed assignment, save your Assignment as WK3Assgn_LastName_Firstinitial
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Rubric
NURS_6630_Week3_Assignment_Rubric
NURS_6630_Week3_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome Selected patient guide describes how the medication works, length of use, side effects, and other considerations. The student patient guide addresses all of the specific information for the patient as outlined in the Assignment directions.
40 to > 29.0 pts Excellent The response comprehensively and clearly explains medication use. The response clearly addresses all the specific information for the patient as outlined in the Assignment directions.
29 to > 19.0 pts Good The response clearly explains medication use. The response clearly addresses 75% of the specific information for the patient as outlined in the Assignment directions.
19 to > 9.0 pts Fair The response vaguely explains medication use. The response clearly addresses 50% of the specific information for the patient as outlined in the Assignment directions.
9 to > 0 pts Poor The response includes inaccurate and vague examples that does not explain medication use, or it is missing. The response clearly addresses 25% of the specific information or does not address the specific information for the patient as outlined in the Assignment directions.
40 pts
This criterion is linked to a Learning Outcome The medication guide is accurate in information and written for the appropriate patient audience. The medication guide is creative and visually appealing. Patient Guide for a 72-year-old male with diagnosis of major depressive disorder and panic disorder – NURS-6630 Week 3 Assignment
10 to > 7.0 pts Excellent The medication guide is accurate in information and written for the appropriate patient audience. The medication guide is creative and visually appealing.
7 to > 4.0 pts Good The medication guide is accurate in information and written for the appropriate patient audience. The medication guide shows some creativity and/or some visually appealing.
4 to > 1.0 pts Fair The medication guide contains some inaccurate information. Not written for the appropriate patient audience. The medication guide does not show creativity and/or is not visually appealing.
1 to > 0 pts Poor The medication guide is not accurate in information and appropriate for the patient audience. The submission is not designed as a patient guide, but the submission is a written paper.
10 pts
This criterion is linked to a Learning Outcome Ethical and Legal considerations are discussed.
20 to > 18.0 pts Excellent The response comprehensively and clearly explains both the ethical and legal considerations of medication use.
18 to > 15.0 pts Good The response clearly explains one of the ethical and/or legal considerations of medication use.
15 to > 10.0 pts Fair The response vaguely explains one of the ethical and/or legal considerations of medication use.
10 to > 0 pts Poor The response includes inaccurate and vague examples that do not explain the ethical and legal considerations of the medication use, or it is missing.
20 pts
This criterion is linked to a Learning Outcome Social determinants of health considerations are applied regarding financial responsibility and ability to attend appointments Patient Guide for a 72-year-old male with diagnosis of major depressive disorder and panic disorder – NURS-6630 Week 3 Assignment
20 to > 18.0 pts Excellent The response comprehensively and clearly explains considerations for social determinants of health.
18 to > 15.0 pts Good The response clearly explains considerations for social determinants of health.
15 to > 10.0 pts Fair The response vaguely explains considerations for social determinants of health.
10 to > 0 pts Poor The response includes inaccurate and vague examples that do not explain considerations for social determinants of health, or it is missing.
20 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation
5 to > 4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
4 to > 3.0 pts Good Contains a couple (one or two) grammar, spelling, and punctuation errors.
3 to > 1.0 pts Fair Contains several (three or four) grammar, spelling, and punctuation errors.
1 to > 0 pts Poor Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting: The submission contains an APA format for title page, citations, and Reference List.
5 to > 4.0 pts Excellent Uses correct APA format for title page, citations, and reference list with no errors.
4 to > 3.0 pts Good Contains one or two APA format errors with title page, citations, and reference list.
3 to > 1.0 pts Fair Contains three or four APA format errors with title page, citations, and reference list.
1 to > 0 pts Poor Missing APA format title page, citations, and/or reference list.
5 pts
Total Points: 100 Patient Guide for a 72-year-old male with diagnosis of major depressive disorder and panic disorder – NURS-6630 Week 3 Assignment
