Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

Decision 1
Begin Paxil 10mg
Client returns to Clinic in 4 weeks
Client informs you that he has no tightness in chest or shortness of breath
Client states that he noticed decreased worries about work over the past 4 or 5 days
HAM-A score has decreased to 18 (partial response)
Decision 2
Increase dose to 40mg
Client returns to clinic in 4 weeks
Client is a bit evasive about his symptoms. Eventually he admits that he stopped taking the medication about a week ago because he was experiencing difficulty acquiring an erection.
Decision 3
Discontinue Paxil and begin Celexa at 20mg po daily
Guidance to Student
Erectile dysfunction with SSRIs may be dose dependent and may resolve with the passage of time. You should discuss this course of action with the client and determine whether he is interested in attempting a re-challenge of the drug. If the symptom persists, discuss other treatment options with client- such as Celexa- although Celexa although Celexa is an SSRI, not all clients will experience the same side effects to different medications in the class. If the client is having a good response, but continues to demonstrate difficulties with erection, you could consider the addition of Bupropion, and if indicated, a phosphodiesterase-5 inhibitor such as Cialis. This would have to be used with caution in consideration of the clients HTN.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.


 

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