4. What medication would you suggest including dosing, medication education and counseling would you provide? (25pts)
My prescription for Mr. RS would be Alprazolam 0.5 mg three times daily along with Zoloft 25mg daily. Titration on Zoloft to be increased to 50mg by the end of the first week and further increased to 100mg after another week. Starting at week 4, Alprazolam could be gradually tapered off and discontinued over the next 2 weeks. Meanwhile, referral is made by clinicians for the patient to meet with a psychiatric nurse practitioner (NP), and/or the psychiatrist for treatments and CBT therapy. It is critical to follow up patient’s progress on counseling and CBT therapy in order to adjust the treatment plan. (McCarron, R. M., Xiong, G. L., & Bourgeois, J. A., 2009).
While taking BZPs, patients should avoid driving and drinking, and consult with the provider if they want to use BZPs in combination with other medications or OTC drugs. Some side effects are reported frequently, such as drowsiness, dry mouth, upset stomach, constipation, lethargy, dizziness, change in sex ability, change in weight, and lowered interest in sex, psychological and physical dependence, and orthostatic hypotension. Patients should contact the provider if any of these side effects bother them or do not go away. There are many adverse effects as well. Patients should contact provider right away to request intervention if any signs of allergic reaction (rash, hives, peeling skin, trouble in breathing), mood/emotion changes or thoughts of suicide, etc. appear. Other signs that should also be reported include imbalance, feeling that is not normal, chest pain, increase heart rate, change in thinking, memory problems, shakiness, difficult to pass urine, blurred vision, hallucinations, trouble speaking, fatigue, twitching, dark urine, yellow skin and eyes. (Lexicomp, 2015). In context of SSRIs, Mr. RS should be educated about the side effects of anxiety, emotional flattening, headache, nausea, GI disturbance, sleep disturbances, weight gain and sexual dysfunction. He should also be informed that SSRIs could take up to 6 weeks to work, although the side effects may appear almost immediately. He should continue to take his medication and reports any side effects to the provider. If side effects are intolerable, he can be weaned off the medication and switched to a different medication. 5. Explain the potential risks of prescribing certain anxiety-reducing medications to patients, and what precautions should be implemented when working within a primary care setting? (15pts) The potential risks of prescribing anxiety-reducing medication to patients include poor medication adherence and suicide ideation. Educating the patient about the mechanism of action and side effects of SSRIs and BZPs increase …show more content…
The precautions that should be implemented for seeing patients with anxiety disorders in primary care settings are as follows. The precaution interventions for patients with anxiety disorders starts from the beginning to the end of the visit. First, perform a comprehensive diagnostic interview, screening and assessment. Second, establish a sound working relationship with the patient by using motivational interviewing techniques to assist patients reflect their mental issues. Third, provide education (CBT, psychotherapy, etc.) and simple skills (relaxation technique and diaphragmatic breathing skill) to patients for reducing the level of anxiety. Fourth, intervene with medication approach by carefully selecting medication and adjusting the dosage for patients who are experiencing anxiety disorders. (Roy-Byrne, P et al.,
My prescription for Mr. RS would be Alprazolam 0.5 mg three times daily along with Zoloft 25mg daily. Titration on Zoloft to be increased to 50mg by the end of the first week and further increased to 100mg after another week. Starting at week 4, Alprazolam could be gradually tapered off and discontinued over the next 2 weeks. Meanwhile, referral is made by clinicians for the patient to meet with a psychiatric nurse practitioner (NP), and/or the psychiatrist for treatments and CBT therapy. It is critical to follow up patient’s progress on counseling and CBT therapy in order to adjust the treatment plan. (McCarron, R. M., Xiong, G. L., & Bourgeois, J. A., 2009).
While taking BZPs, patients should avoid driving and drinking, and consult with the provider if they want to use BZPs in combination with other medications or OTC drugs. Some side effects are reported frequently, such as drowsiness, dry mouth, upset stomach, constipation, lethargy, dizziness, change in sex ability, change in weight, and lowered interest in sex, psychological and physical dependence, and orthostatic hypotension. Patients should contact the provider if any of these side effects bother them or do not go away. There are many adverse effects as well. Patients should contact provider right away to request intervention if any signs of allergic reaction (rash, hives, peeling skin, trouble in breathing), mood/emotion changes or thoughts of suicide, etc. appear. Other signs that should also be reported include imbalance, feeling that is not normal, chest pain, increase heart rate, change in thinking, memory problems, shakiness, difficult to pass urine, blurred vision, hallucinations, trouble speaking, fatigue, twitching, dark urine, yellow skin and eyes. (Lexicomp, 2015). In context of SSRIs, Mr. RS should be educated about the side effects of anxiety, emotional flattening, headache, nausea, GI disturbance, sleep disturbances, weight gain and sexual dysfunction. He should also be informed that SSRIs could take up to 6 weeks to work, although the side effects may appear almost immediately. He should continue to take his medication and reports any side effects to the provider. If side effects are intolerable, he can be weaned off the medication and switched to a different medication. 5. Explain the potential risks of prescribing certain anxiety-reducing medications to patients, and what precautions should be implemented when working within a primary care setting? (15pts) The potential risks of prescribing anxiety-reducing medication to patients include poor medication adherence and suicide ideation. Educating the patient about the mechanism of action and side effects of SSRIs and BZPs increase …show more content…
The precautions that should be implemented for seeing patients with anxiety disorders in primary care settings are as follows. The precaution interventions for patients with anxiety disorders starts from the beginning to the end of the visit. First, perform a comprehensive diagnostic interview, screening and assessment. Second, establish a sound working relationship with the patient by using motivational interviewing techniques to assist patients reflect their mental issues. Third, provide education (CBT, psychotherapy, etc.) and simple skills (relaxation technique and diaphragmatic breathing skill) to patients for reducing the level of anxiety. Fourth, intervene with medication approach by carefully selecting medication and adjusting the dosage for patients who are experiencing anxiety disorders. (Roy-Byrne, P et al.,