[SOLVED] NR546 Week 6: Case Study Discussion

COURSE:

NR546 – Advanced Pharmacology: Psychopharmacology

Preparing the Discussion

Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.

General Directions

Review the provided case study to complete this week’s discussion.

Include the following sections:

  1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
    1. Select one drug to treat the diagnosis(es) or symptoms.
    2. List medication class and mechanism of action for the chosen medication.
    3. Write the prescription in prescription format.
    4. Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
    5. List any side effects or adverse effects associated with the medication.
    6. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
    7. Provide a minimum of three appropriate medication-related teaching points for the client and/or family.

 

 Subjective Objective
The client TJ is a 48-year-old, African American male patient presenting to the emergency department with Depression, suicidal Ideation, and Alcohol Abuse History

Client’s Chief Complaints:

“I think I just want to end it all.”

History of Present Illness

TJ presents to the emergency department with symptoms of severe depression and suicidal ideation. He reports a recent onset of overwhelming feelings of sadness, despair, and hopelessness, which have persisted for the past several months. TJ describes experiencing intense guilt and shame, often feeling like a burden to his family and friends. He admits to having recurrent thoughts of suicide, with a specific plan to overdose on prescription medication.

Additionally, TJ acknowledges a long-standing history of alcohol (ETOH) abuse, which he attributes to coping with stressors in his life. He reports consuming excessive amounts of alcohol daily, often to the point of intoxication, in an attempt to numb his emotional pain and alleviate his depressive symptoms. He acknowledges that his alcohol use has worsened over the past few months, coinciding with the escalation of his depressive symptoms. He admits to drinking a pint or more of vodka a day, last drink was today.

TJ reports experiencing significant distress in multiple areas of his life, including strained relationships with family members, difficulty maintaining employment due to frequent absenteeism, and financial instability. He admits to feeling isolated and disconnected

 Physical Examination:

Height: 6’ weight: 190 lb.

General: Thin male appears older than stated age

Lab work:

AST = 67 IU/L;

ALT = 43 IU/L;

GGT= 36U/L; other liver function tests are WNL.

Hemoglobin =12.5; hematocrit = 38; MCV =95; triglycerides = 200 mg/dl.

Blood alcohol level (BAC)

•                 0.20 mg/dL

 

Toxicology Screen:

•                 Positive for THC

•                 Negative for opioids, benzodiazepines, or other substance

 

Mental status exam:

Appearance: Disheveled and unkempt, with poor grooming and hygiene. He is tearful and displays minimal eye contact throughout the examination.

Alertness and Orientation: alert, fully oriented to person‚ place‚ time‚ and situation,

Behavior: Agitated and restless, with frequent pacing and hand-wringing. He appears preoccupied and distracted, often losing his train of thought mid-sentence.

Speech: Rapid and pressured exhibiting tangentiality

Mood: Depressed. He describes his mood as “the lowest I’ve ever felt” and reports feeling overwhelmed by emotional pain.

Affect: labile, fluctuating between tearfulness and irritability. He exhibits a flat affect at times, with limited emotional expression.

 

Solution

Chlordiazepoxide:

Medication Class: Benzodiazepine.
Mechanism of Action: Chlordiazepoxide acts by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the activity of neurons. This leads to CNS depression, resulting in anxiolytic, sedative, hypnotic, and muscle-relaxant effects.
Prescription:

Chlordiazepoxide 10 mg
Take 1 tablet by mouth three times daily as needed for anxiety and agitation
Dispense: 30 tablets
Refills: 0
Rationale: Chlordiazepoxide can be prescribed to manage TJ’s symptoms of agitation and restlessness, providing short-term relief while awaiting the therapeutic effects of antidepressants. Benzodiazepines are effective in reducing anxiety and agitation associated with depression and can help stabilize mood in the acute phase of treatment. (Feinberg et al., 2017).

Side Effects:

Sedation
Dizziness…………………..original solution for $10 only