CASESTUDYWEEK7

Instructions

Evaluating and managing the side effects of psychotropics is an important part of prescribing. Some side effects can be safely monitored and managed by a PMHNP. While others may require additional tests, collaboration with primary care providers, or even referrals to specialists. It is key to know which side effects are “ok” to treat and which should really be treated by a different provider. Part of this answer may depend on the state in which you ultimately practice, as what you are allowed to prescribe may vary state by state. 

  For this assignment, you will review the PowerPoint  

·         Evaluating and Managing Side Effects of Psychiatric Medications 

download[PowerPoint]

Locate your assigned case study and answer the questions which correspond to the FIRST letter of your LAST name. The answers to these questions will be located in the PowerPoint, but you will need to do additional research to support your decisions. 

Then you will respond to the main postings of two other learners; at least one response should be to a peer who has answered questions different from yours. 

Recall that your main posting should be submitted by Friday at 11:59 p.m., Eastern time. All responses to other learners’ discussion questions must be submitted no later than Sunday at 11:59 p.m, Eastern time in order to be considered for grading purposes. 

  

If your LAST name begins with the letter A through N, please read the following and address the questions:

·         A 56 yr. old woman signs up with you as his new primary care physician. Her previous diagnosis included hyperlipidemia, hyperglycemia, moderate obesity and hypertension. His medications include: Paroxetine 20 mg for 10 years; Quetiapine 150 mg daily for 2 yrs.; Irbesartan 300 mg daily for 1 yr.; and Atorvastatin 10 mg daily for 1 yr. 

·         Labs: FBS = 126, HgbA1C = 6.2, total cholesterol = 200, LDL = 105, HDL = 35, Tg =286. His present height equal 5’9” and weight = 210 lbs. His BP is 140/84. 

·         She tells you that about 10 yrs. ago she became depressed and was started on Paroxetine and gained 30lbs after 1 yr. Her mood at that time was much improved and remained that way for about 2 yrs. At that time, Quetiapine was added, and she achieved remission of her depression. Six months after this she gained another 20lbs, developed mild hypertension, hyperglycemia and hyperlipidemia. All other lab including thyroid testing was normal. She tells you that she has a craving for carbohydrates and does little exercise since developing depression about 15 yrs. ago. 

  Questions: 

·         What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence. 

·         If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?