Case Study: CNS Prescriber Drug Therapy Plan for Depression
Case Study: CNS Prescriber Drug Therapy Plan for Depression
Read the case study below and create a CNS Prescriber Care drug therapy plan for the patient with Depression.
The patient presents to the clinic today for an annual checkup.
Complaint: fatigue
History: Angela is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty.
Assessment: At her annual medical checkup appointment, she reports feeling tired all of the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She denied that she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children. She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life: My husband and kids would go on fine if I died and probably would not miss me that much. The CNS asks Angela to fill out a Becks Depression Scale, which indicates that she has moderate depression.
Answer the following questions related to this case study. Cite at least 3 current, peer-reviewed, scholarly sources in your answers and include a reference list. Cite at least one drug information resource (i.e., UpToDate, Micromedex, Lexicomp).
1. What classes of drugs are used in the management of depression? .
2. What would be the initial pharmacotherapy management plan for the patients depression?
3. What are the monitoring parameters for a patient receiving an antidepressant?
4. At the follow-up visit the patient reports no improvement in symptoms and states she stopped taking the citalopram (Celexa) because it wasnt working. What additional information does the patient need regarding the achievement of results from an SSRI?
5. The patient complains of morning nausea and vertigo while taking citalopram. What would be another pharmacotherapy treatment option?
6. How soon should the patient return to the clinic after the change in medication for follow-up of drug effectiveness?
7. After taking 2 weeks of escitalopram (Lexapro), Angela returns to the clinic for a follow-up visit. She states that she does not feel much different but may be less tired. She reports that the nausea and vertigo she experienced with citalopram has not occurred with escitalopram. What would be the next step in treatment?
8. At what point should the provider consider tapering Angela off the SSRI therapy?
9. Prepare a CNS Prescriber Drug Therapy Plan for the patient in this case study. See attached tool for completion.
NUR 53203 Advanced Pharmacology
Module 4 Case Study: CNS Prescriber Drug Therapy Plan
Grading Tool
Case Study Questions Possible Points Actual Points
Provides accurate and comprehensive answers to the following questions:
1. What classes of drugs are used in the management of depression? 5 2. What would be the initial pharmacotherapy management plan for the patients depression? 10 3. What are the monitoring parameters for a patient receiving an antidepressant? 10 4. What additional information does the patient need regarding the achievement of results from an SSRI? 10 5. What would be another pharmacotherapy treatment option? 10 6. How soon should the patient return to the clinic after the change in medication for follow-up of drug effectiveness? 10 7. After taking 2 weeks of escitalopram (Lexapro), Angela returns to the clinic for a follow-up visit. She states that she does not feel much different but may be less tired. She reports that the nausea and vertigo she experienced with citalopram has not occurred with escitalopram. What would be the next step in treatment? 10 8. At what point should the provider consider tapering Angela off the SSRI therapy? 10 Provides accurate, consistent, and comprehensive answers for completion of the CNS Prescriber Drug Therapy Plan
9. Prepares CNS Prescriber Drug Therapy Plan for the patient in this case study. 15 Other
7. Correct use of APA, grammar, spelling, and sentence construction. 3 8. Smooth writing with logical flow of ideas. 2 9. Cites a minimum of three current, peer-reviewed, scholarly sources and drug information resources to support responses to questions. Provides a Reference List. 5 TOTAL POINTS 100
CNS PRESCRIBER DRUG THERAPY PLAN
Note: The CNS Prescribers Drug Therapy Plan is designed to represent the long-term treatment plan for the patient.
Patients Name: Click or tap here to enter text._________________________________________ Date of Plan: Click or tap to enter a date.Assessment
The Assessment should represent a brief narrative which will usually includes pertinent information such as:
Chief Complaint
History of Present Illness
Medical History
Current Mental Status
Major Changes in Patient Functioning
Major Changes in Prescription
Purpose & Rationale for the Proposed Treatment Plan
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Diagnosis
Please use formal diagnostic categories from DSM-5, or current edition. Clinical Diagnosis(es):
1. Click or tap here to enter text.2. Click or tap here to enter text.General Medical Conditions:
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Drug Therapy Options
Compare and contrast two different options for treatment of the patient.
Option A: Click or tap here to enter text.Option B:Click or tap here to enter text.Mechanism of Action
Provide a short summary Click or tap here to enter text.
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Efficacy
Consider: evidence, therapeutic benefits (e.g. cure rate, lab values), current literature, guidelines
(cite references)
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Additional Considerations
Consider patient values/preferences and patient specific factors that can affect therapy choice (benefits, consequences)
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Safety
Consider: contraindications, risk & frequency of relevant adverse effects, interactions, etc.
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Adherence
Consider: cost, coverage, convenience/complexity, etc.
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Summary
Overall recommendation in this patient.
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Plan: Medications
List medications being prescribed as part of this treatment plan.
MED #1: Click or tap here to enter text.CURRENT PRESCRIPTION: Click or tap here to enter text.DOSAGE/FREQUENCY/ROUTE: Click or tap here to enter text.Clinical Outcomes: List primary clinical outcomes which will serve as indicators of effectiveness: Click or tap here to enter text.Titration/Change Plan: Describe proposed changes (e.g., titration, d/c, addition, etc.) in the use of this medication, including criteria for change:Click or tap here to enter text.MED #2: Click or tap here to enter text.CURRENT PRESCRIPTION: Click or tap here to enter text.DOSAGE/FREQUENCY/ROUTE: Click or tap here to enter text.Clinical Outcomes: List primary clinical outcomes which will serve as indicators of effectiveness:Click or tap here to enter text.Titration/Change Plan: Describe proposed changes (e.g., titration, d/c, addition, etc.) in the use of this medication, including criteria for change: Click or tap here to enter text.Adverse Effects
List most common adverse effects which will be monitored for each medication:
Medications Adverse Effects
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Proposed Monitoring for Pharmacotherapy Plan
Please note your recommended plan for monitoring patient progress (clinical outcomes, adverse drug reactions, labs and testing) and frequency for follow-up with provider (who, when, and how) Click or tap here to enter text.
Laboratory Studies & Clinical Assessments
Check the appropriate studies and indicate frequency of examination. List any additional assessments or laboratory studies which you plan to monitor on a regular basis.
Type of Test Frequency Type of Test Frequency
Electrolytes
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CBZ Level
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BUN/CR
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VPA Level
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Liver Panel
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TSH
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EKG
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TFTs
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Weight
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CBC
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Glucose
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AIMS
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Lithium Level
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EPS
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Lipids
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Other:
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Other:
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Other:
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NOTES:
