Assignment: MAOIs and Ethnicities

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Assignment: MAOIs and Ethnicities

Assignment: MAOIs and Ethnicities

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With many MAOIs, hypertensive crisis is a major concern for nay race. Since minorities are diagnosed with hypertension at higher rates, this causes a greater concern. This is the reason for a tyramine restricted diet.  Foods such as aged chees, yeast and tap beer should be avoided ()

Changes in Therapy

After review of further data with this patient, changes would not be made to the suggested treatment.

Lessons Learned

Throughout this case study many lessons were present.  The lesson of medication compliance was the first lesson learned. Another lesson learned was the lesson of proper medication selection in a patient, especially after a recurrent episode of depression.  Assessment and presentation of psychiatric treatment for patients was another lesson learned from this case study.

Conclusion

In conclusion, this case study involved a 63-year-old male with recurrent depression. The patient has had success and failures with medication and treatment. These failures may be due to medication compliance or improper cessation of medications from a physician. After two years, the patient is finally on the right track. Hopefully, this will continue.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Drugs.com. (2018).  Isocarboxazid. Retrieved from http:/ ttps://www.drugs.com/pro/marplan.html

Serra, F., Spoto, A., Ghisi, M., & Vidotto, G. (2015). Formal Psychological Assessment in Evaluating Depression: A New Methodology to Build Exhaustive and Irredundant Adaptive Questionnaires. PLoS ONE, 10(4), e0122131. http://doi.org/10.1371/journal.pone.0122131

Smith, K. M., Renshaw, P. F., & Bilello, J. (2013). The diagnosis of depression: current and emerging methods. Comprehensive Psychiatry, 54(1), 1–6. http://doi.org/10.1016/j.comppsych.2012.06.006

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved September 11, 2018 from

https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?

Zaninotto, L., Solmi, M., Veronese, N., Guglielmo, R., Ioime, L., Camardese, G., & Serretti, A. (2016). A meta-analysis of cognitive performance in melancholic versus non-melancholic unipolar depression. Journal of affective disorders, 201, 15-24.

POST 2

Three questions that I might ask our patient are:

Tell me when you take your medication? [The reason for this question is to establish his adherence to his medication. Tachyphylaxis aka poop out, may occur due to medication nonadherence. It is therefore important to assess if the client is experiencing tachyphylaxis related to medication nonadherence] (Targum, 2014).
Do you feel a lack of motivation about life? [The Rothschild Scale for Antidepressant Tachyphylaxis suggests a conceptualization of antidepressant tachyphylaxis that is characterized by symptoms of apathy.] (Targum, 2014).
Are you experiencing patterns of sleep disturbance? [This is also a symptom of poop out. It is important to assess these symptoms in order to proceed with his plan of care. Another important question is to assess the client for is substance abuse which was already addressed within the case study.)
According to our case study, our client is a 69-year-old retired male who is married with children and grandchildren. In my opinion, it would be most important to speak to those that are the closest to him (his wife) who can observe him for any signs of activation of bipolar disorder such as: lack of impulse control, irritable and agitated mood lasting longer than a week (Bail, Dains, Flynn, Solomon, & Stewart, 2015). Activation of bipolar disorder would require his antidepressant to be discontinued and switched to a mood stabilizer (Stahl, 2013).

Physical exams and diagnostic tests relevant to our client’s care would be testing his blood pressure before/during initiating treatment and testing for plasma levels of O-desmethylvenlafaxine (ODV) which is an active metabolite of venlafaxine formed as a result of CYP450 2D6 (Stahl, 2013). Plasma levels of ODV will determine if the provider may safely increase his dose based on results. It is imperative to assess our client’s blood pressure related to the effects of the norepinephrine in the SNRI. Based on the check points for his first follow up, I would have changed his phone follow up to a face to face follow up to assess our client better and would have ordered his plasma ODV sooner to properly assess the effectiveness of his medication therapy.

According to the American Psychiatric Association (2013), three differential diagnoses that I am giving our client are: 1. mood disorder due to another medical condition 2. Sadness 3. Adjustment disorder with depressed mood. The one that I think is more likely is sadness. My thought is sadness because our client’s history from the case study reveals a long, waxing and waning major depressive episode where he feels like he is out of options (Stahl, 2013).

Assignment: MAOIs and Ethnicities

Assignment: MAOIs and Ethnicities

Two pharmacologic agents that would be appropriate for our client’s therapy would be Mirtazapine 15 mg PO nightly or Bupropion 75 mg PO BID. Bupropion is an NDRI which is a good augmenting combination with Venlafaxine. It is a powerful enhancer of noradrenergic action. Mirtazapine is a dual serotonin and norepinephrine combination which also works well with Venlafaxine but it may further increase his high cholesterol; for this reason, I would choose the Bupropion.

Lessons that I learned from this case study are certain drugs may not be as effective due to noncompliance, pharmacokinetic failures or even genetic variants. I have also learned the seriousness of how severe depression can be and the importance of knowing not necessarily all of the drugs out on the market for depression but more so the pharmacokinetics and pharmacodynamics of how they work.

Leonie

Reference

Targum, S. D. (2014). Identification and treatment of antidepressant tachyphylaxis. Innovations in Clinical Neuroscience, 11(24), 3-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008298/

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to     physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Retrieved from Walden Library databases.

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