NR508 Week 4 Discussions Latest

Discussion Part One (graded)

Barbara is a married 39-year-old woman with no children, smokes 1 pack/day, and weighs 180 pounds who has scheduled an appointment with you to discuss feelings of anhedonia that she has been experiencing for the past few months. She has a history of depression as a teenager, but has not needed or received therapy for ~20 years. At the appointment, she relays that she has been experiencing chronic fatigue/loss of energy, feelings of worthlessness, appetite disturbances, weight gain, inability to concentrate, psychomotor disturbances, and insomnia.

Please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
Once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.

Discussion Part Two (graded)

Monitoring for efficacy and toxicity of the current drug regimen you prescribed in Part One

Subsequent steps if this patient did not have an adequate response?

Assume you had her on a common, selective serotonin reuptake inhibitor for several months without great response. Explain why the SSRI should be slowly discontinued prior to starting bupropion in Part Three.

Discussion Part Three

You decide to begin the patient on bupropion.

At what dose should she be started on bupropion, and how does bupropion differ from other commonly prescribed antidepressants, such as fluoxetine, venlafaxine, and nortriptyline?
Why would this be the best option for this patient given her symptoms and lifestyle? In your answer, be sure to compare and contrast bupropion with each medication mentioned above (fluoxetine, venlafaxine, and nortriptyline).

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NR508 Week 5 Discussions Latest

Discussion Part One (graded)

Leroy is a 70 year-old-man, whose wife passed away 5 years ago, and whose 2 children live out-of–state. His neighbor caretaker (Ms. Webb, a middle-aged retired CNA, whom his children hired to provide home care to him 3x/week) brings him to your clinic. He presents with quite severe confusion, incidentally to very minor changes in his environment, which provokes some violence (a symptom which startles Ms. Webb), increasingly impaired judgment, and increasing repetitiousness and inconsistencies in his usual behavior. Upon initial work-up and physical exam, you notice an increased respiratory rate, a slight fever (100°F), and cost vertebral angle tenderness on his right side.

Discussion Part Two (graded)

The patient is diagnosed with a severe urinary tract infection (pyelonephritis), and you decide to prescribe him sulfamethoxazole/trimethoprim (SMX/TMP) beginning with 2 g initially as a loading dose, followed by 1 g as a maintenance dose BID. Over the next couple of weeks, the symptoms associated with his UTI diminish, and his mental status improves. However, Ms. Webb brings him back to your clinic with symptoms, which scare her yet again, and she explains that she thinks he may have a relapse of his UTI. These symptoms include a high fever (103.6°F) and tachypnea, and upon pulmonary examination at your clinic, you hear crackles, and find classic findings of lung consolidation.

What laboratory tests should you order, and what is your primary diagnosis at this point and subsequent steps in his treatment and management?
Once explained, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.

Discussion Part Three

Upon receipt of laboratory results, you notice that his eGFR is ~40mL/min, his serum creatinine is 3.0 mg/dl, and his BUN is 50 mg/dl.

How will the medication regimen(s) have to be adjusted given these new laboratory findings, and how should you be monitoring for efficacy and toxicity of this patient’s pharmacological profile with a summary of where this patient currently stands in his medical treatment?