Chemistry

The Impact of Ethnicity on Antidepressant Therapy

Patient Questioning

The first question; when do you feel the depression is under control? The problem is essential to establish the patient’s reason for discontinuing their medication. The second question; do you ever feel forced to take your medication? While it is inconvenient for most people to take drugs, this question explores appropriate ways to ensure the patient maintains their medical regimen and does not feel compelled to take the medication.

Patient Family

Since the patient is married, his wife will be quizzed. The first question will ask whether the patient’s wife’s notable side effects of the medication. The second question will focus on whether the wife knows the medicine her husband is taking. The first question seeks to identify the side effects of the need to address them while the second question tries to discuss the importance of family support.

Physical Examination and Diagnostics

The patient’s appearance and effect will form part of the physical examination. Therefore, grooming, hygiene, and weight will be keenly observed, given the detrimental effects of depression on the three aspects. Psychomotor retardation and slow reactivity may compound the patient’s affect (Howland, 2008). Slow and monotonic speech devoid of content is observed as well. Diagnostic tests include dexamethasone suppression test, notable for depression, electrolyte tests, and complete blood count for ruling out physical conditions, such anemia.

Differential Diagnosis

Hypothyroidism is the most likely condition. The patient reveals memory lapses notable when he forgets to take his medication. Secondly, patient repetitive manic-depressive episodes, which characterize hypothyroidism (Howland, 2008). Other differential diagnoses include manic depressive episodes and hypochondria. The two conditions are notable when the patient worries about death, his mortality after the end of his mother, and elongated repetitive events.

Drug Selection

Two of the antidepressants useful for the patient’s condition based on the pharmacodynamics and pharmacokinetics are the Seroquel and Buspirone. Seroquel is particularly crucial for treating major depressive disorder due to its effectiveness at low dosages of 50mg a day for ten days. Buspirone dosage includes 60mg a day taken twice for ten days. Both drugs act on the numerous receptors in the brain, thus eliminating psychotic thoughts (Stahl, 2013). The patient’s anxiety and sleep problems make the drug necessary. Seroquel is a better option based on its mechanism of action. For instance, its rapid dissociation from D2 receptors enhances its activity on receptor occupancy and further entrenches antipsychotic effects (Yasuda, Zhang, and Huang, 2008). Buspirone has a slow dissociation and requires more dosage, hence less preferable.

Contraindications

Buspirone and Seroquel do not have specific contraindications associated with race. However, anaphylactic reactions are common among patients treated using Seroquel. As a result, Seroquel is not recommended to people with hypersensitivity to quetiapine (Stahl, 2013). Mostly, all patients with conditions, such as low mineral content, obesity, anemia, and tardive dyskinesia, should not use this drug.

Checkpoints

A critical checkpoint concerns a patient making a follow up after four weeks to assess incidences of hypertension and any improvement in the noted symptoms due to Seroquel treatment. According to Stahl (2013), blood pressure is a common symptom associated with Seroquel. Secondly, the follow up will also focus on checking fasting plasma glucose, usually after three months. The patient should also check whether he has added weight.

Lessons Learnt

While the first case did not reveal medications with racial contraindications, I still learned that ethnicity could contribute to either the inefficiency or efficiency of the drug response. The racial ability of a drug is an essential aspect for a nurse practitioner regarding consideration of the risk-benefit ration of drug therapy (Yasuda, Zhang, and Huang, 2008). Essentially, since significant depression is a chronic condition, and it is essential to inform patients about the likelihood of staying on anti-depressive drugs for the rest of their lives.

1. What ideas, research or experiences can you share to tune the treatment plan for clients?

2. Do you believe there needs to be a trial period as we know many meds can take weeks to actually reach a balance that seems effective.

3. How did the posts influenced your understanding, be sure to share how and why. Include additional insights you gained. 1 page

Case 2

The client is a 60 year old man with chief complaint of being unstable. Client states that he has been alternating between a mixed dysphoric and depressed state over the last year with the majority being mixed dysphoric and can wax and wane every few days or even hours. Client has diagnosed of general anxiety, separation anxiety, OCD with ruminations, and major depression. Client psych history indicates suicidal ideations and attempts with overdosing. Also complains of irritability, inflated self esteem, goal oriented, decreased sleep needs overly talkative, racing thoughts, risky behavior, euphoria, and psychomotor agitation. Client has been married and divorced three times with depression episodes after each divorce. Client has a strong maternal history of depression, bipolar, and manic depression in his family. Client has been on multiple medication regimens and has not been compliant with treatment. No children, no drug use, no smoking, and rarely drinks. Client has been diagnosed with Crohn’s disease and currently on azothiaprine and remicaid for treatment. Client, who is a physician, has also prescribed himself Ritalin.

What Questions will you ask the Client

What Physical Exam/Tests needed to be done

Differential Diagnoses

Pharmacologic Agents and Dosage/Contraindications

Ethnicity and Bipolar

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