NURS 6670 Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression

Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression

Answer: Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression

Mr. Henderson is being seen for depression of 15 months’ duration, recurrent type with considerable weight loss (30 pounds). He has hypertension, atrial fibrillation, osteoarthritis and hypothyroidism. His energy level is very low now and he complains of feeling persistently sad and hopeless. He is on a warfarin for atrial fibrillation. The nurse practitioner may consider prescribing an SSRI that does not need interaction with this medication.

Mr. Henderson needs an antidepressant that is not metabolized via cytochrome P450 3A4. SSRIs that share this feature include escitalopram, paroxetine, and sertraline.

When considering whether or not to prescribe an SSRI for Mr. Henderson, it’s best to avoid medications that may cause blood clotting.

The SSRI escitalopram (Lexapro) does not cause drowsiness, and will also help with your insomnia. The other SSRI’s may cause sleepiness and drowsiness, as does the SNRI venlafaxine (Effexor). The experimental drug trazodone can cause drowsiness and difficulty with thinking, although Mr. Henderson is already taking a medication that interacts with it. Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression

Sertraline is a popular drug for major depression, but it is also an interesting case study for drug interactions. While it is metabolized primarily by the hepatic cytochrome P450 2D6 (CYP2D6) enzyme system, it can cause potent inhibition of some CYP450 enzymes, including CYP1A2, 2C9, 2C19 and 2E1. Other SSRIs also have been known to have similar effects; taking these drugs together could result in potentially dangerous drug interactions and side effects. Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression

Celexa is plenty safe with your other medications. It is one of the SSRIs that does not cause CNS side effects.

Selective serotonin reuptake inhibitors (SSRIs) is a class of antidepressants that act on the central nervous system by inhibiting the reuptake of serotonin, an effect which increases the level of serotonin available in the synaptic cleft. SSRIs are different from traditional antidepressants such as tricyclics or monoamine oxidase inhibitors that primarily target norepinephrine and dopamine transporters. As a result, SSRIs commonly used to treat depression, notably escitalopram, fluoxetine, paroxetine, and sertraline. The most common side effects of SSRIs include nausea, diarrhea, sexual dysfunction (including anorgasmia), insomnia and anxiety. However certain SSRIs have been found to be well-tolerated and effective in the elderly patients with major depressive disorder. Additional advantages may be better tolerated compared to other classes of antidepressants particularly in terms of lowering suicide risk

Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression

Celexa (citalopram) is the best SSRI to use with the liver and blood thinners.

You can compare all medication safety rating side ­by-side, including stopping or starting a drug, in the My Medicine Safety App. To access this feature within the app, tap on the “Medication” tab, then tap on the drug name. Tap on the stars if you want to add your own ratings or adjust the default rating. If you would like to print out this information, tap on the three dots next to “Printable Report.” This report shows the medications that are considered safe together with those that should not be taken together. The report also shows whether there is any research supporting that a specific medication should not be used when another medication is being used.

Question:

Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression. His wife died 6 months ago following a difficult 2 years with breast cancer. His primary complaint is that he just does not look forward to anything anymore. He cannot get interested in his children and grandchildren, he no longer enjoys any of his hobbies because he and his wife used to do them together. He does not sleep well, and wakes up frequently during the night. He also admits to thinking more and more about dying himself, although he expressly denies suicidal ideation. His medical history is significant for coronary artery disease, osteoarthritis, hypothyroidism, hypertension, and dyslipidemia. He also has atrial fibrillation and is on warfarin for emboli prophylaxis, but he does not remember the names of all of his other medications. When considering pharmacotherapy for Mr. Henderson, the PMHNP considers that which of the following SSRIs is safest with respect for potential drug interactions?

 

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