03 Jan “My husband and kids

NSG6005 Advanced Pharmacology

Week 9 Discussion

Discussion:

Angela is a 54-year-old married woman with three adult children. She has been the officemanager of a small law firm for 20 years and has enjoyed her work until this past year. She hasrheumatoid arthritis with minimal impairment that has been managed well with NSAIDs. She hasbeen taking conjugated estrogens for 8 years and decided to stop taking them because of herconcern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty.

Assessment:

At her annual medical checkup appointment, she told her primary care provider that she seemedto be tired all the time, and she was gaining weight because she had no interest in her usualexercise activities and had been overeating, not from appetite but out of boredom. She deniedthat she and her husband have had marital difficulties beyond the ordinary and she was pleasedwith the achievements of her children. She noticed that she has difficulty falling asleep at nightand awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep eventhough she still feels tired. She finds little joy in her life but cannot pinpoint any particularconcern. 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 wouldn’t miss me that much.”

The primary care provider asks Angela to fill out a Beck’s Depression Scale, whichindicated she has moderate depression.

1. What medication would you first prescribe to this patient?

2. She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?

3. What are the possible problems with the medication you prescribed?

4. How long should you continue the treatment regimen?