NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology

NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
Sample Answer for NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology Included After Question
Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.
To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.

The Assignment: 5 pages
Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
A Sample Answer For the Assignment: NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
Title:  NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
The DSM V describes Bipolar disorder as a group of mental disorders that result in extreme fluctuation in an individual’s mood, energy, and functioning. Bipolar disorder presents with intervals of deep, prolonged, and profound depression that alternate with intervals of mania characterized by an excessively elevated or irritable mood (APA, 2013). A manic episode represents a significant change from usual behavior. It manifests with at least three of the following symptoms: Inflated self-esteem or grandiosity, increased talkativeness, decreased need for sleep, racing thoughts, easy distraction, increase in goal-directed activity, and engaging in activities that have negative consequences (APA, 2013). This paper seeks to review a client with Bipolar disorder and outline the client’s treatment plan using a decision tree.  
Case Study Overview 
The case scenario depicts a 26-year-old woman of Korean descent on her first appointment after a 21-day hospitalization for acute mania. The client has been diagnosed with bipolar I disorder. Her current weight is 110 pounds, and her height is 5’ 5. She describes her mood as fantastic and mentions that she sleeps roughly 5 hours/night, but she hates sleep because it is not fun (Laureate Education, 2016). The client’s patient records show that she is in overall good health and her lab results are within normal limits. However, genetic testing shows that she is positive for the CYP2D6*10 allele. The client admits that she stopped taking Lithium after being discharged two weeks ago. On MSE, the client is alert and oriented to person, place, time, and event. Her dressing is odd, and her speech is rapid, pressured, and tangential. Her self-reported mood is euthymic, and her affect is broad. She denies visual or auditory hallucinations, and she has no overt delusional or paranoid thought processes readily apparent (Laureate Education, 2016). Her insight is impaired, but she denies suicidal or homicidal ideation. She scores 22 on the Young Mania Rating Scale (YMRS). 
Decision Point One 
Begin Lithium 300 mg orally BID. 
Why I Selected This Decision 
Lithium is a mood stabilizer recommended for treating Mania in Bipolar disorder and maintenance therapy of bipolar disorder in persons with a history of mania. I selected Lithium because it targets unstable mood, which is the major symptom of mania (Won & Kim, 2017). Besides, mania is recommended as first-line therapy for long-term prevention of Bipolar disorder, particularly for euphoric mania.  
I did not select Seroquel because it has documented side effects of dry mouth, fatigue, constipation, and dizziness, contributing to decreased medication compliance. Seroquel is also associated with increased appetite and weight and elevated triglycerides and total cholesterol levels (Shah et al., 2017). The side effects make it an inappropriate drug since the client is overweight.  I did not select Risperdal since the patient was positive for the CYP2D6*10 allele. According to Puangpetch et al. (2016), the CYP2D6*10 allele slows the drug’s clearance resulting in high levels of Risperdal in the blood, causing sedation.  
What I Was Hoping To Achieve By Making This Decision 
I hoped that prescribing Lithium would stabilize the patient’s mood and reduce the severity of manic symptoms by at least 50% in the first four weeks of treatment. According to Won and Kim (2017), Lithium exerts mood-stabilizing effects by acting on cellular targets and exerting neuroprotective effects.  
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients 
Ethical principles of nonmaleficence and beneficence may impact the treatment plan as the PMHNP has a duty to prevent harm and promote better patient outcomes. The PMHNP is obliged to assess a drug for its impact and potential side effects before prescribing it to ensure it will promote better outcomes and have no adverse consequences to the patient (Bipeta, 2019). In this case, the PMHNP assessed each drug’s potential side effects and selected the one associated with better outcomes and fewer adverse effects. 
Decision Point Two 
Assess rationale for non-compliance to elicit reason for non-compliance and educate the client on drug effects and pharmacology. 
Why I Selected This Decision 
I selected this decision because the client reported taking the medication “off and on” when she feels that she needs it. The decision aimed at understanding the primary cause for the patient not complying with the medication (Won & Kim, 2017). Besides, educating the patient on the possible side effects and pharmacology of Lithium would enlighten her on the drug’s impact in improving her health outcomes. 
I did not increase Lithium to 450 mg because the non-compliance behavior would persist if the reasons for the behavior were not identified and addressed. Besides, it is crucial that the PMHNP assess a patient’s response to Lithium and associated side effects before increasing the dose (Won & Kim, 2017).  I did not switch treatment to Depakote because the patient’s response to Lithium had not been established. According to Shah et al. (2017), the evidence for Depakote efficacy in acute depression is not as robust as that for Lithium.  
What I Was Hoping To Achieve By Making This Decision 
I was hoping that assessing and eliciting reason for non-compliance would help in identifying a practical solution to increasing compliance and eventually improve the manic symptoms. I was hoping that educating the patient on Lithium’s drug effects and pharmacology would enable her to understand the importance of adhering to treatment and increase her medication compliance.  
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients 
The ethical principle of autonomy, which means that patients have a right to make decisions about their lives without interference from others, may impact the treatment plan. The PMHNP must respect the patient’s decision regarding her care which may impact the treatment interventions (Bipeta, 2019). In this case, the PMHNP had to elicit the rationale for the patient not complying with treatment, which determined the next intervention. 
Decision Point Three 
Change Lithium to sustained release, preparation at the same dose and frequency. 
Why I Selected This Decision 
I changed Lithium to sustained release because the formulation is documented to prevent Lithium’s side effects, such as nausea and diarrhea, which were reported. The sustained release formulation suppresses the side effects while at the same time effecting its mood-stabilizing properties (Girardi et al., 2016).  I did not change therapy to Depakote because it is also associated with similar side effects as Lithium (Shah et al., 2017). Besides, the sustained Lithium formulation is a better option than Depakote. I did not select Trileptal because it is only recommended as a second-line agent in treating Bipolar disorder (Shah et al., 2017). It was not ideal at this step because there had been no adequate trials with Lithium. 
What I Was Hoping To Achieve By Making This Decision 
I hope that the sustained release formulation would alleviate the severity of side effects and that the patient would report fewer side effects. I also hoped that the patient’s treatment compliance would increase, and there would be improved manic symptoms. According to Girardi et al. (2016), Lithium’s sustained formulation has several advantages, including fewer adverse events, consistent serum lithium concentrations, and improved adherence to therapy. 
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients 
The ethical principle of nonmaleficence may impact the treatment plan since the PMHNP may be forced to change treatment based on associated adverse effects to avoid harming the client (Bipeta, 2019).  In this case, the PMHNP changed Lithium from immediate to sustained formulation to reduce the drug’s side effects and improve the patient’s quality of life.  
Conclusion 
The client in the case study was diagnosed with Bipolar 1 Disorder, a manic-depressive disorder that can occur both with and without psychotic episodes.  She presented with manic symptoms, including excessive talking, reduced need for sleep, and distractibility. In the first decision step, I began treatment with Lithium 300 mg BD to target the manic symptoms and stabilize the patient’s mood. However, the drug did not have any impact since the patient was not compliant with treatment. I assessed the rationale for non-compliance to elicit the reason for non-compliance and educate the patient on Lithium effects and pharmacology. This aimed at establishing the causes of non-compliance and increasing the compliance to promote better outcomes.  
The patient was still not compliant with the medication because of its associated side effects of nausea and diarrhea. I changed the Lithium from immediate to sustained-release preparation but at the same dose and frequency to reduce the side effects and increase compliance. Ethical principles that may impact the treatment plan include beneficence, nonmaleficence, and autonomy. In this case, the PMHNP upheld beneficence by selecting the medication associated with the best possible outcomes for patients with Bipolar disorder. Nonmaleficence was upheld by evaluating the medication’s side effects and changing the Lithium formulation due to the associated side effects. Besides, autonomy was promoted by addressing the patient’s concerns on treatment and identifying solutions to address these concerns. 
 
References 
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 
Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19 
Girardi, P., Brugnoli, R., Manfredi, G., & Sani, G. (2016). Lithium in Bipolar Disorder: Optimizing Therapy Using Prolonged-Release Formulations. Drugs in R&D, 16(4), 293–302. https://doi.org/10.1007/s40268-016-0139-7 
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author 
Puangpetch, A., Vanwong, N., Nuntamool, N., Hongkaew, Y., Chamnanphon, M., & Sukasem, C. (2016). CYP2D6 polymorphisms and their influence on risperidone treatment. Pharmacogenomics and personalized medicine, 9, 131–147. https://doi.org/10.2147/PGPM.S107772 
Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian journal of psychiatry, 59(Suppl 1), S51–S66. https://doi.org/10.4103/0019-5545.196974 
Won, E., & Kim, Y. K. (2017). An Oldie but Goodie: Lithium in the Treatment of Bipolar Disorder through Neuroprotective and Neurotrophic Mechanisms. International journal of molecular sciences, 18(12), 2679. https://doi.org/10.3390/ijms18122679 
 
A Sample Answer 2 For the Assignment: NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
Title:  NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
The DSM V describes Bipolar disorder as a group of mental disorders that result in extreme fluctuation in an individual’s mood, energy, and functioning. Bipolar disorder presents with intervals of deep, prolonged, and profound depression that alternate with intervals of mania characterized by an excessively elevated or irritable mood (APA, 2013). A manic episode represents a significant change from usual behavior. It manifests with at least three of the following symptoms: Inflated self-esteem or grandiosity, increased talkativeness, decreased need for sleep, racing thoughts, easy distraction, increase in goal-directed activity, and engaging in activities that have negative consequences (APA, 2013). This paper seeks to review a client with Bipolar disorder and outline the client’s treatment plan using a decision tree.  
Case Study Overview 
The case scenario depicts a 26-year-old woman of Korean descent on her first appointment after a 21-day hospitalization for acute mania. The client has been diagnosed with bipolar I disorder. Her current weight is 110 pounds, and her height is 5’ 5. She describes her mood as fantastic and mentions that she sleeps roughly 5 hours/night, but she hates sleep because it is not fun (Laureate Education, 2016). The client’s patient records show that she is in overall good health and her lab results are within normal limits. However, genetic testing shows that she is positive for the CYP2D6*10 allele. The client admits that she stopped taking Lithium after being discharged two weeks ago. On MSE, the client is alert and oriented to person, place, time, and event. Her dressing is odd, and her speech is rapid, pressured, and tangential. Her self-reported mood is euthymic, and her affect is broad. She denies visual or auditory hallucinations, and she has no overt delusional or paranoid thought processes readily apparent (Laureate Education, 2016). Her insight is impaired, but she denies suicidal or homicidal ideation. She scores 22 on the Young Mania Rating Scale (YMRS). 
Decision Point One 
Begin Lithium 300 mg orally BID. 
Why I Selected This Decision 
Lithium is a mood stabilizer recommended for treating Mania in Bipolar disorder and maintenance therapy of bipolar disorder in persons with a history of mania. I selected Lithium because it targets unstable mood, which is the major symptom of mania (Won & Kim, 2017). Besides, mania is recommended as first-line therapy for long-term prevention of Bipolar disorder, particularly for euphoric mania.  
I did not select Seroquel because it has documented side effects of dry mouth, fatigue, constipation, and dizziness, contributing to decreased medication compliance. Seroquel is also associated with increased appetite and weight and elevated triglycerides and total cholesterol levels (Shah et al., 2017). The side effects make it an inappropriate drug since the client is overweight.  I did not select Risperdal since the patient was positive for the CYP2D6*10 allele. According to Puangpetch et al. (2016), the CYP2D6*10 allele slows the drug’s clearance resulting in high levels of Risperdal in the blood, causing sedation.  
What I Was Hoping To Achieve By Making This Decision 
I hoped that prescribing Lithium would stabilize the patient’s mood and reduce the severity of manic symptoms by at least 50% in the first four weeks of treatment. According to Won and Kim (2017), Lithium exerts mood-stabilizing effects by acting on cellular targets and exerting neuroprotective effects.  
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients 
Ethical principles of nonmaleficence and beneficence may impact the treatment plan as the PMHNP has a duty to prevent harm and promote better patient outcomes. The PMHNP is obliged to assess a drug for its impact and potential side effects before prescribing it to ensure it will promote better outcomes and have no adverse consequences to the patient (Bipeta, 2019). In this case, the PMHNP assessed each drug’s potential side effects and selected the one associated with better outcomes and fewer adverse effects. 
Decision Point Two 
Assess rationale for non-compliance to elicit reason for non-compliance and educate the client on drug effects and pharmacology. 
Why I Selected This Decision 
I selected this decision because the client reported taking the medication “off and on” when she feels that she needs it. The decision aimed at understanding the primary cause for the patient not complying with the medication (Won & Kim, 2017). Besides, educating the patient on the possible side effects and pharmacology of Lithium would enlighten her on the drug’s impact in improving her health outcomes. 
I did not increase Lithium to 450 mg because the non-compliance behavior would persist if the reasons for the behavior were not identified and addressed. Besides, it is crucial that the PMHNP assess a patient’s response to Lithium and associated side effects before increasing the dose (Won & Kim, 2017).  I did not switch treatment to Depakote because the patient’s response to Lithium had not been established. According to Shah et al. (2017), the evidence for Depakote efficacy in acute depression is not as robust as that for Lithium.  
What I Was Hoping To Achieve By Making This Decision 
I was hoping that assessing and eliciting reason for non-compliance would help in identifying a practical solution to increasing compliance and eventually improve the manic symptoms. I was hoping that educating the patient on Lithium’s drug effects and pharmacology would enable her to understand the importance of adhering to treatment and increase her medication compliance.  
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients 
The ethical principle of autonomy, which means that patients have a right to make decisions about their lives without interference from others, may impact the treatment plan. The PMHNP must respect the patient’s decision regarding her care which may impact the treatment interventions (Bipeta, 2019). In this case, the PMHNP had to elicit the rationale for the patient not complying with treatment, which determined the next intervention. 
Decision Point Three 
Change Lithium to sustained release, preparation at the same dose and frequency. 
Why I Selected This Decision 
I changed Lithium to sustained release because the formulation is documented to prevent Lithium’s side effects, such as nausea and diarrhea, which were reported. The sustained release formulation suppresses the side effects while at the same time effecting its mood-stabilizing properties (Girardi et al., 2016).  I did not change therapy to Depakote because it is also associated with similar side effects as Lithium (Shah et al., 2017). Besides, the sustained Lithium formulation is a better option than Depakote. I did not select Trileptal because it is only recommended as a second-line agent in treating Bipolar disorder (Shah et al., 2017). It was not ideal at this step because there had been no adequate trials with Lithium. 
What I Was Hoping To Achieve By Making This Decision 
I hope that the sustained release formulation would alleviate the severity of side effects and that the patient would report fewer side effects. I also hoped that the patient’s treatment compliance would increase, and there would be improved manic symptoms. According to Girardi et al. (2016), Lithium’s sustained formulation has several advantages, including fewer adverse events, consistent serum lithium concentrations, and improved adherence to therapy. 
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients 
The ethical principle of nonmaleficence may impact the treatment plan since the PMHNP may be forced to change treatment based on associated adverse effects to avoid harming the client (Bipeta, 2019).  In this case, the PMHNP changed Lithium from immediate to sustained formulation to reduce the drug’s side effects and improve the patient’s quality of life.  
Conclusion 
The client in the case study was diagnosed with Bipolar 1 Disorder, a manic-depressive disorder that can occur both with and without psychotic episodes.  She presented with manic symptoms, including excessive talking, reduced need for sleep, and distractibility. In the first decision step, I began treatment with Lithium 300 mg BD to target the manic symptoms and stabilize the patient’s mood. However, the drug did not have any impact since the patient was not compliant with treatment. I assessed the rationale for non-compliance to elicit the reason for non-compliance and educate the patient on Lithium effects and pharmacology. This aimed at establishing the causes of non-compliance and increasing the compliance to promote better outcomes.  
The patient was still not compliant with the medication because of its associated side effects of nausea and diarrhea. I changed the Lithium from immediate to sustained-release preparation but at the same dose and frequency to reduce the side effects and increase compliance. Ethical principles that may impact the treatment plan include beneficence, nonmaleficence, and autonomy. In this case, the PMHNP upheld beneficence by selecting the medication associated with the best possible outcomes for patients with Bipolar disorder. Nonmaleficence was upheld by evaluating the medication’s side effects and changing the Lithium formulation due to the associated side effects. Besides, autonomy was promoted by addressing the patient’s concerns on treatment and identifying solutions to address these concerns. 
 
References 
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 
Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19 
Girardi, P., Brugnoli, R., Manfredi, G., & Sani, G. (2016). Lithium in Bipolar Disorder: Optimizing Therapy Using Prolonged-Release Formulations. Drugs in R&D, 16(4), 293–302. https://doi.org/10.1007/s40268-016-0139-7 
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author 
Puangpetch, A., Vanwong, N., Nuntamool, N., Hongkaew, Y., Chamnanphon, M., & Sukasem, C. (2016). CYP2D6 polymorphisms and their influence on risperidone treatment. Pharmacogenomics and personalized medicine, 9, 131–147. https://doi.org/10.2147/PGPM.S107772 
Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian journal of psychiatry, 59(Suppl 1), S51–S66. https://doi.org/10.4103/0019-5545.196974 
Won, E., & Kim, Y. K. (2017). An Oldie but Goodie: Lithium in the Treatment of Bipolar Disorder through Neuroprotective and Neurotrophic Mechanisms. International journal of molecular sciences, 18(12), 2679. https://doi.org/10.3390/ijms18122679 
A Sample Answer 3 For the Assignment: NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
Title: NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
 
Question 1

Martin is a 92-year-old male who presents to the clinic with signs/symptoms consistent with MDD. The patient suffers from glaucoma and just recently underwent surgery for a cataract. Which of the following is the LEAST appropriate course of therapy when treating the MDD?

a.
sertraline

b.
amitriptyline

c.
duloxetine

d.
vilazodone

0 points
Question 2

Mark is a 46-year-old male with treatment-resistant depression. He has tried various medications, including SSRIs, SNRI, and TCAs. You have decided to initiate therapy with phenelzine. Which of the following must the PMHNP take into consideration when initiating therapy with phenelzine?

a.
There is a minimum 7-day washout period when switching from another antidepressant to phenelzine.

b.
Patient must be counseled on dietary restrictions.

c.
MAOIs may be given as an adjunctive therapy with SSRIs.

d.
A & B

e.
All of the above

0 points
Question 3

Earle is an 86-year-old patient who presents to the hospital with a Community Acquired Pneumonia. During stay, you notice that the patient often seems agitated. He suffers from cognitive decline and currently takes no mental health medications. Treatment for the CAP include ceftriaxone and azithromycin. The LEAST appropriate medication to treat Earle’s anxiety is:

a.
sertraline

b.
duloxetine

c.
citalopram

d.
venlafaxine

0 points
Question 4

Richard is a 54-year-old male who suffers from schizophrenia. After exhausting various medication options, you have decided to start him on Clozapine. Which of the statements below is true regarding Clozapine?

a.
Regular blood monitoring must be performed to monitor for neutropenia.

b.
Clozapine can only be filled by a pharmacy that participates in the REMS program.

c.
Bradycardia is a common side effect of Clozapine.

d.
A & B

e.
All of the above

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NURS 6630 Self Assessment Assessing and Treating Patients With Psychopharmacology
Question 5

Sam is a 48-year-old male who presents to the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy?

a.
duloxetine

b.
sertraline

c.
mirtazapine

d.
buproprion

0 points
Question 6

Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?

a.
haloperidol

b.
lorazepam

c.
benztropine

d.
chlorpromazine

0 points
Question 7

Jane is a 17-year-old patient who presents to the office with signs consistent with schizophrenia. She states multiple times that she is concerned about gaining weight, as she has the perfect prom dress picked out and she finally got a date. Which of the following is the least appropriate choice to prescribe Jane?

a.
Aripiprazole

b.
Olanzapine

c.
Haloperidol

d.
Brexpiprazole

0 points
Question 8

Jordyn is a 27-year-old patient who presents to the clinic with GAD. She is 30 weeks pregnant and has been well controlled on a regimen of sertraline 50mg daily. Jordyn says that “about once or twice a week my husband really gets on my nerves and I can’t take it.” She is opposed to having the sertraline dose increased due to the risk of further weight gain. You have decided to prescribe the patient a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepines to prescribe to this patient?

a.
diazepam

b.
alprazolam

c.
clonazepam

d.
lorazepam

0 points
Question 9

Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn’t work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient states, “I can’t even last 1 more day without feeling like my insides are going to explode with anxiety.” The most appropriate course of action would be:

a.
Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect.

b.
Prescribe a short-term course of low dose benzodiazepine, such as alprazolam.

c.
Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine.

d.
Recommend in-patient mental health for the foreseeable future.

0 points
Question 10

Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn’t work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” The best response is:

a.
3 or 4 days

b.
1 or 2 weeks

c.
3 or 4 weeks

d.
10 weeks

0 points
Question 11

Thomas is a 28-year-old male who presents to the clinic with signs and symptoms consistent with MDD. He is concerne