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I need 2 separate discussion responses to the following topic Side effects are a

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I need 2 separate discussion responses to the following topic
Side effects are a common reason that patients discontinue medications. List one common side effect for each medication and one potential way to manage it.
Amitriptyline:
Side Effect, Sedation
Management, Take it at bedtime.
Bupropion:
Side Effect, Insomnia
Management, Take earlier in the day
Fluoxetine:
Side Effect, Gastrointestinal
Management, Wait to see if tolerable, slow half-life (Heldt, 2020)
Paroxetine:
Side Effect, Sexual dysfunction
Management, reduce the dose or switch medication in a few weeks.
Some potential side effects from antidepressants can be serious; what is the difference between neuroleptic malignant syndrome (NMS) and serotonin syndrome? How are they treated?
Serotonin syndrome RASCAL vs NMS FEVERLAD acronym (Deranged, 2018),
· Rhabdomyolysis
· Agitation / hypervigilance
· Seizures
· Clonus
· Autonomic overdrive – tachycardia, hypertension
· Large pupils – mydriasis
· hyperreflexia
· hyperthermia
· Fever
· Encephalopathy
· Vitals unstable – hyper or hypotension, brady or tachycardia
· Elevated enzymes – CK
· Rigidity of the muscles, hypertonia
· Leukocytosis
· Acidosis
· Diaphoresis
The treatment for serotonin syndrome and NMS would be to reduce or stop the medication depending on severity. In treating both conditions would depend on the symptoms, such as a muscle relaxer for muscle rigidity, as well as IV fluids and oxygen if needed. For a patient with NMS that has a fever, you give antipyretics and plenty of fluids. There may be a need to be on a ventilator if needed, as well as cooling the body with ice packs with NMS. If NMS was drug-related dantrolene or Bromocriptine may be given, these medications are used with Parkinson’s patients.
Are any antidepressants preferred in postpartum depression?
Sertraline is approved for postpartum depression, is safe to start on a low dose then titrate up if needed, but you need to monitor the baby for symptoms such as irritability and poor feeding, especially if the baby was born prematurely always start at the lowest effective dose (Cuomo, 2018).
Which class of antidepressants (if any) are generally recommended to be used in geriatrics?
In my clinical practice as an FNP, I have seen the geriatric population use many SSRI. In my research, I have learned that Citalopram and Escitalopram may widen the QRS intervals in which you may want to stay away from an elderly patient that has cardiac issues. I have seen many take amitriptyline to help them with sleep and pain. I have learned it can cause falls and orthostatic hypotension, so nortriptyline may be a better alternative. In my opinion, you can use many of the SSRI, SNRI, TCA, but it needs to be closely monitored with their PCP. I would be concerned with prescribing a patient an MAOI, due to the many drug interactions it may have. In the geriatric population, you may see a lot of polypharmacy, in which doing medication interaction check and precautions would be wise.
Review prescribing guidelines for benzodiazepines for anxiety in your state. Are there any limitations for APRNs to prescribe? How do the numbers of scripts written by APRN’s compare to those of physicians?
In the state of Nevada, the prescribing guidelines for a new Nurse Practioner are that a supervising physician is needed for the first 2 years or 2000 hrs. A controlled substance protocol agreement is needed between the mid-level and physician or business entity. The prescriptions of benzos and opiates are far more with a physician compared to an FNP. In my current practice, if we see a patient that needs more attention to their acute or chronic condition for example pain, I would refer that patient to a pain management doctor so the patient could be properly treated with a specialist. There may be something in my treatment that I may not be an expert in, in which a specialist can give the proper recommendations as well as knowing the right time to wean the patient off benzos or opiates.
Cuomo, A., Maina, G., Neal, S. M., Montis, G. D., Rosso, G., Scheggi, S., . . . Fagiolini, A. (2018). Using sertraline in postpartum and breastfeeding: Balancing risks and benefits. Expert Opinion on Drug Safety, 17(7), 719-725. doi:10.1080/14740338.2018.1491546
Deranged. (2018). Serotonin syndrome and neuroleptic malignant syndrome: Deranged Physiology. Retrieved November 22, 2020, from https://derangedphysiology.com/main/required-reading/pharmacology-and-toxicology/Chapter 5.3.2/serotonin-syndrome-and-neuroleptic-malignant-syndrome
Heldt, J., & E., J. (2020). Memorable Psychiatry. Retrieved November 22, 2020, from https://b-ok.cc/book/5513359/f980c2?dsource=recommend (Links to an external site.)

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