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L.B. is a 55-year-old white female who presents to her family physician’s office for a yearly routine physical. Her husband passed away 5 months ago after a 2-year battle with lung cancer. She has three children, two of whom are still in college. Her daughter accompanies her to the doctor’s office and says she is concerned about her mother’s recent behavior. She explains that her mother has been “sleeping all the time” and has lost 25 lb in the past 2 months without being on a diet. When the doctor examines L.B., she explains that she has become increasingly fatigued and complains of a lack of energy. She no longer has any desire to participate in her lifelong hobbies of painting and photography because of frequent feelings of sadness. L.B.’s medical history is significant for hypothyroidism, hypercholesterolemia, and recently diagnosed hypertension. Her medications are levothyroxine 0.075 mg daily, simvastatin 20 mg daily, hydrochlorothiazide 25 mg daily, lisinopril 10 mg daily, multivitamins 1 tab daily, and aspirin 81 mg daily. In the office today, L.B.’s blood pressure is 138/88 mm Hg.
Diagnosis: Major Depression
1. List specific goals for treatment for L.B.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for L.B.?
8. What lifestyle changes would you recommend to L.B.?
9. Describe one or two drug–drug or drug–food interaction for the selected agent.
Virginia Poole Arcangelo, Andrew M. Peterson, Veronica Wilbur, & Jennifer A. Reinhold. (2017). Pharmacotherapeutics for Advanced Practice : A Practical Approach: Vol. 4th edition. Wolters Kluwer Health.
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