NURS629- Advanced Psychopharmacology Essay

NURS629- Advanced Psychopharmacology

Case Study #4 Anxiety Disorders

• Indicate your answer to the following case presentations-
• THERE IS ONLY ONE ANSWER FOR EACH QUESTION
• Defend your answer following each question. The defense should be a SHORT response to support your answer choice, nothing beyond a few sentences.
• Cite the text at the bottom of this assignment- there is no need to repeat citations for every defense if you’re only using Stahl’s as your reference.
• If you choose to cite any additional resources beyond the text, include it with the respective question NURS629- Advanced Psychopharmacology Essay

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Patient #1

1. Sandra Rodriguez is 34-year-old woman with a psychiatric history of posttraumatic stress disorder (PTSD). Sandra has been prescribed first line oral medications (SSRs and SNRIs) in the past, which were minimally effective. The PMHNP astutely referred Sandra to a therapist for exposure therapy (a form of Cognitive Behavior Therapy), and she has had partial success (a slight decrease in her symptoms). The PMHNP is considering an adjunct oral medication to reduce or suppress the stressful or fearful experience associated with the remembered stimulus. The PMHNP decides to prescribe an agent d-cycloserine because it has been shown to: NURS629- Advanced Psychopharmacology Essay

A. Increase glutamate neurotransmission during fear conditioning
B. Decrease glutamate neurotransmission during fear conditioning
C. Increase glutamate neurotransmission during fear extinction
D. Decrease glutamate neurotransmission during fear extinction

Defense:

Patient #2

2. Sally Silverstein is a 31-year-old female assault victim is brought to the ER after tracking down passersby for help. She appears traumatized from the incident. Which of the following agents will the PMHNP consider as a potential preemptive treatment to the development of PTSD? NURS629- Advanced Psychopharmacology Essay

A. N-methyl-D-aspartate (NMDA) agonist such as D-cycloserine
B. Alpha 2 delta ligand such as pregabalin
C. Beta adrenergic blocker such as propranolol
D. Benzodiazepine such as diazepam NURS629- Advanced Psychopharmacology Essay

Defense:

Patient #3

3. Ryan Tauro is a 38-year-old male with a history of treatment-resistant PTSD. He experienced improvement of his symptoms on the following oral medications: quetiapine 300 mg/day, duloxetine 90 mg/day, and zolpidem 10 mg at bedtime. However, at one of his psychiatric follow-up visits, he complained of ongoing nightmares and difficulty staying asleep. The PMHNP initiated Ryan on prazosin 3 mg at bedtime. At his follow-up visit he reported having relief from the nightmares but he experienced intolerable dizziness throughout the day, prazosin was discontinued by the PMHNP. Ryan has returned to the clinic with complaints of worsening nightmares. Should the PMHNP restart the patient on prazosin? If so, at what dose? NURS629- Advanced Psychopharmacology Essay

A. Yes; dose should be restarted at 1 mg at bedtime
B. Yes; dose should be restarted at 3 mg at bedtime
C. No; prazosin is contraindicated with quetiapine
D. No; prazosin should not be reattempted in patients with previous intolerability

Defense:

Patient #4 NURS629- Advanced Psychopharmacology Essay

4. Tammy Waldman is a 46-year-old female patient who has been experiencing several anxiety-based symptoms for many years. She was previously diagnosed with generalized anxiety disorder. She now presents with difficulty concentrating in addition to difficulty falling asleep. Her family has recently told her that she seems to be displaying heightened anger responses toward them over minor details. Oftentimes she will cry for extended periods of time and become irritable and distant. If this patient were to continue to experience chronic stressful reactions to stimuli, the PMHNP may consider prescribing an SSRI because these agents can potentially: NURS629- Advanced Psychopharmacology Essay

A. Increase hippocampal volume
B. Reduce brain-derived neurotrophic factor (BDNF) production
C. Decrease hippocampal volume
D. Increase brain-derived neurotrophic factor (BDNF) production
E. A & B
F. C & D
G. A & D

Defense: NURS629- Advanced Psychopharmacology Essay