NUR 635 Topic 4 DQ 1

Sample Answer for NUR 635 Topic 4 DQ 1 Included After Question

Olivia is a 16-year-old biracial female. She reports feeling down and depressed nearly every day for the past 2 weeks. She has also withdrawn from drama club, an extracurricular activity that she previously enjoyed. She denies any recent losses or being bullied but feels that her ability to concentrate has decreased. Her mother shares that Olivia is spending more time sleeping or napping alone in her room and seems sullen, withdrawn, and irritable when she does interact with family. Olivia’s mother notes that Olivia’s appetite has declined and that Olivia remarks that she is not hungry with most meals. Olivia’s mother tells the provider that Olivia does not seem interested in most of her usual activities or her phone. Olivia comments to the provider that she feels that her family and friends would be better off if she “weren’t around.” She denies thoughts or plans of hurting herself or others. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Using the DSM-5 diagnostics in the topic Resources, determine which symptoms Olivia is displaying that fall under the diagnostic criteria.
  • What class of medication is considered first-line treatment? When should Olivia start seeing benefit from this medication, and when should we see the full effect of the medication? What are the common side effects? What is the black box warning associated with the medication?
  • How would address the following questions with Olivia’s mom: What do we do if there are no improvements after starting treatment? How long do we continue treatment? Address increase of suicide with antidepressants.
  • Olivia’s mother inquires if a natural approach using St. John’s wort is an option. Based on your understanding, address the following: evidence of efficacy and potential drug-drug interactions associated with St. John’s wort.
  • On a mechanism of action perspective, differentiate between fluoxetine, venlafaxine, amitriptyline, phenelzine, bupropion, and trazodone.
  • What are the major symptoms to counsel patient regarding serotonin syndrome? What should the patient do regarding seeking treatment for serotonin syndrome?
  • Do all antidepressants carry the adverse reaction of serotonin syndrome? If the answer is no, identify which medication class does not and explain why.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education 

This assignment aligns to AACN Core Competencies 1.1, 1.2, 1.3, 2.2, 2.4, 2.5, 4.1, 9.2, 9.6

A Sample Answer For the Assignment: NUR 635 Topic 4 DQ 1

Title: NUR 635 Topic 4 DQ 1

Using the DSM-5 diagnostics in the topic Resources, determine which symptoms Olivia is displaying that fall under the diagnostic criteria.

-Depressed Mood: Olivia reports feeling down and depressed nearly every day for the past 2 weeks.

-Anhedonia: She has withdrawn from a previously enjoyed extracurricular activity (drama club) and has lost interest in most of her usual activities.

-Appetite Changes: Olivia’s appetite has declined, and she remarks that she is not hungry with most meals.

-Sleep Disturbances: She is spending more time sleeping or napping alone in her room. Although this can be a bit complex in adolescents since they often have irregular sleep patterns, a significant increase or decrease in sleep can be indicative of MDD.

-Feelings of Worthlessness or Inappropriate Guilt: Olivia comments that she feels her family and friends would be better off if she “weren’t around,” suggesting feelings of worthlessness or guilt.

-Difficulty Concentrating: She reports a decrease in her ability to concentrate, which is one of the cognitive symptoms often seen in MDD.

-Suicidal Ideation: Olivia mentions that she feels her family and friends would be better off if she “weren’t around.” While she denies thoughts or plans of hurting herself or others, this statement suggests passive suicidal ideation.

What class of medication is considered first-line treatment? When should Olivia start seeing benefit from this medication, and when should we see the full effect of the medication? What are the common side effects? What is the black box warning associated with the medication?

-The first-line treatment for Major Depressive Disorder (MDD) typically involves a combination of psychotherapy (talk therapy) and medication. One class of medication often considered first-line for treating MDD is Selective Serotonin Reuptake Inhibitors (SSRIs). An example of an SSRI commonly used is fluoxetine (Prozac).

-Onset of Benefit: Patients often begin to experience some improvement in their symptoms within the first 2 to 4 weeks of treatment, but the full therapeutic effect may take 6 to 8 weeks or even longer to become evident.

-Common Side Effects: Nausea, Diarrhea, Insomnia or drowsiness, Sexual dysfunction, Weight gain or loss, Anxiety or restlessness.

-Black Box Warning: Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults (up to age 24) during the early stages of treatment. This warning emphasizes the importance of closely monitoring individuals in this age group when they start an antidepressant.

How would address the following questions with Olivia’s mom: What do we do if there are no improvements after starting treatment? How long do we continue treatment? Address increase of suicide       with antidepressants.

-It’s crucial to convey to Olivia’s mom that not everyone responds to treatment in the same way or at the same pace. If there are no noticeable improvements after a reasonable period of time, typically 6 to 8 weeks of treatment.

-Treatment continuation: The first step is to schedule a follow-up appointment with Olivia’s healthcare provider. During this appointment, the provider will evaluate Olivia’s progress and may consider adjusting her treatment plan. This could involve changing the medication, increasing the dosage, or exploring other treatment options.

-Suicide Risk: Emphasize the importance of close monitoring of Olivia’s mood and behavior during the initial weeks of treatment. Olivia’s mom should be encouraged to keep a vigilant eye on any changes in Olivia’s emotional state, especially any increase in suicidal thoughts. Encourage Olivia’s mom to have open communication with Olivia about her feelings and thoughts. Encourage Olivia to reach out if she experiences any worsening of her mood or thoughts of self-harm. Ensure that Olivia and her mom are aware of what to do in case of a mental health crisis.

On a mechanism of action perspective, differentiate between fluoxetine, venlafaxine, amitriptyline, phenelzine, bupropion, and trazodone.

Fluoxetine (Prozac) – Selective Serotonin Reuptake Inhibitor (SSRI):

   – Mechanism: Fluoxetine primarily inhibits the reuptake of serotonin, a neurotransmitter, in the brain. This leads to increased serotonin levels in the synaptic cleft, enhancing mood regulation.

   – Specificity: It is selective for serotonin reuptake, meaning it primarily affects serotonin and has minimal impact on other neurotransmitters.

 –Venlafaxine (Effexor) – Serotonin-Norepinephrine Reuptake Inhibitor (SNRI):

   – Mechanism: Venlafaxine inhibits the reuptake of both serotonin and norepinephrine. This dual action on two neurotransmitters is thought to provide a broader spectrum of antidepressant effects.

   – Specificity: It affects both serotonin and norepinephrine systems, potentially making it more effective for individuals who don’t respond well to SSRIs alone.

-Amitriptyline (Elavil) – Tricyclic Antidepressant (TCA):

   – Mechanism: Amitriptyline is a TCA that inhibits the reuptake of serotonin and norepinephrine. It also has anticholinergic and histaminergic properties.

   – Specificity: Like venlafaxine, it affects both serotonin and norepinephrine. However, it has a broader range of side effects due to its effects on other neurotransmitter systems.

-Phenelzine (Nardil) – Monoamine Oxidase Inhibitor (MAOI):

   – Mechanism: Phenelzine is an MAOI that inhibits the activity of the enzyme monoamine oxidase. This leads to increased levels of serotonin, norepinephrine, and dopamine in the brain.

   – Specificity: MAOIs have a broad impact on multiple neurotransmitters, which can be effective but also leads to dietary restrictions and potential drug interactions.

-Bupropion (Wellbutrin) – Atypical Antidepressant:

   – Mechanism: Bupropion primarily increases the levels of norepinephrine and dopamine by inhibiting their reuptake. It also has minimal impact on serotonin.

   – Specificity: Unlike SSRIs or SNRIs, bupropion has a unique mechanism, which can be advantageous for individuals concerned about sexual side effects associated with other antidepressants.

-Trazodone (Desyrel) – Serotonin Antagonist and Reuptake Inhibitor (SARI):

   – Mechanism: Trazodone primarily blocks serotonin receptors (antagonist) and, to a lesser extent, inhibits serotonin reuptake.

   – Specificity: It has a somewhat unique mechanism, different from typical SSRIs and SNRIs, which can make it suitable for some individuals but also has sedative effects.

What are the major symptoms to counsel patient regarding serotonin syndrome? What should the patient do regarding seeking treatment for serotonin syndrome?

-Serotonin syndrome is a potentially life-threatening condition that can occur when there is an excess of serotonin in the brain, often due to the use of medications. Patients taking antidepressants, particularly those that increase serotonin levels, should be educated about the major symptoms of serotonin syndrome and what to do if they suspect they are experiencing it. The major symptoms to counsel a patient regarding serotonin syndrome include: Agitation and Restlessness, Confusion, Excessive Sweating, Hyperthermia, Muscle Rigidity, Shaking, Diarrhea and Gastrointestinal Symptoms, Tachycardia, Dilated Pupils.

-If experiencing serotonin syndrome, here are some actions: Stop Taking the Medication, Seek Medical Attention, Inform Healthcare Provider, Stay Hydrated, Monitor Vital Signs.

Do all antidepressants carry the adverse reaction of serotonin syndrome? If the answer is no, identify which medication class does not and explain why.

No, not all antidepressants carry the risk of causing serotonin syndrome. The risk of serotonin syndrome is primarily associated with certain classes of antidepressant medications, particularly those that increase serotonin levels in the brain.

Antidepressant classes that do not typically carry a significant risk of causing serotonin syndrome include:

-SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), are generally considered to have a lower risk of causing serotonin syndrome when taken alone as prescribed. However, in rare cases, it can still occur, especially when SSRIs are combined with other medications that increase serotonin.

-SNRIs, like venlafaxine (Effexor) and duloxetine (Cymbalta), have a relatively lower risk of causing serotonin syndrome when taken within the recommended dosage range. However, at high doses or when used inappropriately, there can be an increased risk.

-Bupropion is an atypical antidepressant that primarily affects norepinephrine and dopamine levels in the brain. It has minimal impact on serotonin, so the risk of serotonin syndrome with bupropion alone is low.

A Sample Answer 2 For the Assignment: NUR 635 Topic 4 DQ 1

Title: NUR 635 Topic 4 DQ 1

 Depression Diagnosis and Treatment

Using the DSM-5 diagnostics in the topic Resources, determine which symptoms Olivia is displaying that fall under the diagnostic criteria.

Olivia is displaying several symptoms that fall under the diagnostic criteria for major depressive disorder:

  • Depressed mood most of the day, nearly every day (Maurer, Raymond & Davis, 2018).
  • Loss of interest or pleasure in most activities (anhedonia).
  • Significant weight loss and decreased appetite.
  • Insomnia or hypersomnia.
  • Fatigue or loss of energy.
  • Feelings of worthlessness or excessive guilt.
  • Diminished ability to think or concentrate.
  • Recurrent thoughts of death (Maurer, Raymond & Davis, 2018) (as evidenced by Olivia’s comment about her family and friends being better off without her).

What class of medication is considered first-line treatment? When should Olivia start seeing benefit from this medication, and when should we see the full effect of the medication? What are the common side effects? What is the black box warning associated with the medication?

The first-line treatment for MDD in adolescents often includes selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine. SSRIs exert action by inhibiting the reuptake of serotonin, thus increasing serotonin activity (Chen, 2023). Olivia should start to see some improvement in her symptoms within a few weeks of starting the medication, but the full effect may take several weeks (usually 6-8 weeks) to manifest. Common side effects of SSRIs include nausea, insomnia, headache, and potential sexual side effects (Chen, 2023). It is essential to monitor for suicidal ideation, especially in the early stages of treatment. The black box warning associated with SSRIs, including fluoxetine, is an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults during the early phases of treatment.

How would address the following questions with Olivia’s mom: What do we do if there are no improvements after starting treatment? How long do we continue treatment? Address increase of suicide with antidepressants.

If Olivia does not show improvement after starting treatment, it is crucial to reassess her treatment plan. The duration of treatment for MDD typically spans several months to a year or more. It should continue for at least six months after symptom remission to prevent relapse. If there is no improvement or worsening of symptoms, the healthcare provider should consider alternative treatments or consult with a mental health specialist. It is essential to closely monitor Olivia for any signs of increased suicidal ideation or behavior.

Olivia’s mother inquires if a natural approach using St. John’s wort is an option. Based on your understanding, address the following: evidence of efficacy and potential drug-drug interactions associated with St. John’s wort.

St. John’s Wort is often considered a natural alternative for treating depression, but its efficacy is not as well-established as conventional antidepressants (Benitez et al., 2022). Studies have shown mixed results regarding its effectiveness. It is important to inform Olivia’s mother that while some individuals may find relief with St. John’s Wort, it can also have interactions with other medications, including antidepressants, leading to potentially dangerous side effects. St. John’s Wort can interfere with the metabolism of various drugs, reducing their effectiveness or increasing the risk of adverse reactions.

On a mechanism of action perspective, differentiate between fluoxetine, venlafaxine, amitriptyline, phenelzine, bupropion, and trazodone.

Fluoxetine, Venlafaxine, Amitriptyline, Phenelzine, Bupropion, and Trazodone are all medications used to treat various mental health conditions, but they differ in their mechanisms of action. To start with, fluoxetine, a selective serotonin reuptake inhibitor (SSRI), primarily works by increasing the levels of serotonin in the brain. This neurotransmitter plays a key role in regulating mood, and fluoxetine helps by blocking the reabsorption of serotonin, thereby enhancing its availability in the synapses. On the other hand, venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that not only boosts serotonin levels but also affects norepinephrine, providing a dual action (Chang, Kuang & Liu, 2022). This makes it effective for a broader range of conditions, including depression and anxiety.

Amitriptyline, however, belongs to the tricyclic antidepressant (TCA) class and acts by inhibiting the reuptake of both serotonin and norepinephrine, while phenelzine is a monoamine oxidase inhibitor (MAOI) that works by inhibiting the enzyme responsible for breaking down neurotransmitters like serotonin, norepinephrine, and dopamine (Chang, Kuang & Liu, 2022). Conversely, bupropion has a unique mechanism of action as a norepinephrine-dopamine reuptake inhibitor (NDRI). It increases the levels of both norepinephrine and dopamine in the brain, which can help improve mood and focus. Lastly, trazodone primarily acts as a serotonin antagonist and reuptake inhibitor (SARI). It blocks certain serotonin receptors while also increasing serotonin availability in the brain.

What are the major symptoms to counsel patient regarding serotonin syndrome? What should the patient do regarding seeking treatment for serotonin syndrome?

Serotonin syndrome is a potentially life-threatening condition characterized by excessive serotonin activity. Major symptoms include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, high body temperature, and sweating (Loader, 2022). Olivia should be educated to seek immediate medical attention if she experiences any of these symptoms. Serotonin syndrome can be caused by interactions between certain antidepressants, especially when combined with other medications or substances that increase serotonin levels. It’s crucial to inform Olivia of all medications, supplements, or recreational substances she may be using to minimize the risk of serotonin syndrome.

Do all antidepressants carry the adverse reaction of serotonin syndrome? If the answer is no, identify which medication class does not and explain why.

Not all antidepressants carry an equal risk of causing serotonin syndrome. The highest risk is associated with the combination of MAOIs and other serotonergic drugs, which should be avoided due to the potential for severe serotonin syndrome. SSRIs and SNRIs have a lower risk but can still cause serotonin syndrome, particularly when taken in high doses or combined with other serotonergic agents. Atypical antidepressants like bupropion have a lower risk overall, making them a safer option when the risk of drug interactions is a concern.

References

Benitez, J. S. C., Hernandez, T. E., Sundararajan, R., Sarwar, S., Arriaga, A. J., Khan, A. T., … & Matayoshi-Pérez, A. (2022). Advantages and Disadvantages of Using St. John’s Wort as a Treatment for Depression. Cureus14(9).

Chang, F., Kuang, X., & Liu, Y. (2022). The Development and Mechanism of Treatment of Depression. Highlights in Science, Engineering and Technology8, 133-142.

Chen, X. (2023). The anti-depression function of selective serotonin reuptake inhibitor. Highlights in Science, Engineering and Technology36, 1121-1126.

Loader, K. (2022). Too much of a good thing? Diagnosis and management of patients with serotonin syndrome. Emergency Nurse30(3).

Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: screening and diagnosis. American family physician98(8), 508-515.