Week4 case study : Some potential side effects from antidepressants can be serious; what is the difference between neuroleptic malignant syndrome and serotonin syndrome? How are they treated? – Solution

Some potential side effects from antidepressants can be serious; what is the difference between neuroleptic malignant syndrome and serotonin syndrome? How are they treated? 

·         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.

1.      Amitriptyline 

2.      Bupropion 

3.      Fluoxetine 

4.      Paroxetine 

·         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? 

·         Are any antidepressants approved for or preferred in postpartum depression? 

·         Which class of antidepressants (if any) are generally recommended to be used in geriatrics? 

·         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. 

Review prescribing guidelines for benzodiazepines for anxiety in your state. Are there any limitations for APRN’s to prescribe? How do the numbers of scripts written by APRN’s compare to those of physicians? 

Sample Solution

Week 4 Case Study Medication Prescription

List one common side effect for each medication and one potential way to manage it.

• Amitriptyline 

One common side effect of Amitriptyline is dizziness. However, dizziness/drowsiness can be managed by taking the medication at bedtime.

• Bupropion 

The most common side effect of bupropion is anxiety. To manage the anxiety, use the instant release bupropion at a low daily dose and raise the dosage daily until the daily target dosage is reached.

• Fluoxetine 

A common side effect of Fluoxetine is a sleeping problem (insomnia). Fluoxetine insomnia can be managed by taking the medication in the morning.

• Paroxetine 

The most common side effect of Paroxetine is nausea. Paroxetine nausea can be managed by taking the medication with food.

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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? 

NMS is strongly predicted by lead pipe muscular rigidity, hyporeflexia, and hemodynamic dysregulation, whereas serotonin syndrome is characterized by neuromuscular activity, including clonus and hyperreflexia (Turner, Nguyen, Kim, & McCarron, 2019). Serotonin syndrome is treated by first discontinuing all serotonergic agents followed by supportive care to normalize vital signs such as oxygenation, cooling agents, IV fluids, benzodiazepines, or antihypertensives. Severe cases require a prescription of a serotonergic antagonist such as cyproheptadine or neuromuscular sedation.   Equally, NMS is treated by first discontinuing the causative medication followed by supportive therapy such as benzodiazepines, antihypertensives, or cooling blankets. Severe cases require intubation or ICU admission for close monitoring.  

Are any antidepressants approved for or preferred in postpartum depression (PPD)? 

Yes. Some of the approved antidepressants include Fluoxetine and sertraline (ADAA, 2018).

Which class of antidepressants (if any) are generally recommended to be used in geriatrics? 

The recommended class of antidepressants for geriatric patients is selective serotonin reuptake inhibitors (SSRIs). SSRIs tend to have a high safety profile, are better tolerated, and have few side effects (Herron & Mitchell, 2018).

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 APRNs compare to those of physicians? 

According to the NYC DOHMH (2016), benzodiazepines should be prescribed at the lowest possible dose and for the shortest duration, i.e., between 2 and 4 weeks. Besides, benzodiazepines should not be prescribed together with opioid analgesics. Like most states, APRNs in New York are allowed by the Public Health Law § 281 to prescribe. Notable, APRNs have to complete a New York State Education Department approved pharmacology coursework to be certified to prescribe or dispense all types of medication for patient’s treatment with limited exceptions (NYS ED, 2015). However, the APRNs must government approvals and meet other criteria for medication prescription. Moreover, APRNs can only prescribe through electronic prescribing. Regarding benzodiazepines prescription, APRNs must collaborate with a doctor.

References

Anxiety and Depression Association of America (ADAA). (2018). Postpartum Depression. Retrieved 4 August 2021, from https://adaa.org/living-with-anxiety/women/postpartum-depression

Herron, J. W., & Mitchell, A. (2018). Depression and antidepressant prescribing in the elderly. Prescriber, 29(3), 12-17. https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1654

New York State Education Department (NYS ED). (2015). Prescription Privileges and Electronic Prescribing. http://www.op.nysed.gov/prof/nurse/np-ppep.pdf

The New York City Department of Health and Mental Hygiene (NYC DOHMH). (). City Health Information: Judicious Prescribing of Benzodiazepines. Retrieved 4 August 2021, from https://www1.nyc.gov/assets/doh/downloads/pdf/chi/chi-35-2.pdf

Turner, A. H., Nguyen, C. T., Kim, J. J., & McCarron, R. M. (2019). Differentiating serotonin syndrome and neuroleptic malignant syndrome. Curr Psychiatr, 18, 30-36. https://cdn.mdedge.com/files/s3fs-public/CP01802030.PDF