PATIENT GUIDE

WK3Assgn George D - Week 3 assignment

Psychopharmacologic Approaches to Treatment of Psychopathology (Approaches to Treatment) (Walden University)

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WK3Assgn George D - Week 3 assignment

Psychopharmacologic Approaches to Treatment of Psychopathology (Approaches to Treatment) (Walden University)

Scan to open on Studocu

Studocu is not sponsored or endorsed by any college or university Downloaded by Tiara Nicole (tiarasank@yahoo.com)

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PATIENT GUIDE

Diana George

Walden University

NURS 6330: Approaches to Treatment

Dr. Rob Dominic Letterio

March 17, 2024

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PATIENT GUIDE

MEDICATION GUIDE

Fluoxetine (floo·aak·suh·teen) Brand name- Prozac

Age- 8 years Sex- Female Ethnicity- Asian Diagnosis- Severe Depressive Disorder

Indications: Selective Serotonin Reuptake Inhibitors (SSRIs) – Fluoxetine (Prozac)  Fluoxetine is considered the first-line treatment approved by the FDA for pediatric

depression.  Relatively favorable safety profile and efficacy in managing depressive symptoms

(Reyad et al., 2020).  SSRIs are generally well-tolerated in children and have a lower risk of serious side

effects compared to other classes of antidepressants (Yan & Goldman, 2019)

Directions:  Take 10 mg once daily in the morning. This initial dose may be increased after one to

two weeks, not to exceed 20 mg per day (Frey et al., 2023).  Administer in the morning due to its long half-life and the potential for activating effects

(Andrade, 2022).  Administer the medication exactly as prescribed with or without food.  Do not alter the dosage or frequency without consulting the physician.  Take the missed dose as soon as you remember, then continue your regular schedule.  If it is close to the next dose, it is better to skip the missed dose, resume with the usual

dosing schedule, and not double the dose to make up for a missed one.

How Fluoxetine works to treat symptoms:  Selective Serotonin Reuptake Inhibitors (SSRIs) block the reabsorption (reuptake) of

the neurotransmitter serotonin in the brain. This leads to an increase in the levels of serotonin available in the synaptic clefts between neurons, which can help regulate mood, emotions, and behavior (Edinoff et al., 2021).

 SSRIs have been implicated in promoting neuroplasticity, which is the brain's ability to reorganize its neural connections in response to learning and experience. (Rădulescu et al., 2021)

 SSRIs have been implicated in promoting neurogenesis in certain brain regions (involves the generation of new neurons that cause sustained elevation of Serotonin (Seginishida, 2017).

 SSRIs have also been shown to influence the expression of neurotrophic factors, such

as brain-derived neurotrophic factor (BDNF), which play a critical role in neuronal survival, increasing the transcription of neurotrophic factors in the brain (Yang et al., 2020)

Treatment Plan and Follow-up visit:  Considering and offering options for non-pharmacological measures like therapy or as

an adjunct treatment prior to starting medication  Current practice parameters and clinical guidelines recommend that pediatric patients

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with severe depressive disorder who have responded favorably to SSRIs should continue medication for an extended period to prevent relapse and maintain remission.

 Pediatric patients with severe depressive disorder may require long-term maintenance treatment with SSRIs to prevent the recurrence of depressive episodes and sustain improvements in mood and functioning.

 The patient should return for a follow-up visit approximately 2 to 4 weeks after initiating fluoxetine therapy to assess treatment response and monitor for any adverse effects.

 Subsequent follow-up appointments should be scheduled as needed based on clinical

judgment, typically every 4 to 6 weeks thereafter (Park & Zarate, 2019).

List of Medications, Supplements, Herbal Supplements, and Food to Avoid while on Fluoxetine:

 Antidepressants like MAOI can cause a life-threatening condition called serotonin syndrome, a potentially life-threatening condition characterized by altered mental status, autonomic dysfunction, and neuromuscular abnormalities (Badar, 2024)

 Serotonergic drugs: Medications like triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and amphetamines can increase the risk of serotonin syndrome when taken with Prozac (Foong et al., 2018).

 St. John's wort is an herbal remedy used to treat depression and can increase the risk of side effects while taking Fluoxetine.

 Anticonvulsant medication interacts with SSRI, which may lead to anticonvulsant toxicity.

 Drugs like Pimozide and Thioridazine that prolong QT interval can increase the risk of serious heart arrhythmias and sudden death when taken with Prozac (Waleekhachonloet et al., 2019).

 SSRIs increase the risk of bleeding when taken with NSAIDs or blood thinners.  There are no specific dietary restrictions while taking Fluoxetine, but it is recommended

to maintain a balanced and healthy diet to support overall well-being.  Avoid rich or spicy food.

 Side-effects:

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Urgent or Emergent Considerations: Immediate intervention or calling a doctor may be necessary for the following cases.

 Suicidal Ideation and Behavior- increased agitation, impulsivity, or worsening of depressive symptoms is imperative.

 Serotonin syndrome- is characterized by a constellation of symptoms, including agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and tremors. In severe cases, serotonin syndrome can lead to life-threatening complications, such as seizures and hyperthermia (Scotton et al., 2019).

 Allergic Reactions—Although uncommon, pediatric patients may develop allergic

responses to SSRIs, presenting with skin rashes, itching, swelling, or difficulty

breathing.

Legal and Ethical consideration:  Informed consent from the parent or legal guardian is required before initiating

treatment in minors.  Applying evidence-based care generated from research specifically for children.  Avoiding harmful therapies extrapolated from patient data or experience.  Providing confidentiality within the limits of legal requirements.

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 Thorough assessment and ongoing monitoring of the patient's mental health status, including potential risks and benefits of medication therapy, are necessary to ensure safe and effective care delivery.

 Beneficences- the moral obligation to act for the benefit of patients, including protecting, preventing harm, and helping those in danger.

 Support developing autonomy in children in participation.  Non-maleficence- Reduce or avoid potential harmful effects on the child's optimal

development.  Prescribers must adhere to relevant laws, regulations, and professional standards

governing pediatric psychiatric practice to uphold patient safety and well-being.  Fidelity- Must prioritize the welfare of the patient rather than the interests of the third

parties.  Justice- Competent mental health care should be available for all children

Contraindication:  Pregnancy  Hepatic or renal insufficiency.  hypersensitivity to fluoxetine

Social Determinants of Health Considerations:  Assist patients with resources such as patient assistance programs offered by

pharmaceutical companies, sliding scale fee services, or community-based organizations that provide financial assistance for medication expenses.

 Collaborate with the patient and their family to identify cost-effective treatment options, such as generic formulations or alternative medications covered by insurance plans or governmental assistance programs.

 Addressing transportation barriers - options such as telemedicine appointments, transportation vouchers, or arranging for home visits

 Collaborating with community resources, such as transportation services or social service agencies, can also help alleviate transportation barriers and facilitate access to healthcare services.

 Manage medication changes over the phone or through electronic messages to help

decrease cost and frequency.  It is very important for healthcare providers to look for all patients' social determinants

for continuity and optimal results of care.  Financial hardship can make it difficult for individuals to afford prescribed

medications, leading to non-adherence and poorer health outcomes.  Without financial resources, individuals may be unable to afford health

insurance or out-of-pocket costs for medical care, leading to delayed or foregone care.

 Individuals may have difficulty getting to medical appointments, pharmacies, or

emergency care when needed without transportation.

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References

Andrade, C. (2022). Psychotropic drugs with long half-lives. The Journal of Clinical Psychiatry,

83(4). HYPERLINK

"https://doi.org/10.4088/jcp.22f14593"https://doi.org/10.4088/jcp.22f14593

Badar, A. (2024). Serotonin syndrome: An often-neglected medical emergency. Journal of

Family and Community Medicine, 31(1), 1–8. HYPERLINK

"https://doi.org/10.4103/jfcm.jfcm_236_23"https://doi.org/10.4103/jfcm.jfcm_236_23

Edinoff, A., Akuly, H., Hanna, T., Ochoa, C., Patti, S., Ghaffar, Y., Kaye, A., Viswanath, O.,

Urits, I., Boyer, A., Cornett, E. M., & Kaye, A. (2021). Selective serotonin reuptake

inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387–

401. HYPERLINK "https://doi.org/10.3390/neurolint13030038"https://doi.org/10.3390/

neurolint13030038

Foong, A., Grindrod, K., Patel, T., & Kellar, J. (2018). Demystifying serotonin syndrome (or

serotonin toxicity). Canadian family physician Medecin de famille canadien, 64(10),

720–727. HYPERLINK

"https://pubmed.ncbi.nlm.nih.gov/30315014/"https://pubmed.ncbi.nlm.nih.gov/

30315014/

Frey, M., Smigielski, L., Tini, E., Fekete, S., Fleischhaker, C., Wewetzer, C., Karwautz, A.,

Correll, C. U., Gerlach, M., Taurines, R., Plener, P. L., Malzahn, U., Kornbichler, S.,

Weninger, L., Brockhaus, M., Reuter-Dang, S.-Y., Reitzle, K., Rock, H., Imgart,

H.,...Egberts, K. (2023). Therapeutic drug monitoring in children and adolescents:

Findings on fluoxetine from the tdm-vigil trial. Pharmaceutics, 15(9), 2202.

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HYPERLINK "https://doi.org/10.3390/pharmaceutics15092202"https://doi.org/10.3390/

pharmaceutics15092202

Park, L., & Zarate, C. (2019). Depression in the primary care setting. New England Journal of

Medicine, 380(6), 559–568. HYPERLINK

"https://doi.org/10.1056/nejmcp1712493"https://doi.org/10.1056/nejmcp1712493

Rădulescu, I., Drăgoi, A., Trifu, S., & Cristea, M. (2021). Neuroplasticity and depression:

Rewiring the brain's networks through pharmacological therapy (review). Experimental

and Therapeutic Medicine, 22(4). HYPERLINK

"https://doi.org/10.3892/etm.2021.10565"https://doi.org/10.3892/etm.2021.10565

Reyad, A., Plaha, K., Girgis, E., & Mishriky, R. (2020). Fluoxetine in the management of major

depressive disorder in children and adolescents: A meta-analysis of randomized

controlled trials. Hospital Pharmacy, 56(5), 525–531. HYPERLINK

"https://doi.org/10.1177/0018578720925384"https://doi.org/10.1177/0018578720925384

Scotton, W., Hill, L., Williams, A., & Barnes, N. (2019). Serotonin syndrome: Pathophysiology,

clinical features, management, and potential future directions. International Journal of

Tryptophan Research, 12, 117864691987392. HYPERLINK

"https://doi.org/10.1177/1178646919873925"https://doi.org/10.1177/1178646919873925

Seginishida, E. (2017). The effect of serotonin-targeting antidepressants on neurogenesis and

neuronal maturation of the hippocampus mediated via 5-ht1a and 5-ht4 receptors.

Frontiers in Cellular Neuroscience, 11. HYPERLINK

"https://doi.org/10.3389/fncel.2017.00142"https://doi.org/10.3389/fncel.2017.00142

Waleekhachonloet, O., Limwattananon, C., & Rattanachotphanit, T. (2019). Coprescription of qt

interval-prolonging antipsychotics with potentially interacting medications in thailand.

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Therapeutic Advances in Drug Safety, 10, 204209861985488. HYPERLINK

"https://doi.org/10.1177/2042098619854886"https://doi.org/10.1177/2042098619854886

Yan, T., & Goldman, R. D. (2019). Time-to-effect of fluoxetine in children with depression.

Canadian family physician Medecin de famille canadien, 65(8), 549–551. HYPERLINK

"https://pubmed.ncbi.nlm.nih.gov/31413023/"https://pubmed.ncbi.nlm.nih.gov/

31413023/

Yang, T., Nie, Z., Shu, H., Kuang, Y., Chen, X., Cheng, J., Yu, S., & Liu, H. (2020). The role of

bdnf on neural plasticity in depression. Frontiers in Cellular Neuroscience, 14.

HYPERLINK "https://doi.org/10.3389/fncel.2020.00082"https://doi.org/10.3389/

fncel.2020.00082

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