w9 Second response to Chris

4 minutes ago

Respond to Chris.

Round 2 response to Chris

RE: Week 9 grand rounds presentation

Still requires 2 citations and 2 refs.

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He,

Thank you very much for your informative response. I agree with you that FDA approved versus first line can be tricky. I also agree with you that Nortriptyline places the patient at risk for many unwanted side effects and toxicity. "Tricyclic antidepressants are no longer considered first-line agents for older adults given their potential for side effects, including postural hypotension, which can contribute to falls and fractures, cardiac conduction abnormalities, and anticholinergic effects" (Wiese, 2011). Therefore we will monitor patient very closely and ensure she is educated on the adverse effects and signs of toxicity. Also this particular patient has been on Nortriptylin 25mg for over a year without any side effects so we are hopeful that it will eliminate her depressive symptoms that have returned without the unwanted side effects.

Reference:

Wiese, B. S. (2011). Geriatric depression: The use of antidepressants in the elderly. British Columbia Medical Journal, 53(7), 341–374.

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