Assignment Wk3 Psychopharmacology

Running Head: Case study 1

Case study 5

Case Study

Walden University

Name

NURS – 6630N

March 9, 2019

 

 

 

 

 

Case Study

Optimizing the dosing of medicines for neonates and children remains a challenge. The importance of pharmacokinetic (PK) and pharmacodynamics (PD) research is recognized both in medicines regulation and pediatric clinical pharmacology, yet there remain barriers to undertaking high-quality PK and PD studies. While these studies are essential in understanding the dose–concentration–effect relationship and should underpin dosing recommendations, this review examines how challenges affecting the design and conduct of pediatric pharmacological studies can be overcome using targeted pharmacometric strategies. Model-based approaches confer benefits at all stages of the drug life-cycle, from identifying the first dose to be used in children, to clinical trial design, and optimizing the dosing regimens of older, off-patent medications. To benefit patients, strategies to ensure that new PK, PD and trial data are incorporated into evidence-based dosing recommendations are needed.

The client selected is an African American child having depression with normal development milestone. Other aspects reveal that the child has high ratings in depression scale. The criterion is used to diagnose the child.

Decision point one

In this case, we had to prescribe the first choice of drug to get an effective effect. Some Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice to use in children with depressive disorder. The best medicine is Zoloft having sertraline. Now we decided the starting dose and that was 25mg to be administered orally. According to Vitiello (2012), if the medicine does not work in starting dose, we need to increase the dose. The child had been prescribed Zoloft and he came back with no change in his mental health.

Decision point two

If the drug is not working in a low dose, we need to increase the dose. Decision point two involved increasing the dose from 25mg to 50mg.The purpose of increasing the dose was to lower the depressive symptoms. Being within the range, we expected minimal desired effects (Stahl, 2013). Giving a single dose is more likely to give persistent desired effects in client. The patient experienced 50 percent decrease in symptoms. Hence Zoloft was successful in managing the patient’s depression. You must be cautious about the side effects of sertraline. One of the major is suicidal thoughts.

Decision point three

Decision point three is to decide if the dose will be maintained or increased to get rid of symptoms completely. The best decision is to maintain the dose because if the patient has shown 50 percent improvement then he will show more with the passage of time. His dose had been maintained now he further experienced decrease in symptoms. The best treatment is the complete remission as it is the main aim in contemporary psychopharmacology (Stahl, 2013). Then I recommended that the dose will be maintained for three months for complete omission of symptoms. The dose can be increased to 75mg if the tolerance is developed.

 

Ethical considerations

Before a patient is offered a psychotropic medication, a thorough diagnostic evaluation and careful review of the patient’s history (including past symptoms and response to treatment) are essential Vitiello (2012),. Learning what the patient’s hopes, greatest concerns, and motivations are is essential to developing an appropriate therapeutic strategy that may include the use of psychopharmacological agents to address specific target symptoms. The goal is to prescribe psychotropic medications only when they are clearly indicated and when there is a strong evidence base. In many circumstances, combined biological and psychosocial interventions may offer the greatest therapeutic benefit. Another consideration is to develop a good relationship with patient as he has to feel comfortable with you. Then you may be able to treat in a better way. Safe administration should also be ensured.

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrievedfrom http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf