Question

How would you treat:

A 35-year-old female who presents with panic disorder and cannot tolerate a SSRI or SNRI?

A 12-year-old male who presents with anxiety?

A 22-year-old female in her 28th week of pregnancy who presents with depression?

Read each description above. Then, complete the following:

List one medication to treat each condition and explain how it works. Include the dose, side effects, and drug interactions.

When monitoring patient response, we have an acute phase, continuous phase, and maintenance phase and can modify the drug therapy. What does this mean?

Please I need detailed answer

Answer 1

1. 35 yr old female

in a panic attack, the patient suffers from sudden episodes of intense fear with physical reactions without any apparent reason or danger.

SSRI and SNRI are two major treatment medication in panic attack cases. however, this patient cannot tolerate these medications.

here, our drug of choice is benzodiazepines, are sedatives which depress the central nervous system and only uses for short-term basis forms the dependency.

drugs: clonazepam, alprazolam

dose

an initial recommended dose is 0.25 mg twice daily, a dose can be increased in every three days as 0.125- 0.25mg twice daily. the target dose for one day is 1mg

side effects

sedation, dizziness, impaired coordination, depression, increased salivation and fatigue

interaction

it increases the sedative effects of opiates and antihistamines

2.12 yr old male

ANXIETY causes excessive worry and anxiety, significant distress and affects the ability of a person to work.

antidepressants, benzodiazepine, buspirone, pregabalin are major drug choice in anxiety disorder.

buspirone- reduce anxiety by stimulating serotonin and dopamine receptors on nerves, thus alters chemical messages received by nerves

dose- 15 -20mg/day. maximum daily dose should not exceed 60 mg

side effects

chest pain, shortness of breath, dizziness, headache, blurred vision

drug interaction

if used with erythromycin increases the plasma concentration of buspirone and if used with haloperidol it increases the concentration of haloperidol.

3. 22 yr pregnant female with depression

During pregnancy, the medicines of priority are SSRI(SELECTIVE SEROTONIN REUPTAKE INHIBITORS), SNRI (SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS), bupropion and tricyclic antidepressants

SSRI s are generally an option for depression during pregnancy.

action

increases extracellular level of serotonin by reducing the reabsorption into presynaptic cell.

side effects

drowsiness, nausea, dry mouth, diarrhoea, agitation

drug interaction

• SSRI s with alcohol depress central nervous system
• used with MAOI s(monoamine oxidase inhibitors) causes fatal reactions

there are three phases in antidepressant treatment

1. acute phase

in acute phase it stabilizes acute symptoms and lasts upto 2 to 3 months

2. continuous phase

this phase is to prevant relapse and continue treatment for another 3 to 4 months

3 maintanence phase or prophylaxis

this phase is to prevent the recurrence of disorder