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Leah 

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Treatment for a Patient With a Common Condition

Three Questions to Ask The Patient.

            Various questions would be relevant to the patient based on her condition. They would include;

• Have you been taking caffeinated drinks in the evening?

This question aims to find if the patient takes caffeine and the time, she takes it. Caffeine is a strong stimulant that causes a decrease in 6-sulfatoxymelatonin if taken during the night leading to sleep disturbances (Stuhec, 2022).

• How long do you sleep every night? How has your sleeping pattern been before and after the death of your husband?

An individual with unpleasant feelings and thoughts or worries excessively will have sleep disturbances. The question aims to find if the sleep disturbances began before or after her husband’s death to make a sound clinical decision.

• Have you ever experienced feelings of hopelessness, depression, or anxiety in the past?

People who suffer from a significant loss of a family member or loved one experience depression, sleep disturbances, and insomnia. The question aims to assess the patient’s risk for depression following the loss of her husband. A positive response would necessitate the need for proper treatment and management of depressive symptoms (Choi et al., 2020).

People in The Patient’s Life You Would Need to Speak to For Further Analysis.

            They include family members, current caretakers, and friends. This will comprise people who have been close to the patient before and after the death of her husband. But, I would seek the patient’s consent before inviting them for further assessment (Paudel et al., 2020). The people will give pertinent information about how the patient has been before and after the death of her husband to understand her better for appropriate diagnosis and treatment procedures. Some questions would be;

• How was her sleeping pattern before her husband’s death?
• Has she been complaining of depressive symptoms or feeling down?
• Has she been taking her medications as prescribed?

Physical Exams and Diagnostic Tests Appropriate For The Patient

            I would assess or, screen the patient for depressive symptoms using various physical examinations and diagnostic tests. I would use Geriatric Depression Scale (GDS) to diagnose the possibility of depression. This diagnostic test is used in detecting depression among people with cognitive impairment (Schroeck et al., 2016). I would use this tool since it is easy, reliable, and detects depressive symptoms in older people. For the physical exam, I would also ask the patient if she has feelings of hopelessness, guilt, or worthlessness. 

Differential Diagnoses

            The possible differential diagnoses for this patient would be anxiety, insomnia, dementia, and depression. But, based on the patient’s physical assessment and symptoms, she has depression resulting to insomnia (Paudel et al., 2020). This is a possible clinical condition since it is caused by stressful or upsetting life incidents such as the death of a loved one, family member, divorce, or illness. The disorder also occurs mainly among older adults. From the patient’s description, she lost her husband ten months ago, which might be the underlying contributing factor (Burke et al., 2019). The patient is current on Sertraline, a drug for treating depression.

Appropriate Pharmacologic Agents for The Patient’s Antidepressant Therapy

            The patient is currently on Sertraline 100 mg daily. While the duration of intake is not mentioned, there must be some positive improvements. But, this SSRI causes insomnia and needs to be augmented with a low dosage of trazodone (TCA). A low dose of trazodone would improve sleep patterns and eradicate depressive symptoms. However, the drug must be discontinued after improvement to avoid oversedation. Considering the patient history of diabetes, Sertraline makes it hard to maintain blood sugar levels (Burke et al., 2019). Thus, there is a need to prescribe Bupropion (antidepressant). Patients with DM and depression depict an improvement after taking the antidepressant since it regulates blood sugar. However, constant monitoring of the patient’s blood pressure is paramount since Bupropion might elevate the condition (Choi et al., 2020).

Potential Contraindications to Using or Alterations In Dosing

            Sertraline (Zoloft) is contraindicated among patients who take pimozide, monoamine oxidase inhibitors (MAOI), or thioridazine. The MAOI includes methyl blue and linezolid. Thus, it should never be prescribed with serotonergic drugs. Besides, Bupropion is typically contraindicated among patients diagnosed with liver and kidney disorders. This is because the medication’s effect might be intensified due to slow excretion from the liver or kidney (Burke et al., 2019). Again, Trazadone is usually contraindicated for people taking monoamine oxidase inhibitors or who have a history of drug intake. Thus, it would be inappropriate to prescribe to such patients. They might lead to vomiting, nausea, and dizziness. Hence, during ethical prescribing and decision-making on drug prescription, it is imperative to consider these contraindications (Schroeck et al., 2016).

Possible “Check Points” and Therapeutic Changes

            It would be recommendable to follow up with this patient within four weeks to ascertain her response to the prescribed medications and possible side effects. It would also be advisable to assess if the Trazadone prescribed is boosting the patient’s sleep pattern and depressive symptoms (Paudel et al., 2020). If an improvement is noted, I will discontinue or reduce the drug dosage to prevent oversedation. However, if there is no improvement in the symptoms, I will consider prescribing a different medication such as Doxepin. This is another medication (tricyclic antidepressant) that treats depression, insomnia, and anxiety (Schroeck et al., 2016).