[email protected]

New Order

Case Study For Anxiety Disorders Assignment Paper

Case Study For Anxiety Disorders Assignment Paper

NURS629- Advanced Psychopharmacology

Case Study #4 Anxiety Disorders

• Indicate your answer to the following case presentations-
• THERE IS ONLY ONE ANSWER FOR EACH QUESTION
• Defend your answer following each question. The defense should be a SHORT response to support your answer choice, nothing beyond a few sentences.
• Cite the text at the bottom of this assignment- there is no need to repeat citations for every defense if you’re only using Stahl’s as your reference.
• If you choose to cite any additional resources beyond the text, include it with the respective question Case Study For Anxiety Disorders Assignment Paper

ORDER A PLAGIARISM-FREE PAPER HERE

Patient #1

1. Sandra Rodriguez is 34-year-old woman with a psychiatric history of posttraumatic stress disorder (PTSD). Sandra has been prescribed first line oral medications (SSRs and SNRIs) in the past, which were minimally effective. The PMHNP astutely referred Sandra to a therapist for exposure therapy (a form of Cognitive Behavior Therapy), and she has had partial success (a slight decrease in her symptoms). The PMHNP is considering an adjunct oral medication to reduce or suppress the stressful or fearful experience associated with the remembered stimulus. The PMHNP decides to prescribe an agent d-cycloserine because it has been shown to:

A. Increase glutamate neurotransmission during fear conditioning
B. Decrease glutamate neurotransmission during fear conditioning
C. Increase glutamate neurotransmission during fear extinction
D. Decrease glutamate neurotransmission during fear extinction

Defense: Case Study For Anxiety Disorders Assignment Paper

Patient #2

2. Sally Silverstein is a 31-year-old female assault victim is brought to the ER after tracking down passersby for help. She appears traumatized from the incident. Which of the following agents will the PMHNP consider as a potential preemptive treatment to the development of PTSD?

A. N-methyl-D-aspartate (NMDA) agonist such as D-cycloserine
B. Alpha 2 delta ligand such as pregabalin
C. Beta adrenergic blocker such as propranolol
D. Benzodiazepine such as diazepam

Defense:

Patient #3

3. Ryan Tauro is a 38-year-old male with a history of treatment-resistant PTSD. He experienced improvement of his symptoms on the following oral medications: quetiapine 300 mg/day, duloxetine 90 mg/day, and zolpidem 10 mg at bedtime. However, at one of his psychiatric follow-up visits, he complained of ongoing nightmares and difficulty staying asleep. The PMHNP initiated Ryan on prazosin 3 mg at bedtime. At his follow-up visit he reported having relief from the nightmares but he experienced intolerable dizziness throughout the day, prazosin was discontinued by the PMHNP. Ryan has returned to the clinic with complaints of worsening nightmares. Should the PMHNP restart the patient on prazosin? If so, at what dose? Case Study For Anxiety Disorders Assignment Paper

A. Yes; dose should be restarted at 1 mg at bedtime
B. Yes; dose should be restarted at 3 mg at bedtime
C. No; prazosin is contraindicated with quetiapine
D. No; prazosin should not be reattempted in patients with previous intolerability

Defense:

Patient #4

4. Tammy Waldman is a 46-year-old female patient who has been experiencing several anxiety-based symptoms for many years. She was previously diagnosed with generalized anxiety disorder. She now presents with difficulty concentrating in addition to difficulty falling asleep. Her family has recently told her that she seems to be displaying heightened anger responses toward them over minor details. Oftentimes she will cry for extended periods of time and become irritable and distant. If this patient were to continue to experience chronic stressful reactions to stimuli, the PMHNP may consider prescribing an SSRI because these agents can potentially: Case Study For Anxiety Disorders Assignment Paper

ORDER HERE

A. Increase hippocampal volume
B. Reduce brain-derived neurotrophic factor (BDNF) production
C. Decrease hippocampal volume
D. Increase brain-derived neurotrophic factor (BDNF) production
E. A & B
F. C & D
G. A & D

Defense:

NURS629- Advanced Psychopharmacology

Case Study #4 Anxiety Disorders

  • Indicate your answer to the following case presentations-
  • THERE IS ONLY ONE ANSWER FOR EACH QUESTION
  • Defend your answer following each question. The defense should be a SHORT response to support your answer choice, nothing beyond a few sentences.
  • Cite the text at the bottom of this assignment- there is no need to repeat citations for every defense if you’re only using Stahl’s as your reference.
  • If you choose to cite any additional resources beyond the text, include it with the respective question Case Study For Anxiety Disorders Assignment Paper

Patient #1

  1. Sandra Rodriguez is 34-year-old woman with a psychiatric history of posttraumatic stress disorder (PTSD). Sandra has been prescribed first line oral medications (SSRs and SNRIs) in the past, which were minimally effective. The PMHNP astutely referred Sandra to a therapist for exposure therapy (a form of Cognitive Behavior Therapy), and she has had partial success (a slight decrease in her symptoms). The PMHNP is considering an adjunct oral medication to reduce or suppress the stressful or fearful experience associated with the remembered stimulus. The PMHNP decides to prescribe an agent d-cycloserine because it has been shown to:
  2. Increase glutamate neurotransmission during fear conditioning
    B. Decrease glutamate neurotransmission during fear conditioning
    C. Increase glutamate neurotransmission during fear extinction
    D. Decrease glutamate neurotransmission during fear extinction

Defense: Agent d-cycloserine has shown to decrease glutamate neurotransmission during fear conditioning. According to Inslicht et al. (2022), agent d-cycloserine inhibit neurotransmission that is regulated by the glutamate receptor subtypes -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)/kainate. The -aminobutyric acid GABAA antagonist bicuculline does not inhibit this reduction, but the glycine antagonist strychnine does.

Patient #2

  1. Sally Silverstein is a 31-year-old female assault victim is brought to the ER after tracking down passersby for help. She appears traumatized from the incident. Which of the following agents will the PMHNP consider as a potential preemptive treatment to the development of PTSD?
  2. N-methyl-D-aspartate (NMDA) agonist such as D-cycloserine
    B. Alpha 2 delta ligand such as pregabalin
    C. Beta adrenergic blocker such as propranolol
    D. Benzodiazepine such as diazepam Case Study For Anxiety Disorders Assignment Paper

Defense:

The correct answer is A; N-methyl-D-aspartate (NMDA) agonist such as D-cycloserine.

The NMDA receptor variants are distributed differently across the central nervous system and perform roles in the genesis, reinforcing, and suppression of fear conditioning. D-cycloserine improves fear extinction/ therapy in both lab animals and anxious humans, while its effects appear to diminish over time. D-cycloserine has been employed extensively in the treatment of obsessive-compulsive disorder, phobias, and panic disorder in conjunction with CBT Inslicht et al. (2022)Case Study For Anxiety Disorders Assignment Paper.

Patient #3

  1. Ryan Tauro is a 38-year-old male with a history of treatment-resistant PTSD. He experienced improvement of his symptoms on the following oral medications: quetiapine 300 mg/day, duloxetine 90 mg/day, and zolpidem 10 mg at bedtime. However, at one of his psychiatric follow-up visits, he complained of ongoing nightmares and difficulty staying asleep. The PMHNP initiated Ryan on prazosin 3 mg at bedtime. At his follow-up visit he reported having relief from the nightmares but he experienced intolerable dizziness throughout the day, prazosin was discontinued by the PMHNP. Ryan has returned to the clinic with complaints of worsening nightmares. Should the PMHNP restart the patient on prazosin? If so, at what dose?
  2. Yes; dose should be restarted at 1 mg at bedtime
    B. Yes; dose should be restarted at 3 mg at bedtime
    C. No; prazosin is contraindicated with quetiapine
    D. No; prazosin should not be reattempted in patients with previous intolerability

Defense:

The correct answer is A. Yes; dose should be restarted at 1 mg at bedtime. The PMHNP needs to restart prazosin dose at 1mg at bedtime to prevent or reduce initial dose syncope. Then, in every 2–3 nights, the dose should be increased by 1 mg till the clinical response is obtained (Yücel et al. 2020)Case Study For Anxiety Disorders Assignment Paper.

  1. Tammy Waldman is a 46-year-old female patient who has been experiencing several anxiety-based symptoms for many years. She was previously diagnosed with generalized anxiety disorder. She now presents with difficulty concentrating in addition to difficulty falling asleep. Her family has recently told her that she seems to be displaying heightened anger responses toward them over minor details. Oftentimes she will cry for extended periods of time and become irritable and distant. If this patient were to continue to experience chronic stressful reactions to stimuli, the PMHNP may consider prescribing an SSRI because these agents can potentially:
  2. Increase hippocampal volume
    B. Reduce brain-derived neurotrophic factor (BDNF) production
    C. Decrease hippocampal volume
    D. Increase brain-derived neurotrophic factor (BDNF) production
  3. A & B
    F. C & D
    G. A & D

Defense: The correct answer is A & D.

Antidepressant selective serotonin reuptake inhibitors (SSRIs) increase BDNF expression of genes. There is additionally indications of synergistic effects between the two systems in emotional responses, as well as genetic epitasis between serotonin transporter genes and BDNF. The SSRIs also Increase hippocampal volume by activating the glucocorticoid receptor. These agents stimulate neuronal genesis and differentiation of human hippocampus progenitor cells through a GR-dependent pathway connected with GR phosphorylation via PKA transmission (Hutchison et al., 2021).

References

Inslicht, S. S., Niles, A. N., Metzler, T. J., Lipshitz, S. A. L., Otte, C., Milad, M. R., … & Neylan, T. C. (2022). Randomized controlled experimental study of hydrocortisone and D-cycloserine effects on fear extinction in PTSD. Neuropsychopharmacology, 47(11), 1945-1952.

Hutchison, S. M., Mâsse, L. C., Pawluski, J. L., & Oberlander, T. F. (2021). Perinatal selective serotonin reuptake inhibitor (SSRI) and other antidepressant exposure effects on anxiety and depressive behaviors in offspring: A review of findings in humans and rodent models. Reproductive Toxicology, 99, 80-95. Case Study For Anxiety Disorders Assignment Paper

Yücel, D. E., van Emmerik, A. A., Souama, C., & Lancee, J. (2020). Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials. Sleep medicine reviews, 50, 101248.

NURS629- Advanced Psychopharmacology

Case Study #4 Anxiety Disorders

  • Indicate your answer to the following case presentations-
  • THERE IS ONLY ONE ANSWER FOR EACH QUESTION
  • Defend your answer following each question. The defense should be a SHORT response to support your answer choice, nothing beyond a few sentences.
  • Cite the text at the bottom of this assignment- there is no need to repeat citations for every defense if you’re only using Stahl’s as your reference.
  • If you choose to cite any additional resources beyond the text, include it with the respective question Case Study For Anxiety Disorders Assignment Paper

Patient #1

  1. Sandra Rodriguez is 34-year-old woman with a psychiatric history of posttraumatic stress disorder (PTSD). Sandra has been prescribed first line oral medications (SSRs and SNRIs) in the past, which were minimally effective. The PMHNP astutely referred Sandra to a therapist for exposure therapy (a form of Cognitive Behavior Therapy), and she has had partial success (a slight decrease in her symptoms). The PMHNP is considering an adjunct oral medication to reduce or suppress the stressful or fearful experience associated with the remembered stimulus. The PMHNP decides to prescribe an agent d-cycloserine because it has been shown to:
  2. Increase glutamate neurotransmission during fear conditioning
    B. Decrease glutamate neurotransmission during fear conditioning
    C. Increase glutamate neurotransmission during fear extinction
    D. Decrease glutamate neurotransmission during fear extinction Case Study For Anxiety Disorders Assignment Paper

Defense:

Patient #2

  1. Sally Silverstein is a 31-year-old female assault victim is brought to the ER after tracking down passersby for help. She appears traumatized from the incident. Which of the following agents will the PMHNP consider as a potential preemptive treatment to the development of PTSD?
  2. N-methyl-D-aspartate (NMDA) agonist such as D-cycloserine
    B. Alpha 2 delta ligand such as pregabalin
    C. Beta adrenergic blocker such as propranolol
    D. Benzodiazepine such as diazepam

Defense:

Patient #3

  1. Ryan Tauro is a 38-year-old male with a history of treatment-resistant PTSD. He experienced improvement of his symptoms on the following oral medications: quetiapine 300 mg/day, duloxetine 90 mg/day, and zolpidem 10 mg at bedtime. However, at one of his psychiatric follow-up visits, he complained of ongoing nightmares and difficulty staying asleep. The PMHNP initiated Ryan on prazosin 3 mg at bedtime. At his follow-up visit he reported having relief from the nightmares but he experienced intolerable dizziness throughout the day, prazosin was discontinued by the PMHNP. Ryan has returned to the clinic with complaints of worsening nightmares. Should the PMHNP restart the patient on prazosin? If so, at what dose?
  2. Yes; dose should be restarted at 1 mg at bedtime
    B. Yes; dose should be restarted at 3 mg at bedtime
    C. No; prazosin is contraindicated with quetiapine
    D. No; prazosin should not be reattempted in patients with previous intolerability Case Study For Anxiety Disorders Assignment Paper

    ORDER TODAY

Defense:

Patient #4

  1. Tammy Waldman is a 46-year-old female patient who has been experiencing several anxiety-based symptoms for many years. She was previously diagnosed with generalized anxiety disorder. She now presents with difficulty concentrating in addition to difficulty falling asleep. Her family has recently told her that she seems to be displaying heightened anger responses toward them over minor details. Oftentimes she will cry for extended periods of time and become irritable and distant. If this patient were to continue to experience chronic stressful reactions to stimuli, the PMHNP may consider prescribing an SSRI because these agents can potentially:
  2. Increase hippocampal volume
    B. Reduce brain-derived neurotrophic factor (BDNF) production
    C. Decrease hippocampal volume
    D. Increase brain-derived neurotrophic factor (BDNF) production
  3. A & B
    F. C & D
    G. A & D Case Study For Anxiety Disorders Assignment Paper