Case Study
It has been six weeks since you first saw Josie. She is in the office for a follow-up visit by herself.
Josie reports, “I think my symptoms are 80% better on medication. But I do still worry and obsess, particularly at work. I am also getting horrible anxiety attacks, where I freeze and am not able to move. It has happened about once a week since my last visit.
“…. Ah…. I hate to admit this. Ummmm…. This is confidential, right? The last one at work was during a code blue.
“…. But yes, overall, I feel much better. The medication is working in general. It’s just, occasionally that I feel like that. I’m tolerating the medication well but I have noticed dry mouth and a decreased sexual drive. And, um, yeah, you can imagine the friction that is causing in my relationship with Robs.
“So, what I’m thinking is, could I have Xanax? Or maybe Ativan? I know those are really good for anxiety like this. I think they’d really help me.”
Questions
Hypothetically From your perspective as Josie’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.
- Compare and contrast at least four medications that Josie could take “as needed.” Please include generic/brand name, pros, and cons for each medication.
- Are there any additional questions that you would want to know and/or labs that you would order before prescribing an “as needed” medication?
- Which pharmacological treatment would you choose? Please include rationale, starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education.
- What community and support resources would you provide to Josie?
- Would you refer Josie to therapy? If so, what type? Please provide evidence for your decision.
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