Case: An elderly widow who just lost her spouse.Subjective: A patient presents to your primary care office today with chief complaint of insomnia.ÿPatient is 75 YO with PMH of DM, HTN, and MDD.ÿHer husband of 41 years passed away 10 months ago.ÿSince then, she states her depression has gotten worse as well as her sleep habits.ÿThe patient has no previous history of depression prior to her husband?s death.ÿShe is awake, alert, and oriented x3.ÿPatient normally sees PCP once or twice a year.ÿPatient denies any suicidal ideations.ÿPatient arrived at the office today by private vehicle.ÿPatient currently takes the following medications:Metformin 500mg BIDJanuvia 100mg dailyLosartan 100mg dailyHCTZ 25mg dailySertraline 100mg dailyCurrent weight: 88 kgCurrent height: 64 inchesTemp: 98.6 degrees FBP: 132/86List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.Identify people in the patient?s life you would need to speak to or get feedback from to further assess the patient?s situation. Include specific questions you might ask these people and why.Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.List two pharmacologic agents and their dosing that would be appropriate for the patient?s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client?s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?Include any ?check points? (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
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