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A• Select one drug to treat the diagnosis(es) or symptoms.

I would recommend prescribing Escitalopram (Lexapro) to address the symptoms of this Major Depressive Disorder (MDD) in the patient.

B• List medication class and mechanism of action for the chosen medication.
Escitalopram is an SSRI (selective serotonin reuptake inhibitor); it is frequently classed as an antidepressant, although it is more than that.

It is used to treat a variety of diseases, including major depressive disorder (for patients 12 and older), generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), to name a few.
It functions by enhancing serotonin neurotransmission, inhibiting the locks serotonin reuptake pump (serotonin transporter), desensitizing serotonin receptors, particularly serotonin 1A autoreceptors, and likely increasing serotonergic neurotransmission (Stahl, 2020).

C• Write the prescription in prescription format.

Date: 11/28/23
Patient DOB/Age: XX-XX-XXXX/25
Allergies: NKDA, allergic to grass, perennial trees, dust mites, and cockroaches.
Medication: Escitalopram (Lexapro) 10 mg
SIG: 1(10 mg) tab by mouth daily
Dispense: #30
Number of refills: 1
Prescriber name: Ketsia Louis Juste/APRN, PMHNP-BC
DEA number: XXXXXXX
NPI#: XXXXXXX

D• Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.

The goal of treatment is complete remission of existing symptoms as well as avoidance of future relapses. As first-line pharmacotherapy for Major Depressive Disorder, the use of SSRIs is highly advised.
The typical starting dose of Escitalopram is 10 mg, with the option to increase after one week for symptom management. When switching from another SSRI to escitalopram, a 4-week dose reduction is advised.
It may function for several years to prevent return of symptoms (Landy et al., 2022).

The onset of therapeutic action is frequently delayed by 2-4 weeks. If it does not work after 6-8 weeks, the dosage may need to be increased, or it may not work at all (Stahl, 2020).

E• List any side effects or adverse effects associated with the medication.

The most noticeable symptom of major depression is a severe and persistent low mood, intense sadness, or a sense of dread.
Patients taking Escitalopram should be routinely observed for behavioral or mood disorders, such as suicidal thoughts, though these are rare.
Sexual dysfunction (erectile dysfunction, delayed ejaculation in men, diminished sexual desire in both men and women, anorgasmia).
Dry mouth, nausea, vomiting, diarrhea, constipation could happen as well.

Mostly central nervous system (insomnia but also sedation, agitation, tremors, headache, dizziness).
SIADH (syndrome of inappropriate antidiuretic hormone secretion), rare hyponatremia (mostly in older individuals and frequently reversible upon discontinuing escitalopram), and also rare bleeding (Stahl, 2020).

F• Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.

Because SSRIs and SNRIs are processed in the liver by the P450 system, they have the potential for drug-drug interactions. When combining these medications with other medication whose metabolism can be affected by P450 inhibition, specific caution must be implemented. Medication interactions may vary between individuals due to genetic differences in these enzymes.
A set of baseline laboratory tests before starting a patient on antidepressant drug therapy to rule out underlying medical disorders that may be contributing to the patient’s depression or that may prevent the use of a certain drug. A complete blood cell count (CBC), a complete metabolic panel (CMP) (includes blood sodium, normal range is 135 to 145 mEq/L),and a thyroid-stimulating hormone level should all be performed.
Electrocardiography may also be helpful since some antidepressants can lengthen the QT interval or raise blood levels of other medicines that have this effect (Landy et al., 2022).

G• Provide a minimum of three appropriate medication-related teaching points for the client and/or family.

Face-to-face monitoring and blood work should be done on a regular basis, especially during the first few weeks of treatment. Also remind the patients this medication could take at least 2 to 6 weeks for full effect; therefore it is critical to continue taking the drug even if symptoms do not improve immediately (LeWine, 2022).

Use with caution, keeping an eye out for signs of activation of known or unknown bipolar disorder and/or suicidal ideation, and informing parents or guardians of the risk so they may assist in monitoring child or adolescent patients.

Warn patients and caregivers about the likelihood of activating adverse effects whenever feasible, and ask them to report such symptoms immediately.

Regular Monitoring: Stress the need for regular follow-up appointments and laboratory tests to monitor medication efficacy and detect any adverse effects early (Stahl, 2020).

INSTRUCTIONS-
Engage peers and faculty by offering new insights, applications, perspectives, information, or implications for practice. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice. Communicate with minimal errors in English grammar, spelling, syntax, and punctuation. “¯Use current APA format within 5yrs to format citations and references and is free of errors. 1 paragraph. provide 2 references with in-text citation. with one of the references being Stahl, S. M. (2021).”¯Stahl’s Essential Psychopharmacology: Prescriber’s guide(7th ed.).”¯Cambridge University Press.