Neurology Case Study
Mrs. Jones has been newly diagnosed with both depression and anxiety. She has been prescribed lorazepam to manage her anxiety and fluoxetine for her depression.
Fluoxetine belongs to the pharmacologic class of agents known as selective serotonin inhibitors (SSRIs). It acts by inhibiting the reuptake of serotonin by the neurons thereby increasing its concentration at the synapses. The monoamine hypothesis suggests that the pathophysiology of depression can be explained by the deficiency of serotonin, norepinephrine, and dopamine in the cerebral cortex and the limbic system (Selph & McDonagh, 2019). Therefore, by increasing the brain concentration of serotonin through the use of fluoxetine, depression becomes managed.
Lorazepam belongs to the chemical class of pharmacologic agents known as benzodiazepines that are widely recognized and used as sedative-hypnotics. It exerts its actions by increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, thereby depressing the central nervous system and ultimately reducing anxiety (Sartori & Singewald, 2019). It is effective on a standing-dose or as-needed (PRN) schedule such as prescribed in this particular case for Mrs. Jones to manage her anxiety.
There are several safety concerns that the patient should be aware of when taking the medications. The patient should be educated that lorazepam is a sedative-hypnotic drug that should be taken only within the prescribed dosages to minimize the adverse effects. The dose prescribed should be appropriate enough to achieve the therapeutic effects without impairing the psychological, physiological, or motor functioning during the working hours since the drugs are highly sedative (Sartori & Singewald, 2019). Further, the patient should be cautioned about the consumption of alcohol together with the concurrent use of over-the-counter medications containing ant-histaminergic or anticholinergic drugs while on lorazepam treatment due to the risk of cardiorespiratory depression.
Similarly, fluoxetine has its safety concerns. It increases the risk of suicidal thinking and such ideation should be communicated to the healthcare provider by the patient (Selph & McDonagh, 2019). The patient should also be informed about the increased risk of serotonin syndrome especially when taking fluoxetine concomitantly with monoamine oxidase inhibitors (MAOIs). As well, the patient should be cautioned that the bleeding tendency can be aggravated when on fluoxetine since she is also taking the NSAID prescription drug ibuprofen which a common culprit drug in causing gastrointestinal bleeding.
There are several precautions and assessments that the nurse needs to take when administering the medications lorazepam and fluoxetine to Mrs. Jones. The nurse should assess whether the patient is allergic to any other medications due to the risk of drug hypersensitivity reactions. The nurse should also ensure that the patient is not concurrently on other drugs that have serious interactions with these new medications such as opioids, antihistamines, and anticholinergics. The patient should further be warned not to operate machinery or drive after taking the medications since the drugs are known to cause drowsiness. When needs arise to withdraw or stop the drugs, the nurse should not stop the drugs abruptly due to the risk of withdrawal reactions such as seizures. Instead, the nurse should taper down the doses slowly.
There are important educational points that the nurse needs to give Mrs. Jones regarding the newly prescribed medications. Foremost, the patient should be educated about the reason for each of the new medication. The dosage schedule together with potential drug interactions should be explained thoroughly to her. Mrs. Jones should also be advised on the common side effects of these medications. For example, fluoxetine can cause drowsiness, seizures, and serotonin syndrome, whereas lorazepam can cause sedation, visual disturbances, respiratory depression, and coma.
Sartori, S. B., & Singewald, N. (2019). Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacology & therapeutics, 204, 107402. Retrieved from https://www.sciencedirect.com/science/article/pii/S0163725819301512
Selph, S. S., & McDonagh, M. S. (2019). Depression in Children and Adolescents: Evaluation and Treatment. American family physician, 100(10), 609-617. Retrieved from https://www.aafp.org/afp/2015/0715/p94.html