Laura is a 55-year-old white female who presents to her family physician’s office for a yearly routine physical. Her husband passed away five months ago after a two-year battle with lung cancer. She has three children, two of whom are still in college. Her daughter accompanies her to the doctor’s office and says she is concerned about her mother’s recent behavior. She explains that her mother has been “sleeping all the time” and has lost 25 lb in the past two months without being on a diet.
When the doctor examines Laura, she explains that she has become increasingly fatigued and complains of a lack of energy. She no longer has any desire to participate in her lifelong hobbies of painting and photography because of frequent feelings of sadness. In the office today, Laura’s blood pressure is 138/88 mm Hg.
Laura’s medical history is significant for hypothyroidism, hypercholesterolemia, and recently diagnosed hypertension.
Medications
- levothyroxine 0.075 mg daily
- simvastatin 20 mg daily
- hydrochlorothiazide 25 mg daily
- lisinopril 10 mg daily
- multivitamins 1 tab daily
- aspirin 81 mg daily
Diagnosis
Major Depression
Case study questions
- List specific goals for treatment for Laura.
- What drug therapy would you prescribe? Why?
- What are the parameters for monitoring success of the therapy?
- Discuss specific patient education based on the prescribed therapy.
- List one or two adverse reactions for the selected agent that would cause you to change therapy.
- What would be the choice for second-line therapy? Provide rationale for your answer.
- What over-the-counter and/or alternative medications would be appropriate for Laura? Why?
- What lifestyle changes would you recommend to Laura? Why?
- Describe one or two drug–drug or drug–food interaction for the selected agent.
- What labs would you order and why?
- When would you have the patient return to your office?
