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- Ordered; Nozinan 1'/2ounces subcut daily divided Into do ses for delirium lagitation• 3. Av ailable: NOzinan 2mg /ml Admiristered datly dose is Administered darly dose isThis patient is a 45 year old female admitted to the psychiatric unit for major depressive disorder withassociated psychosis. She has a history of breast cancer with inoperable metastases to the brain. NKDAAllergies NKDA Current MedicationsFentanyl (Duragesic) 75mcg/hr patch Q3daysSertraline (Zoloft) 200 mg po dailyLorazepam (Ativan) 0.5 – 2 mg po or IM q4h prn agitationRisperidone (Risperdal) 1 mg po BIDPhenytoin (Dilantin) 300 mg po QHSPMH Major depression with psychosisHx of breast cancerBrain metastases1. This patient is complaining that her gums are getting larger and are starting to grow over her teeth.What might be causing this?This patient is a 45 year old female admitted to the psychiatric unit for major depressive disorder withassociated psychosis. She has a history of breast cancer with inoperable metastases to the brain. NKDAAllergies NKDA Current MedicationsFentanyl (Duragesic) 75mcg/hr patch Q3daysSertraline (Zoloft) 200 mg po dailyLorazepam (Ativan) 0.5 – 2 mg po or IM q4h prn agitationRisperidone (Risperdal) 1 mg po BIDPhenytoin (Dilantin) 300 mg po QHSPMH Major depression with psychosisHx of breast cancerBrain metastasesWhat is the mechanism of action of sertraline and the common side effects?
- This patient is a 45 year old female admitted to the psychiatric unit for major depressive disorder withassociated psychosis. She has a history of breast cancer with inoperable metastases to the brain. NKDAAllergies NKDA Current MedicationsFentanyl (Duragesic) 75mcg/hr patch Q3daysSertraline (Zoloft) 200 mg po dailyLorazepam (Ativan) 0.5 – 2 mg po or IM q4h prn agitationRisperidone (Risperdal) 1 mg po BIDPhenytoin (Dilantin) 300 mg po QHSPMH Major depression with psychosisHx of breast cancerBrain metastases2. The physical therapist comes to you the next afternoon & states that he is unable to arouse thepatient for therapy. You enter the room and discover that the patient has been chewing on an oldfentanyl patch. She has probably overdosed. What medication can be given to this patient?This patient is a 45 year old female admitted to the psychiatric unit for major depressive disorder withassociated psychosis. She has a history of breast cancer with inoperable metastases to the brain. NKDAAllergies NKDA Current MedicationsFentanyl (Duragesic) 75mcg/hr patch Q3daysSertraline (Zoloft) 200 mg po dailyLorazepam (Ativan) 0.5 – 2 mg po or IM q4h prn agitationRisperidone (Risperdal) 1 mg po BIDPhenytoin (Dilantin) 300 mg po QHSPMH Major depression with psychosisHx of breast cancerBrain metastases1. This patient is complaining that her gums are getting larger and are starting to grow over her teeth.What might be causing this?2. The physical therapist comes to you the next afternoon & states that he is unable to arouse thepatient for therapy. You enter the room and discover that the patient has been chewing on an oldfentanyl patch. She has probably overdosed. What medication can be given to this patient?3. What are common side effects of fentanyl? How should they be…This patient is a 45 year old female admitted to the psychiatric unit for major depressive disorder withassociated psychosis. She has a history of breast cancer with inoperable metastases to the brain. NKDAAllergies NKDA Current MedicationsFentanyl (Duragesic) 75mcg/hr patch Q3daysSertraline (Zoloft) 200 mg po dailyLorazepam (Ativan) 0.5 – 2 mg po or IM q4h prn agitationRisperidone (Risperdal) 1 mg po BIDPhenytoin (Dilantin) 300 mg po QHSPMH Major depression with psychosisHx of breast cancerBrain metastases The patient started to hallucinate and became combative with the staff. Her physician ordered 5mg ofhaloperidol to be given IM. Later that day the patient came to the nursing station complaining ofsevere spams in her neck and back. What is his happening to her and what is causing it?symptoms?
- Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomniaWhich of his medications might be causing the insomnia? How could this be addressed?Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia1. Discuss possible reasons this patient fell.2. List common side effects of Levodopa/Carbidopa3. He states that he doesn’t think his antidepressant is working. How will you address his concern?4. Which of his medications might be causing the insomnia? How could this be addressed?5. List some general education points regarding sleep hygiene.6. Do you have…Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia 5. List some general education points regarding sleep hygiene
- Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia Do you have any concerns about his pain medication?Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia 1. His wife tells you that he has started having hallucinations. Which medication might be causing this?Discuss why this happens.