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

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

Although it’s not widely used, Prozac is one of the few antidepressants approved by the FDA for children and teenagers. It’s also safe to use in people with diabetes, as it doesn’t increase blood sugar levels. One of the most common types of antidepressant is fluoxetine, which has a high effectivity rate. This medication belongs to a class of drugs known as selective serotonin reuptake inhibitors. These are designed to increase the levels of serotonin in the body, which helps improve mood and well-being (Sohel et al., 2022).

Another common type of antidepressant is Escitalopram, which is also known as Lexapro. It’s safe to use in children and teenagers, as it doesn’t increase blood sugar levels. It can additionally help alleviate anxiety symptoms.

For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making

There has been little difference in the response time and outcome of patients between white and minority groups in depression. Despite the various investigations that have been conducted on the subject, the exact effects of ethnicity on the treatment response remains unclear. There is still a need for further studies to understand the possible effects of different ethnic groups on the treatment response (Lesser 2010).There is currently not enough evidence supporting the link between ethnicity and the treatment outcomes of depression. In previous studies, it was shown that minority patients had worse outcomes than white patients. However, more recent studies have shown that the effects of race on the response time of African-Americans and Latinos to treatment have been refuted (Murphy et. al., 2013).

Although it is not yet clear if ethnicity affects the response time of certain medications, there are still contraindications that should be considered when taking these drugs (Pediatric Oncall, 2020). For patient who has hypersensitivity to fluoxetine or any component in its formulation or seizure should not use Prozac. It is also contraindicated to patient who is taking monoamine oxidase inhibitors (MAOI).  Contraindication of Lexapro include Serotonin Syndrome, taking MAOIs, hypersensitivity to Lexapro, Activation of Mania/Hypomania, Abnormal Bleeding, Angle Closure Glaucoma etc.

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.

Fluoxetine-It should be given at a dosage of 20 mg/day in the morning. A dose adjustment may be ordered if the symptoms do not improve or if the patient’s clinical condition worsens. An increase should not exceed the maximum daily dosage of fluoxetine. Since the patient is an older adult, a lower or less frequent dosage may be considered. It should be maintained until the patient stops taking the medication, or if they can no longer tolerate the side effects. A gradual reduction should also be performed if the patient decides to stop taking the medication (Sohel et al., 2022).

Escitalopram- The appropriate dose adjustments should be made according to the patient’s needs. For instance, if she is taking extended therapy, the lowest effective dose may be maintained. In addition to age, other factors such as drug interactions and the effects of other medications should also be taken into account. Should the patient experience intolerable symptoms, a gradual reduction in the dose may be performed (NLM, n.d.)

References

Lesser, I. M., Myers, H. F., Lin, K.-M., Bingham Mira, C., Joseph, N. T., Olmos, N. T., … Poland, R. E. (2010). Ethnic differences in antidepressant response: a prospective multi-site clinical trial. Depression and anxiety. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113513/#:~:text=Evidence%20comparing%20depressio.

Legg, T. J. (2018). Diagnosing Depression. Healthline. https://www.healthline.com/health/depression/tests-diagnosis.