Metformin 500mg BID 

 A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

  • Metformin 500mg BID 
  • Januvia 100mg daily 
  • Losartan 100mg daily 
  • HCTZ 25mg daily 
  • Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

  • List three questions you might ask the patient if she      were in your office. Provide a rationale for why you might ask these      questions.
  • Identify people in the patient’s life you would need to      speak to or get feedback from to further assess the patient’s situation.      Include specific questions you might ask these people and why.
  • Explain what, if any, physical exams, and diagnostic      tests would be appropriate for the patient and how the results would be      used.
  • List a differential diagnosis for the patient. Identify      the one that you think is most likely and explain why.
  • 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 a rationale for why you might choose one agent over      the other.
  • For the drug therapy you select, identify any      contraindications to use or alterations in dosing that may need to be      considered based on the client’s ethnicity. Discuss why the      contraindication/alteration you identify exists. That is, what would be      problematic with the use of this drug in individuals of other ethnicities?
  • indicate any therapeutic changes that you might make      based on possible outcomes that may happen given your treatment options      chosen.

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