Case Study: A Puerto Rican Woman With Comorbid Addiction
Sample Solution
Case Summary: A 35-year-old Puerto Rican woman with comorbid addiction presents to the clinic complaining of anxiety and depression. She has a history of opioid use disorder and is currently in recovery. She has been sober for 6 months and is attending regular therapy sessions. She is also taking naltrexone to prevent relapse.
Patient Factors Impacting Medication Selection:
- Comorbid addiction: The client's history of opioid use disorder is a significant factor to consider when prescribing medication. Opioids and other addictive substances can interact with many medications, so it is important to choose medications that are safe and effective for people with addiction.
Full Answer Section
- Ethnicity: The client's Puerto Rican ethnicity may also impact her response to certain medications. Some medications are metabolized differently in different ethnic groups. It is important to be aware of these differences when prescribing medication.
Decision #1 (1 page)
Decision:
The first decision that I need to make is which antidepressant to prescribe to the client. I have three options:
- Sertraline (Zoloft)
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
Rationale:
I chose sertraline as my first choice because it is a well-studied and effective antidepressant. It is also safe and well-tolerated in people with addiction. Sertraline is a selective serotonin reuptake inhibitor (SSRI), which means that it works by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a role in mood regulation.
Bupropion is another effective antidepressant, but it is not as well-studied in people with addiction. Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI), which means that it works by increasing the levels of norepinephrine and dopamine in the brain. These neurotransmitters play a role in mood, energy, and motivation.
Mirtazapine is an effective antidepressant, but it is not as well-studied in people with addiction. Mirtazapine is a tetracyclic antidepressant (TCA), which means that it works by increasing the levels of serotonin and norepinephrine in the brain. It also works by blocking histamine receptors, which can cause drowsiness.
Why I did not select the other two options:
I did not select bupropion because it is not as well-studied in people with addiction. Bupropion can also increase the risk of seizures, which is a concern in people with addiction.
I did not select mirtazapine because it is not as well-studied in people with addiction. Mirtazapine can also cause weight gain, which is a concern in some people.
What I was hoping to achieve by making this decision:
By prescribing sertraline, I hope to improve the client's mood and reduce her symptoms of anxiety and depression. I also hope to improve her quality of life.
Ethical considerations:
It is important to be aware of the ethical considerations involved in prescribing medication to people with addiction. One important consideration is the risk of relapse. It is important to choose medications that are safe and effective for people with addiction and that have a low risk of relapse.
Another important consideration is the client's autonomy. It is important to respect the client's right to make her own decisions about her treatment. I will involve the client in the decision-making process and will provide her with all of the information she needs to make an informed decision.
Decision #2 (1 page)
Decision:
The second decision that I need to make is whether or not to prescribe an anxiolytic to the client. I have three options:
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Buspirone (Buspar)
Rationale:
I chose buspirone as my first choice because it is an anxiolytic that has a low risk of addiction. Buspirone is a serotonin partial agonist, which means that it works by increasing the levels of serotonin in the brain. Serotonin plays a role in anxiety regulation.
Alprazolam and lorazepam are benzodiazepines, which are effective anxiolytics but have a high risk of addiction. Benzodiazepines work by increasing the activity of GABA, a neurotransmitter that has calming effects.
Why I did not select the other two options:
I did not select alprazolam or lorazepam because they have a high risk of addiction. I do not want to increase the client's risk of relapse.
What I was hoping to achieve by making this decision:
By prescribing buspirone, I hope to reduce the client's anxiety symptoms. I also